Coil Embolization For Rare Hepatic Variant Anatomy Prior To Radioembolization: Case Report and Literature Review

Purpose: Radioembolization is a safe and effective treatment option for patients with primary and metastatic cancers to the liver. Before treatment, patients must undergo catheter-based angiographic mapping to ensure safe delivery of radioactive particles to liver tumors. Celiac trunk and hepatic artery anatomical variants are frequent, and knowledge of these aberrations becomes essential during procedural planning. When necessary, coil embolization is required to prevent inadvertent embolization of nontarget organs. This case report of extremely rare variant right hepatic artery supply highlights the importance of preprocedural noninvasive planning, mapping catheter angiography, and use of detachable coils for safe and effective vessel occlusion.

Materials and Methods: A literature review of typical and variant celiac and hepatic arterial anatomy was performed. An additional report of rare anastomotic collateral between the dorsal pancreatic artery arising from the celiac trunk and the right hepatic artery was evaluated for suitability for coil embolization.

Results: Whereas the classic celiac trunk configuration of the left gastric artery, common hepatic artery, and splenic artery has been demonstrated in 89% of patients, the standard hepatic arterial anatomy has been shown in 62% of patients. We recognized an extremely rare hepatic arterial variant with the celiac trunk giving rise to a dorsal pancreatic artery, which supplied a superior pancreaticoduodenal artery communicating with the right hepatic artery. A detachable 4 mm x 13 cm Azur coil (Terumo Interventional Systems, Somerset, NJ) and two 5-mm Cook Tornado coils (Cook Medical, Bloomington, IN) were placed in this superior pancreaticoduodenal artery, resulting in redistribution of hepatic arterial blood flow. There were no procedure-related adverse events. Additionally, at the time of right hepatic artery radioembolization, this vessel remained completely occluded, resulting in successful right lobe treatment.

Conclusions: During vascular planning for hepatic artery radioembolization, recognition of rare hepatic arterial anatomy and variants remains fundamental. When used judiciously, detachable coil embolization provides a safe and effective manner to redistribute hepatic arterial blood flow to prevent inadvertent nontarget embolization in the setting of variant arterial anatomy