Transcatheter arterial chemoembolization of hepatocellular carcinoma in a patient with celiac trunk occlusion: a therapeutic challenge

Abstract Transcatheter arterial chemoembolization is a technique for provoking ischemia and cytotoxic activity by selectively injecting microspheres containing chemotherapy drugs into vessels supplying a tumor. An 87-year-old female patient on palliative treatment for hepatocellular carcinoma and with indications for chemoembolization underwent preparatory angiography, which revealed celiac trunk occlusion. The treatment option chosen was selective catheterization of the hepatic artery proper to release the chemotherapy agent via an alternative route through the superior mesenteric artery with communication using the pancreaticoduodenal arcade. Studies have reported evidence showing increased survival after chemoembolization and also reduced tumor growth rate. However, difficulties with accessing and catheterizing the artery feeding the tumor via the alternative access make the procedure a challenge, because of the tortuosity of the pancreaticoduodenal arcade.

摘要 经导管动脉化疗栓塞术（Transcatheter arterial chemoembolization）是一种通过向肿瘤供血血管内选择性注入载化疗药物微球，以诱发缺血与细胞毒性作用的诊疗技术。1例接受肝细胞癌姑息治疗且符合化疗栓塞指征的87岁女性患者，术前接受血管造影检查，结果显示其腹腔干闭塞。临床最终选择的治疗方案为：经肠系膜上动脉通过胰十二指肠动脉弓建立的吻合通路，对肝固有动脉实施选择性插管，以此替代途径输注化疗药物。已有研究证实，化疗栓塞术可延长患者生存期并延缓肿瘤生长速率。但由于胰十二指肠动脉弓走行迂曲，经该替代入路抵达并插管至肿瘤供血动脉存在操作难度，使得该手术颇具挑战性。