IATROGENIC DISSECTION OF THE CELIAC ARTERY AND ITS BRANCHES DURING TRANSCATHETER ARTERIAL EMBOLIZATION FOR HEPATOCELLULAR-CARCINOMA - OUTCOME IN 40 PATIENTS

Purpose: To study the sequelae of iatrogenic dissection of the celiac axis and its branches in a large patient population. Methods: We analyzed 40 patients with hepatocellular carcinoma (HCC) whose celiac artery or its branches were dissected during transcatheter arterial embolization (TAE) and underwent follow-up angiography within 2 months. Results: The two most common sites of dissection were the celiac artery in 13 patients (32.5%) and the proper hepatic artery in 11 patients (27.5%). Follow-up angiography revealed complete recanalization in 32.5% (13/40), irregularity and narrowing of the lumen in 40% (16/40), and complete obstruction in 27.5% (11/ 40). Therefore, 72.5% (29/40) of the dissected arteries recanalized. Pseudoaneurysm formation of the dissected artery was observed in 32.5% (13/40). Subsequent TAE was possible via the dissected arteries in 79% (27/34) of patients in this series. Conclusion: Iatrogenic dissection of the celiac and proximal hepatic arteries heals spontaneously in the majority of patients, and in most instances allows subsequent TAE.