Transcatheter arterial chemoembolization of hepatocellular carcinoma in patients with celiac axis occlusion using pancreaticoduodenal arcade as a challenging.

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Transcatheter arterial chemoembolization of hepatocellular carcinoma in patients with celiac axis occlusion using pancreaticoduodenal arcade as a challenging alternative route Noha M. Attia, Moustafa H.M. Othman European Journal of Radiology Open Volume 4, Pages 53-57 (January 2017) DOI: 10.1016/j.ejro.2017.04.002 Copyright © 2017 Elsevier Ltd Terms and Conditions

Fig. 1 A) SMA angiogram showing hypertrophied PDA (arrow) supplying the hepatic arteries. B) Microcatheter passing through the arcade reaching the PHA. C) Post TACE angiogram revealed lipiodol trapment in the left hepatic lobe focal lesion (arrow). D) Axial MSCT arterial phase showing good lipiodol trapment with no residual enhancing tumor tissue. European Journal of Radiology Open 2017 4, 53-57DOI: (10.1016/j.ejro.2017.04.002) Copyright © 2017 Elsevier Ltd Terms and Conditions

Fig. 2 A) SMA angiogram showing hypertrophied PDA supplying the hepatic and splenic arteries. B) Tip of the catheter is at the inferior PDA (arrow). C) Microcatheter passing through the arcade reaching the RHA using the looping technique (arrow). D) Post TACE showing lipiodol trapment in the lesion. European Journal of Radiology Open 2017 4, 53-57DOI: (10.1016/j.ejro.2017.04.002) Copyright © 2017 Elsevier Ltd Terms and Conditions

Fig. 3 A) SMA angiogram showing hypertrophied PDA. B) Tip of Simmons catheter seen inside the PDA (arrow). C) Microcatheter passing through the arcade reaching the RHA (arrow). D) Post TACE angiogram showing good lipiodol entrapment inside segment VII HCC. E) The second session of TACE for the same patient showing the tip of the catheter in the PDA (arrow). F) Angiogram after the second session of TACE showing lipiodol trapping with disappearance of pathological vessels. European Journal of Radiology Open 2017 4, 53-57DOI: (10.1016/j.ejro.2017.04.002) Copyright © 2017 Elsevier Ltd Terms and Conditions