Lesser Branches of the Celiac Axis in Liver Embolotherapy

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 2.00
Procedures: 2.00
Abdomen and Pelvis: 2.00

Magnetic Resonance Imaging: 2.00
Procedures: 2.00
Body: 2.00

Nuclear Medicine Technology: 1.50
Procedures: 1.50
Gastrointestinal and Genitourinary Procedures: 1.50

Registered Radiologist Assistant: 2.75
Procedures: 2.75
Neurological, Vascular, and Lymphatic Sections: 2.75

Sonography: 2.00
Procedures: 2.00
Abdomen: 2.00

Radiation Therapy: 2.00
Procedures: 2.00
Treatment Sites and Tumors: 2.00

Vascular-Interventional Radiography: 2.75
Procedures: 2.75
Vascular Interventional Procedures: 2.75

Vascular Sonography: 2.00
Procedures: 2.00
Abdominal/Pelvic Vasculature: 2.00

Outline

1. Introduction
2. Classic Hepatic Arterial Anatomic Variants
   1. Replaced or Accessory LHA
   2. Replaced or Accessory RHA
   3. Other Anatomic Variants
3. Parasitized Collateral Vessels of the Celiac Axis Involved in Tumor Supply
   1. Right Inferior Phrenic Artery
   2. Omental Arteries
   3. Cystic Artery
4. Nonhepatic Branches of the Hepatic Arterial Circulation to Cinsider in Vascular Optimization for Liver Embolotherapy
   1. CHA Territory
   2. PHA Territory
   3. LHA Territory
   4. RHA Territory
5. Conclusions

Objectives

Upon completion of this course, students will:

1. know the curative treatment options for hepatic malignancy
2. understand the challenges liver transplant patients face
3. understand the therapeutic options for nonsurgical cases of hepatic malignancy
4. know the percentage of hepatic tumors obtaining their blood supply from the hepatic arteries
5. discuss the percentage of patients with conventional hepatic anatomy including origin of the RHA and LHA in these patients
6. understand targeted arteries during embolization therapy and the primary goal of vascular optimization
7. define aberrant
8. note the two types of aberrant hepatic arteries
9. understand the segmentation system of the liver and its advantages
10. know the classical origination of the left hepatic artery
11. define anomalous and the importance of the term
12. note the percentage of the population that has a replaced right hepatic artery
13. know what segment of the liver is fed by the left hepatic artery
14. know what percentage of the population has a replaced common hepatic artery
15. discuss the percentage and size of tumors demonstrating collateral blood supply
16. define TACE
17. know the most commonly identified extrahepatic collateral vessel during TACE
18. identify what area of the body receives blood from the phrenic arteries
19. describe the side effects of right inferior phrenic artery chemoembolization
20. describe the omentum
21. be familiar with the origin of the gastroepiploic arteries
22. list the three areas of the body supplied by the cystic artery
23. describe a side effect from chemoembolization of the cystic artery
24. know the primary goal of vascular optimization prior to radioembolization
25. understand the most frequently targeted arteries to receive prophylactic embolization
26. know what area of the body is supplied by the gastroduodenal artery
27. note the most common origination point for the dorsal pancreatic artery
28. list the arteries located in the proper hepatic artery territory
29. understand why the right gastric artery is difficult to catheterize
30. discuss how the supraduodenal artery can be identified
31. know when is it necessary to coil the retroduodenal artery
32. know what area of the body the left gastric artery supplies
33. list the two arteries from which the falciform artery can originate
34. know where the cystic artery originates
35. describe how the cystic artery appears on angiographic images