Solitary hepatocellular carcinoma fed by the cystic artery: Limitation of transcatheter arterial embolization

Purpose: To clarify the limitations of transcatheter treatment for hepatoce llular carcinoma (HCC) with parasitic feeders from the cystic artery. Methods: Three male patients had a solitary HCC (average diameter 3 cm) fed by the cystic artery among 221 patients with HCC from 1994 to 1997. One tu mor was nourished entirely from the cystic artery arising from the medial b ranch of the left hepatic artery, and two tumors were fed partially by the cystic arteries arising from the anterior inferior branch of the right hepa tic artery. We analyzed the indications for transcatheter treatment for the se three patients. Results: We chose not to embolize the cystic artery for fear of necrosis of the gallbladder. Although embolization of the anterior branch of the right hepatic artery was performed in one patient with a tumor fed partially by the cystic artery, only half the tumor was embolized. Two patients underwen t hepatic resection, and one received percutaneous ethanol injection therap y. At follow-up of 28-40 months (average 33 months) all patients are alive. Conclusion: Feeding by the cystic artery represents a limitation of TAE for HCC.