Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Wadanaka-cho, Fukui, Japan.
Jpn J Radiol. 2010 Aug;28(7):502-11. doi: 10.1007/s11604-010-0456-7. Epub 2010 Aug 27.
The inferior phrenic artery (IPA) is the most common extrahepatic collateral vessel to hepatocellular carcinoma (HCC); however, there are many anatomical variations in its origin and branches. In addition, the IPA is frequently reconstructed through several pathways, mainly through the retroperitoneal network, because of the occlusion of its orifice due to atherosclerosis or previous catheter manipulation. Infrequently, selective catheterization into the IPA is impossible even using a microcatheter, particularly in the IPA that originates from the proximal or distal portion of the celiac trunk or from the aorta with an acute angle. In this article, we describe anatomical variations of the IPA and catheterization techniques, such as a catheter with a large side hole and a catheter with a cleft, to facilitate catheterization into the IPA that is difficult using a conventional coaxial technique. Radiologists should have sufficient knowledge of such variations and catheterization techniques to perform transcatheter arterial chemoembolization for HCCs through the IPA effectively and safely.
膈下动脉（IPA）是肝细胞癌（HCC）最常见的肝外侧支血管；然而，其起源和分支有许多解剖变异。此外，由于动脉硬化或先前的导管操作导致其口部闭塞，IPA 经常通过几种途径进行重建，主要通过腹膜后网络进行重建。由于起源于腹腔干近端或远端部分或与主动脉成锐角的 IPA 很少使用微导管进行选择性导管插入，即使使用微导管也不可能进行选择性导管插入。在本文中，我们描述了 IPA 的解剖变异和导管插入技术，例如带有大侧孔的导管和带有裂隙的导管，以促进使用传统同轴技术难以进行的 IPA 导管插入。放射科医生应该充分了解这些变异和导管插入技术，以便通过 IPA 有效地和安全地进行经导管动脉化疗栓塞治疗 HCC。
