Hepatic falciform ligament artery: angiographic anatomy and clinical importance

The hepatic falciform ligament artery (HFLA) was evaluated by angiography a nd also by dissections. Based on the findings, the mechanism of the post-ch emoembolization skin rash was studied. A total of 340 liver cirrhosis patie nts who underwent hepatic artery chemoembolization for hepatocellular carci noma were reviewed in terms of the angiographic incidence of the HFLA, vari ations in its origin, and the incidence of skin rash. The HFLA was demonstr ated in 26 (7.6%) of the 340 patients on angiography. Two HFLAs were observ ed in one patient. The origin was the middle hepatic artery (A4) in 16 case s, 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 cas es. 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) dir ect and (2) via the ensiform branch of the internal thoracic artery. These were located at the lower and upper part of the falciform ligament, respect ively. The distribution of a chemotherapeutic agent through these anastomos es 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.