Ibukuro K, Tsukiyama T, Mori K, Inoue Y
Mitsui Memorial Hospital, Department of Radiology, Tokyo, Japan.
Surg Radiol Anat. 1998;20(5):367-71. doi: 10.1007/BF01630623.
The hepatic falciform ligament artery (HFLA) was evaluated by angiography and also by dissections. Based on the findings, the mechanism of the post-chemoembolization skin rash was studied. A total of 340 liver cirrhosis patients who underwent hepatic artery chemoembolization for hepatocellular carcinoma were reviewed in terms of the angiographic incidence of the HFLA, variations in its origin, and the incidence of skin rash. The HFLA was demonstrated in 26 (7.6%) of the 340 patients on angiography. Two HFLAs were observed in one patient. The origin was the middle hepatic artery (A4) in 16 cases, the superior branch of the middle hepatic artery in three, the inferior branch of the middle hepatic artery in two, the inferior branch of the left hepatic artery (A3) in three, and the confluence of A3 and A4 in three cases. There were no patients who developed post-chemoembolization skin rash. Two cadavers were dissected to investigate the anastomosis between the HFLA and the subcutaneous artery. Two different anastomoses were found: (1) direct and (2) via the ensiform branch of the internal thoracic artery. These were located at the lower and upper part of the falciform ligament, respectively. The distribution of a chemotherapeutic agent through these anastomoses is the likely cause of post-chemoembolization skin rash. If prophylactic embolization of the proximal portion of the HFLA using a metallic coil is performed, the skin rash will be prevented.
通过血管造影术及解剖对肝镰状韧带动脉（HFLA）进行了评估。基于这些发现，对化疗栓塞后皮疹的机制进行了研究。回顾了340例因肝细胞癌接受肝动脉化疗栓塞的肝硬化患者，分析了HFLA的血管造影发生率、其起源的变异情况以及皮疹的发生率。血管造影显示，340例患者中有26例（7.6%）存在HFLA。1例患者观察到两条HFLA。其起源为肝中动脉（A4）16例，肝中动脉上支3例，肝中动脉下支2例，肝左动脉（A3）下支3例，A3与A4汇合处3例。没有患者出现化疗栓塞后皮疹。解剖了两具尸体以研究HFLA与皮下动脉之间的吻合情况。发现了两种不同的吻合方式：（1）直接吻合；（2）通过胸廓内动脉的剑突支吻合。它们分别位于镰状韧带的下部和上部。化疗药物通过这些吻合支的分布可能是化疗栓塞后皮疹的原因。如果使用金属线圈对HFLA近端进行预防性栓塞，皮疹将得到预防。
