Hepatic artery embolization, also known as trans-arterial embolization (TAE), is one of the several therapeutic methods to treat primary liver tumors or
metastases
Metastasis is a pathogenic agent's spreading from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, ...
to the liver. The
embolization
Embolization refers to the passage and lodging of an embolus within the bloodstream. It may be of natural origin ( pathological), in which sense it is also called embolism, for example a pulmonary embolism; or it may be artificially induced ...
therapy can reduce the size of the tumor, and decrease the tumor's impact such its hormone production, effectively decreasing symptoms. The treatment was initially developed in the early 1970s.
The several types of hepatic artery treatments are based on the observation that tumor cells get nearly all their nutrients from the hepatic artery, while the normal cells of the liver get about 70-80 percent of their nutrients and 50% their oxygen supply from the portal vein, and thus can survive with the hepatic artery effectively blocked.
In practice, hepatic artery embolization occludes the blood flow to the tumors,
achieving significant tumor shrinkage in over 80% of people.
Shrinkage rates vary.
Background
The several types of
hepatic artery
The common hepatic artery is a short blood vessel that supplies oxygenated blood to the liver, pylorus of the stomach, duodenum, pancreas, and gallbladder.
It arises from the celiac artery and has the following branches:
Additional images
...
treatments are based on the observation that
tumor cells get nearly all their nutrients from the hepatic artery, while the normal cells of the liver get about 70-80 percent of their nutrients and 50% their oxygen supply from the
portal vein
The portal vein or hepatic portal vein (HPV) is a blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas and spleen to the liver. This blood contains nutrients and toxins extracted from digested contents. Approxima ...
, and thus can survive with the hepatic artery effectively blocked.
In practice, hepatic artery embolization is an option if the neoplastic growth is mainly within the liver.
By occluding the blood supply to the tumors,
achieving significant tumor shrinkage in over 80% of people.
Shrinkage rates vary.
The therapy can effectively decrease symptoms by reducing the size of the tumor, or by decreasing the tumor's impact, for example by decreasing the tumor's production of
hormone
A hormone (from the Ancient Greek, Greek participle , "setting in motion") is a class of cell signaling, signaling molecules in multicellular organisms that are sent to distant organs or tissues by complex biological processes to regulate physio ...
s.
Primary liver tumors, metastatic
neuroendocrine tumor
Neuroendocrine tumors (NETs) are neoplasms that arise from cells of the endocrine (hormonal) and nervous systems. They most commonly occur in the intestine, where they are often called carcinoid tumors, but they are also found in the pancreas, lu ...
s to the liver
and other
metastases
Metastasis is a pathogenic agent's spreading from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, ...
to the liver
may be considered for therapy directed via the hepatic artery.
Method
The percutaneous
Seldinger technique
The Seldinger technique, also known as Seldinger wire technique, is a medical procedure to obtain safe access to blood vessels and other hollow organ (anatomy), organs. It is eponym, named after Sven Ivar Seldinger (1921–1998), a Sweden, Swedish ...
introduces a
catheter
In medicine, a catheter ( ) is a thin tubing (material), tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. ...
, which is a thin flexible tube made of medical grade material, into the
hepatic artery
The common hepatic artery is a short blood vessel that supplies oxygenated blood to the liver, pylorus of the stomach, duodenum, pancreas, and gallbladder.
It arises from the celiac artery and has the following branches:
Additional images
...
under radiological control.
This approach was developed for
metastatic
Metastasis is a pathogenic agent's spreading from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, ...
neuroendocrine tumor
Neuroendocrine tumors (NETs) are neoplasms that arise from cells of the endocrine (hormonal) and nervous systems. They most commonly occur in the intestine, where they are often called carcinoid tumors, but they are also found in the pancreas, lu ...
s in the early 1970s.
Tumor cells get over 90% of their nutrients from the hepatic artery,
while the normal cells of the liver get about 70-80 percent of their nutrients and 50% their oxygen supply from the portal vein, and thus can survive with the hepatic artery effectively blocked.
Once the catheter is carefully placed in the artery or in a selected branch, the blood flow can be occluded by injecting various items, such as plastic particles, glue, metal coils, foam, or by deploying a balloon.
Additional considerations and procedural details have been reviewed.
Related methods
In hepatic artery chemotherapy (HAC), chemotherapy agents are given into the hepatic artery, often by steady infusion over hours or even days. Compared with systemic chemotherapy, a higher proportion of the chemotherapy agents is (in theory) delivered to the lesions in the liver.
Hepatic artery chemoembolization (HACE), sometimes called
transarterial chemoembolization
Transcatheter arterial chemoembolization (TACE) is a minimally invasive procedure performed in interventional radiology to restrict a tumor's blood supply. Small embolic particles coated with chemotherapeutic drugs are injected selectively thro ...
(TACE), combines hepatic artery embolization with hepatic artery chemo infusion.
In one method, embospheres bound with chemotherapy agents injected into the hepatic artery, lodge in downstream capillaries. The spheres not only block blood flow to the lesions but by halting the chemotherapy agents in the neighborhood of the lesions, they provide a much better targeting leverage than chemo infusion provides.
See also
*
Neuroendocrine tumor
Neuroendocrine tumors (NETs) are neoplasms that arise from cells of the endocrine (hormonal) and nervous systems. They most commonly occur in the intestine, where they are often called carcinoid tumors, but they are also found in the pancreas, lu ...
*
Carcinoid syndrome
Carcinoid syndrome is a paraneoplastic syndrome comprising the signs and symptoms that occur secondary to neuroendocrine tumors (formerly known as carcinoid tumors). The syndrome is caused by neuroendocrine tumors most often found in the gut ...
References
External links
eMedicine: EmbolizationEmbolization therapy for liver cancer{{Webarchive, url=https://web.archive.org/web/20161123085838/http://www.cancer.org/cancer/livercancer/detailedguide/liver-cancer-treating-embolization-therapy , date=2016-11-23
Oncology
Palliative care
Interventional radiology