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Hepatocellular Carcinoma: Involvement of the Internal Mammary Artery¹

¹ From the Department of Radiology, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi 641-8510, Japan. Received December 3, 1999; revision requested December 28; final revision received June 23, 2000; accepted July 11. Address correspondence to M.N. (e-mail: motoki05@wakayama-med.ac.jp).

PURPOSE: To investigate factors related to the development of internal mammary arteries (IMAs) as feeding arteries of hepatocellular carcinomas (HCCs).

MATERIALS AND METHODS: In 30 patients with HCC located in ventral hepatic areas directly beneath the diaphragm, bilateral internal mammary arteriography was performed to explore involvement of the IMA with HCC. The number of previous transcatheter arterial embolizations (TAEs), tumor size, time from initial TAE to IMA angiography, inferior phrenic artery (IPA) involvement with tumor, presence of hepatic artery occlusion, and use of other treatments were compared in groups with and without involvement of the IMA.

RESULTS: The group with IMA involvement included 10 patients; the group without involvement, 20 patients. TAE had been performed two to 12 times in the group with involvement and zero to six times in the group without involvement (P = .01). Mean tumor sizes in these two groups were 5.1 and 6.0 cm, respectively; hepatic artery occlusion was noted in nine and zero patients (P = .01) in the two groups. The time from initial TAE to IMA angiography ranged from 3 to 53 months (median, 31.5 months) and from zero to 89 months (median, 0 months) (P = .01). IPA involvement was observed in seven and four patients (P = .015).

CONCLUSION: These results strongly suggest that, regardless of tumor size, when HCCs are located in the ventral hepatic areas directly beneath the diaphragm, the IMAs serve as feeding arteries in patients with hepatic artery occlusion caused by repeated TAE.

Index terms: Arteries, internal mammary, 949.121, 949.122 • Hepatic arteries, stenosis or obstruction, 952.44 • Liver neoplasms, 761.323 • Liver neoplasms, blood supply • Liver neoplasms, chemotherapeutic embolization, 761.1264

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