Y90-radioembolization via variant hepatic arteries: Is there a relevant risk for non-target embolization?

Markus Zimmermann; Maximilian Schulze-Hagen; Federico Pedersoli; Peter Isfort; Alexander Heinzel; Christiane Kuhl; Philipp Bruners

doi:10.4329/wjr.v11.i7.102

Y90-radioembolization via variant hepatic arteries: Is there a relevant risk for non-target embolization?

World J Radiol. 2019 Jul 28;11(7):102-109. doi: 10.4329/wjr.v11.i7.102.

Authors

Markus Zimmermann¹, Maximilian Schulze-Hagen², Federico Pedersoli², Peter Isfort², Alexander Heinzel³, Christiane Kuhl², Philipp Bruners

Affiliations

¹ and Philipp Bruners, Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen 52074, Germany. mzimmermann@ukaachen.de.
² and Philipp Bruners, Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen 52074, Germany.
³ Department of Nuclear Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, Aachen 52074, Germany.

Abstract

Background: The hepatic arterial anatomy is highly variable, with the two most common variants being a replaced right hepatic artery (RHA) originating from the superior mesenteric artery (SMA) and a left hepatic artery (LHA) originating from the left gastric artery (LGA). These anatomical variants could potentially increase the risk for non-target embolization during Y90-Radioembolization due to the close proximity between hepatic and enteric vessel branches.

Aim: To evaluate the safety of Yttrium-90 radioembolization (⁹⁰Y-RE) with resin microspheres in patients with a variant hepatic arterial anatomy.

Methods: In this retrospective single-center observational study, 11 patients who underwent RE with ⁹⁰Y-resin microspheres via a LHA originating from the LGA, and 13 patients via a RHA originating from the SMA were included. Patient and treatment data were reviewed regarding clinical and imaging evidence of non-target embolization of ⁹⁰Y-resin microspheres to the GI tract. Positioning of the tip of the microcatheter in relationship to the last hepatoenteric side branch was retrospectively analyzed using angiographic images, cone-beam CT and pre-interventional CT-angiograms.

Results: None of the 24 patients developed clinical symptoms indicating a potential non-target embolization to the GI tract within the first month after ⁹⁰Y-RE. On the postinterventional ⁹⁰Y-bremsstrahlung images and/or ⁹⁰Y-positron emission tomographies, no evidence of extrahepatic ⁹⁰Y-activity in the GI tract was noted in any of the patients. The mean distance between the tip of the microcatheter and the last enteric side branch during delivery of the ⁹⁰Y microspheres was 3.2 cm (range: 1.9-5 cm) in patients with an aberrant LHA originating from a LGA. This was substantially shorter than the mean distance of 5.2 cm (range: 2.9-7.7 cm) in patients with an aberrant right hepatic originating from the SMA.

Conclusion: ⁹⁰Y-RE via aberrant hepatic arteries appears to be safe; at least with positioning of the microcatheter tip no less than 1.9 cm distal to the last hepatoenteric side branch vessel.

Keywords: Aberrant hepatic arteries; Hepatic arterial variants; Radioembolization; Safety; Yttrium 90.