To evaluate and describe the prevalence of hepatic arterial variants seen at digital subtraction angiography in a large series of patients. Data were collected prospectively by using an arterial anatomy database questionnaire that was completed at the time each visceral angiographic examination was performed from May 1996 to October 2000. Six hundred patients underwent at least one visceral angiographic examination at one institution during the study period. Three hundred sixty-eight (61.3%) patients had the standard hepatic arterial anatomy. One hundred nineteen (19.8%) patients had variant left hepatic arteries (LHAs), and 89 (14.8%) had variant right hepatic arteries (RHAs). Twenty-eight (4.7%) patients had a variant anatomy involving both the LHA and the RHA. Twenty-four (4.0%) patients had a variant origin of the common hepatic artery (CHA) arising from either the superior mesenteric artery (SMA) or the aorta. In two patients, the proper hepatic artery (PHA) was the first branch of the SMA and the gastroduodenal artery (GDA) was a branch of the celiac axis. Double hepatic arteries were seen in 22 (3.7%) patients. Trifurcation or quadrifurcation of the GDA was seen in 50 (8.3%) patients, and the GDA originated distal to one hepatic artery in 25 (4.2%) patients in whom both hepatic arteries originated from the CHA. A replaced LHA was less common than has been previously reported, and in two cases, the PHA arose from the SMA. Digital subtraction visceral angiographic results are comparable to results of seminal angiographic studies in which the cut-film technique was used.

OBJECTIVE. The purpose of this study was to determine the incidence of variant intrahepatic portal vein anatomy detected on CT portography and to discuss surgical implications.CONCLUSION. Variant portal vein anatomy is nearly as common as variant hepatic artery anatomy. The complexity of hepatic interventions now performed by interventional radiologists and surgeons, including portal vein embolization, anatomic resection, and transplantation, make recognition and understanding of normal and variant portal vein anatomy increasingly important.

BACKGROUND. The authors evaluated the impact of bland particle embolization on survival in patients with metastatic sarcoma to the liver. METHODS. Twenty-four patients with liver-dominant metastases from sarcoma were treated with particle embolization from 1996 to 2002. Primary tumors included 16 gastrointestinal stromal tumors (GISTs), 7 intestinal leiomyosarcomas, and 1 liposarcoma. Thirteen patients had known extrahepatic disease. Embolization was performed by using polyvinyl alcohol or trisacryl microspheres to effect stasis in the target vessel(s). Follow-up images to assess response were obtained 4 weeks after the procedure. Decrease in the size of the target lesion by >25% or development of >50% necrosis on follow-up imaging was considered a treatment response. RESULTS. Nineteen patients had metachronous liver metastases, and the median disease-free interval was 22 months (range 10–156 months) from resection of the primary tumor. Ten patients underwent prior liver resection for metastatic disease. Of 15 evaluable patients, 9 patients (60%) had a radiographic response. The median follow-up for all patients was 21 months. The median follow-up for surviving patients was 59 months. Overall survival from the time of initial embolization was 62% at 1 year, 41% at 2 years, and 29% at 3 years. Patients who had radiographic evidence of response survived significantly longer than patients who did not respond (63 months vs. 19 months; P < .007). Patients with GIST survived significantly longer than patients with visceral leiomyosarcoma (median, 36 months vs. 18 months; P < .03). CONCLUSIONS. Bland embolization was efficacious in some patients with metastatic sarcoma to the liver. Radiographic evidence of response was correlated with improved survival. This regional therapy may enter the treatment algorithm for patients who have unresectable disease or disease that has failed conventional therapies. Cancer 2006. © 2006 American Cancer Society.

OBJECTIVE. The objective of our study was to evaluate the safety and efficacy of transhepatic lobar portal vein embolization (PVE) using polyvinyl alcohol (PVA) particles to induce contralateral lobar hypertrophy in patients with liver-only metastases and normal underlying liver function.MATERIALS AND METHODS. Fifty-eight consecutive patients with small predicted future liver remnants (FLRs) underwent PVE with PVA particles to induce hypertrophy of the contralateral hemi-liver before surgical resection of liver metastases. Total liver, right hemi-liver, and left hemi-liver volumes were calculated before and after embolization using a 3D workstation.RESULTS. Eight patients underwent left PVE; 47, right PVE; and three, right and segment IV PVE. There were no major complications of the procedure. The mean increases in the ratio of the FLR to the total estimated liver volume after right, right and segment IV, and left PVE were 9%, 10%, and 3%, respectively; the corresponding mean hypertrophy ratios were 24.3%...