Adjuvant percutaneous radiofrequency ablation of feeding artery of hepatocellular carcinoma before treatment

AIM:To evaluate the feasibility and efficacy of percutaneous radiofrequency ablation(RFA) of the feeding artery of hepatocellular carcinoma(HCC) in reducing the blood-flow-induced heat-sink effect of RFA.METHODS:A total of 154 HCC patients with 177 pathologically confirmed hypervascular lesions participated in the study and were randomly assigned into two groups.Seventy-one patients with 75 HCCs(average tumor size,4.3 ± 1.1 cm) were included in group A,in which the feeding artery of HCC was identified by color Doppler flow imaging,and were ablated with multiple small overlapping RFA foci [percutaneous ablation of feeding artery(PAA)] before routine RFA treatment of the tumor.Eighty-three patients with 102 HCC(average tumor size,4.1 ± 1.0 cm) were included in group B,in which the tumors were treated routinely with RFA.Contrast-enhanced computed tomography was used as post-RFA imaging,when patients were followed-up for 1,3 and 6 mo.RESULTS:In group A,feeding arteries were blocked in 66(88%) HCC lesions,and the size of arteries decreased in nine(12%).The average number of punctures per HCC was 2.76 ± 1.12 in group A,and 3.36 ± 1.60 in group B(P = 0.01).The tumor necrosis rate at 1 mo post-RFA was 90.67%(68/75 lesions) in group A and 90.20%(92/102 lesions) in group B.HCC recur-rence rate at 6 mo post-RFA was 17.33%(13/75) in group A and 31.37%(32/102) in group B(P = 0.04).CONCLUSION:PAA blocked effectively the feeding artery of HCC.Combination of PAA and RFA significantly decreased post-RFA recurrence and provided an alternative treatment for hypervascular HCC.

Use of Muscle Feeding Arteries as Recipient Vessels for Soft Tissue Reconstruction in Lower Extremities

Summary:Microsurgical free tissue transfer is still playing an important role in lower extremity reconstruction.Finding a suitable recipient artery for anastomosis is critical in the microsurgical procedure,especially in an extensive wound,or in a complex trauma combined with vascular injury.From April 2014 to March 2018,we retrospectively reviewed patients with traumatic/posttraumatic,oncologic,and electrical wounds in the lower extremity.Those treated with muscle feeding artery as recipient vessels were included.The latissimus dorsi(LD)muscle free flap,anterior lateral thigh(ALT)perforator free flap,and deep inferior epigastric perforator(DIEP)free flap were raised.The muscle feeding arteries to vastus lateral muscle and to medial head of gastrocnemius muscle,concomitant veins,and great saphenous vein were used as recipient vessels.Injuries included in the study were caused by tumour in 2 cases,car accident in 3 cases,crushing in 3 cases,burns in one case,and electrical injury in one case.The wound size varied from 14 cm x 6 cm to 30 cm x 20 cm.LD,ALT,and DIEP free flaps were used in 6,3,and 4 patients,respectively.The muscle feeding arteries to medial head of gastrocnemius muscle,to sartorius muscle,and to vastus lateral muscle were used as recipient arteries in 4,5,and one patient,respectively.Concomitant and great saphenous veins were used as recipient veins in 10 and 4 patients,respectively.Using the muscle feeding artery is feasible to avoid injury to the main artery and facilitate dissection and anastomoses,particularly when the wound is located proximal to the mid-third of the lower leg.

The Significance of Anatomical Variations of Hepatic Artery and Multiple Arterial Supplies in Embolization of Liver Tumors

A new therapeutic measure-step by step-embolization of every feeding vessel in dealing with liver cancer has been proposed on the base of the following criteria after reviewing the coeliac and superior mesenteric arteriographies in 100 cases of liver cancer.The emphasis is put on: 1.Anatomic variation of hepatic arteries. 2. Multiple feeding vessels, and 3. The importance of the presence of stenosis after embolization and the formation of collateral circulation.