Chemoembolization of the Left Inferior Phrenic Artery in Patients With Hepatocellular Carcinoma: 9-Year Single-Center Experience

Abstract

OBJECTIVE. The purpose of this study was to evaluate retrospectively the radiologic findings and imaging response of hepatocellular carcinoma supplied by the left inferior phrenic artery. MATERIALS AND METHODS. From January 2000 through December 2008, chemoembolization of the left inferior phrenic artery was performed on 152 patients (123 men, 29 women; mean age, 55.8 years) with hepatocellular carcinoma. The CT scans and digital subtraction angiograms of these patients were retrospectively reviewed in consensus by two investigators, who evaluated tumor location, tumor-feeding vessels, origin of the left inferior phrenic artery, technical success of chemoembolization, complications, and tumor response. Tumor response was assessed on the basis of the criteria of the European Association for the Study of the Liver. RESULTS. Tumors supplied by the left inferior phrenic artery were located in Couinaud segment 2/3 (n = 100), segment 4 (n = 45), and other segments (n = 7). The most common tumor-feeding vessel was the anteromedial limb of the left inferior phrenic artery (n = 82) followed by the lateral limb (n = 40) and the anterior limb (n = 30). Selective chemoembolization via the left inferior phrenic artery was achieved in 58 of the patients (38%). Complete or partial response as detected on first follow-up CT images (mean follow-up time, 2.5 months) was achieved by 30 patients. In 33 patients in whom the tumor was supplied exclusively by the left inferior phrenic artery, the tumor response was more favorable in patients who underwent selective than in those who underwent nonselective chemoembolization via the left inferior phrenic artery (p = 0.028). CONCLUSION. Selective chemoembolization via the left inferior phrenic artery is possible and results in good response of tumors supplied exclusively by the left inferior phrenic artery.