Transcatheter oily chemoembolization of the extrahepatic collaterals in hepatocellular carcinoma.

Twenty patients with hepatocellular carcinoma who had hepatic artery occlusion from repeated transcatheter oily chemoembolization (TOCE), were treated with additional TOCE through extrahepatic collaterals. Repeated TOCE were performed through the inferior phrenic artery (10 patients), branches of the gastroduodenal artery (6 patients), the internal mammary artery (2 patients), the pancreatico-duodenal arcade (1 patient), the accessory hepatic artery (1 patient), the capsular branch of the right renal artery (1 patient) and the 12th intercostal artery (1 patient). The TOCE was unsuccessful in 4 patients with accessory hepatic artery, one patient with cystic artery arising from superior mesenteric artery, one patient with omentoepiploic artery and one patient with left gastric anastomose with right gastric artery. The success rate of TOCE in the extrahepatic arteries was 76.67 per cent while there was a 23.33 per cent failure rate. The overall cumulative survival rates were 80 per cent (6 months), 50 per cent (12 months) and 18.8 per cent (18 months). One patient developed skin necrosis at the right chest wall following TOCE of the right internal mammary artery for HCC. One patient developed hemiplegia following TOCE of the right 12th intercostal artery. The extrahepatic collaterals are important alternative routes for continuous transcatheter management of hepatocellular carcinoma following hepatic artery occlusion.