A Case of Repeated Transcatheter Arterial Chemoem bolization in a Patient with Hepatocellular Carcinoma Accompanying Incidental Aortic Dissection = A Case of Repeated Transcatheter Arterial Chemoem bolization in a Patient with Hepatocellular Carcinoma Accompanying Incidental Aortic Dissection

다국어 초록 (Multilingual Abstract)

Aims: Transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) in patients with aortic dissection is a potentially risky and demanding technique. Access to the true aortic lumen might not be allowed by the arterial entry route chosen.
Methods: Here we report a case of repeated sessions of TACE through true and false lumens in a HCC patient with chronic aortic dissection.
Results: A 56-year old male presented with infiltrative HCC with right portal vein tumor thrombosis. Abdominal computer tomography scan also revealed an incidental asymptomatic aortic dissection involving descending aorta from proximal segment to superior mesenteric artery (SMA) origin level. Celiac trunk was supplied by false lumen, and SMA was supplied by true lumen. On SMA angiography, right hepatic artery was originated from SMA. HCC was supplied by segment 7 and 8 branch of right hepatic artery. Infusion of adriamycin and lipiodol mixture and subsequent embolization was performed to superior branches of right hepatic artery. Catheterization to celiac axis was failed due to its origin from pseudolumen caused by aortic dissection. Complete response was achieved after sequential radiation therapy. After 1 year, nodular HCC recurred at segment 4. On this session of repeated TACE, catheterization to false lumen was successful. Left hepatic angiography showed tumor stain supplied by segment 4 branch, and embolization was performed. One year later, viable portion was noted in infiltrative HCC at segment 7. Repeated TACE was performed to embolize segment 7 branch supplying infiltrative tumor.
Conclusions: In this case, we presented our experience with selective hepatic angiography and SMA angiography in a HCC patient with descending aortic dissection. To our knowledge, this is the first description of hepatic angiography using true and false lumen in a HCC patient with a concomitant aortic dissection.