Purpose. To investigate the extrahepatic collateral arteries related to hepatic artery occlusion (HAO) and to determine its benefits in the transarterial management of liver tumors. Methods and Findings. Eleven patients (7 hepatocellular carcinomas, 3 liver metastases, and 1 with hemangioma) with HAO confirmed with digital subtraction angiography (DSA) were admitted to our hospital. Of the 11 patients, 7 were men and 4 were women, with an average age of 41.5 ± 15.5 years (range: 29 to 70 years). DSA was performed to evaluate the collateral routes to the liver. In the 11 patients with HAO, DSA showed complete occlusion of the common hepatic artery in 9 patients and the proper hepatic artery (PHA) in 2 patients. Extrahepatic collateral arteries supplying the liver were readily evident. The collateral arteries originated from the superior mesenteric artery (SMA) in 8 patients, from the gastroduodenal artery in 2 patients, and from the left gastric artery (LGA) in 1 patient. Transcatheter treatment was successfully performed via the collateral artery in all patients except the one who had hemangioma. Conclusions. DSA is an effective method for detecting collateral circulation related to HAO and may provide information to guide transcatheter management decisions. 1. Introduction Transarterial chemoembolization and infusion chemotherapies have been widely used to treat liver neoplasms [1–5]. However, certain complications following transarterial treatment, such as femoral nerve injury, liver cancer rupture, duodenum perforation, liver abscesses, and hepatic artery occlusion (HAO), were sometimes reported [6, 7]. Above all, HAO is a serious complication because it prevents continuation of transarterial therapy. It was previously reported that the collateral arterial supply to the liver was evident immediately after HAO [8–10]. It is essential to study the collateral circulation related to HAO in transcatheterization procedures for liver tumor management [11]. Previous reports have indicated that computed tomography (CT) and computed tomography angiography (CTA) could reveal the arterial collateral system in patients with HAO [12, 13]; however, to the best of our knowledge, few studies have addressed the features of extrahepatic collateral routes related to HAO by using digital subtraction angiography (DSA) and benefits in the transarterial management of liver tumors. In our practice, we primarily found that the collateral pathways after HAO were different from those reported in the literature [12, 13], and the details of the extrahepatic collateral routes to
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