ARRS 2022 Abstracts

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E2078. To Coil or Not to Coil? Tumoral Vascular Flow Redistribution Strategies
Authors
  1. Eduardo Chacon; University of Kentucky
  2. Chadi Diab; University of Kentucky
  3. Merve Ozen; University of Kentucky
  4. Mohamed Issa; University of Kentucky
  5. Driss Raissi; University of Kentucky
  6. Gaby Gabriel; University of Kentucky
  7. Roberto Galuppo; University of Kentucky
Background
Radioembolization is an effective and safe treatment option for patients with unresectable hepatic neoplasms. As such, it has become a widely and valid alternative for treatment. The treatment success depends highly on the appropriate identification of tumor arterial supply. The most recent literature shows that delivery of a tumoricidal dose is paramount to induce tumor necrosis. Hepatic neoplasms are supplied by hepatic artery branches, including different described variants; however, a significant group of hepatic neoplasms can recruit intrahepatic and extrahepatic collateral supply. Timely diagnosis and management of these collateral feeders is paramount for effective treatment. Altering vascular tumor supply is necessary to achieve a consolidative dose.

Educational Goals / Teaching Points
This pictorial review of a case series intends to describe intrahepatic and extrahepatic tumoral vascular supply and the current strategies available to alter tumor vascular supply.Y90 radioembolization has a steep learning curve, and current strategies to alter tumor vascular supply involve: direct radioembolization (split dose), chemoembolization, or bland embolization; temporary versus permanent embolization with gelfoam, particles, coils or plugs; and flow redistribution mediated by catheters (antireflux catheter, balloon catheter, etc).

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit aims to highlight considerations in management of hepatic neoplasms with parasitized arterial supply. We present a case series reviewing extrahepatic collateral circulation. Case 1 demonstrates coil embolization of the left inferior phrenic artery supplying the left hepatic lobe malignancy (segment II). Case 2 demonstrates bland embolization of the right internal mammary artery supplying a right hepatic tumor (segment VIII). Case 3 shows exclusion of the extratumoral branch by using antireflux catheter, therefore allowing a segmentectomy dose into the tumoral territory.

Conclusion
Y90 mapping remains the most important stage for treatment success and patient’s safety. Consolidation of treatment by altering tumor vascular flow is paramount to achieve appropriate tumoricidal response. Different strategies to alter vascular flow are currently available.