Treating hepatic carcinoma with internal mammary artery blood supply through transcatheter arterial chemoembolization

Objective: To study blood supply by the internal mammary artery (IMA)for hepatic carcinoma and evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE)via IMA. Methods: 86 cases of hepatic cancer(HCC) fed by the IMA underwent TACE of the IMA. All of the patients had previously undergone several TACE for HCC. 16 patients had undertaken percutaneous microwave coagulation therapy in addition to TAE. 4 patients had a history of surgery for upper abdomen. Plain and enhanced CT and MRI scannings were performed before operation. Internal mammary arteriography was carried out during the interventional procedure to clarify the feeding range and then the superselected catheterization of the feeding branch was done with TACE. The IMA angiographic features, tumor location, clinical observation, laboratory tests, imageology were evaluated, and finally were correlated with the angiographic findings of the IMA. Results: All lesions were massive type and located at the ventral aspect and subcapsular region of the liver: 57 cases in segment 4, 5, 8, and 29 cases in segment 5, 7, 8. Recurrent HCCs were supplied by the right IMA in 80 cases, from the left IMA in 5 cases and with the bilateral IMA in 1 case. Lipiodol-TACE of the IMA for HCC can be performed without skin complications in cases of subselective catheterization. Conclusion Tumors located ventrally and superficially in the liver may recruit blood supply through IMA collaterals, often occurring in massive type of HCC after several times of TACE. TACE of IMA is safe and has become technically feasible in almost all patients, although cutaneous damage should be cautious during the interventional procedure. (authors)