한국산학기술학회논문지 (Journal of the Korea Academia-Industrial cooperation Society)

  • 제20권3호
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  • Pages.188-193
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  • 2019
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  • 1975-4701(pISSN)
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  • 2288-4688(eISSN)
한국산학기술학회 (The Korea Academia-Industrial cooperation Society)
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간세포암의 경동맥 화학색전술 중 발견된 후천성 동정맥 기형에 관한 드문 증례보고

A Rare Case of Acquired Arteriovenous Malformation in Transarterial Chemoembolization for Hepatocellular Carcinoma

  • 문성남 (원광대학교병원 영상의학과) ;
  • 서상현 (원광대학교병원 영상의학과)
  • Moon, Sung-Nam (Department of Radiology, Wonkwang University Hospital) ;
  • Seo, Sang-Hyun (Department of Radiology, Wonkwang University Hospital)
  • 투고 : 2019.01.24
  • 심사 : 2019.03.08
  • 발행 : 2019.03.31
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초록

경동맥 화학색전술은 널리 이용되며 빠르게 발전하고 있는 간세포암의 비수술적 치료법이다. 만족할만한 치료결과를 얻기 위해서는 환자의 해부학적 특성을 이해하고 종양 공급 동맥을 찾아내서 올바른 치료 계획을 세워야 한다. 본 연구에서는 간세포암의 경동맥 화학색전술 중에 방해요인으로 작용한 후천성 동정맥 기형의 증례를 보고하고자 한다. 72세 남자가 2일전부터 지속된 복통으로 내원하였다. 만성 B형 간염환자로 10년 전 간세포암에 대한 고식적 경동맥 화학색전술을 시행 받고 완치된 과거력이 있었다. 전산화 단층 촬영상 간우엽의 8분절에 결절성 간세포암이 발견되었으며 우간동맥은 상장간막동맥에서 기시하는 기형을 가지고 있었으며 종양 주변에 과혈관성 종양 구조가 관찰되었다. 1차 경동맥 화학색전술을 실시하였을 때 좌간동맥에서 기시하는 종양 공급동맥을 찾아 이를 약물방출미세구와 Adriamycin 50mg을 이용하여 화학색전하였다. 우간동맥조영술을 시행하였을 때 동정맥 기형이 관찰되었으며 간세포암은 관찰되지 않았다. 1개월 후 시행한 전산화 단층 촬영상 괴사된 종양과 남은 병변이 관찰되어 2차 경동맥 화학색전술을 시행하였다. 우간동맥을 통하여 미세유도철사와 카테터를 이용하여 동정맥 기형을 지나쳐 초선택하였고 시행한 조영술에서 남은 간세포암의 병변이 조영됨을 확인할 수 있었다. 이를 약물방출미세구와 Adriamycin을 이용하여 화학색전하였다. 시술 후 혈관 조영술에서 간세포암이 조영되지 않는 것을 확인하였고, 그 후 환자는 특별한 합병증 없이 퇴원하였다. 저자들은 매우 드물게 발생하는 간세포암 주변의 후천성 동정맥 기형을 발견하였고, 방해요인으로 작용한 동정맥 기형을 넘어 초선택적 경동맥화학색전술을 시행하여 간세포암을 치료하였다.

Transarterial chemoembolization (TACE) is a commonly used and rapidly evolving non-invasive treatment for hepatocellular carcinoma (HCC). It is important that understanding individual anatomical variants and planning for tumor-feeding artery access to acquire adequate treatment effectiveness. In this study, we will report acquired arteriovenous malformation which interferes with TACE for HCC. A 72-year-old man with persistent abdominal pain for 2 days visited our hospital. The patient was chronic hepatitis B carrier and had a history of HCC treated with conventional TACE 10 years ago. Hypervascular nodular HCC in the liver segment 8 and aberrant right hepatic artery from the superior mesenteric artery were detected on computed tomography (CT). When first TACE was performed, the tumor-feeding artery originating from the left hepatic artery was found and embolized. There was no tumor-feeding artery from the right hepatic artery but arteriovenous malformation was found. After a month, follow up CT showed necrotic lesion and residual HCC and we performed secondary TACE. On secondary TACE, we selected the right hepatic artery and passed through arteriovenous malformation. Superselective-angiogram showed remnant tumoral staining and remnant tumor was embolized using drug-eluting bead and Adriamycin. Final angiogram showed no remnant tumoral staining and the patient was discharged without complication. We found the rare case of arteriovenous malformation adjacent to HCC, and we performed superselective TACE beyond arteriovenous malformation to treat HCC.

키워드

SHGSCZ_2019_v20n3_188_f0001.png 이미지

Fig. 1. 1st session transarterial chemoembolization (TACE)

SHGSCZ_2019_v20n3_188_f0002.png 이미지

Fig. 2. 2nd session transarterial chemoembolization (TACE)

참고문헌

  1. Saraswat VA, Pandey G, Shetty S. Treatment algorithms for managing hepatocellular carci-noma. J Clin Exp Hepatol ; 4 Suppl 3: S80-9, 2014. DOI: https://doi.org/10.1016/j.jceh.2014.05.004
  2. Chen D, Wang R, Meng X, Yan H, Jiang S, Feng R, Zhu K, Xu X, Dou X, Jin L. Prognostic value of serum gamma- glutamyl transferase in unre-sectable hepatocellular carcinoma patients treated with transcatheter arterial chemoem-bolization combined with conformal radiotherapy. Oncol Lett; 8: 2298-304, 2014. DOI: https://doi.org/10.1016/j.jceh.2014.05.004
  3. Murata S, Mine T, Sugihara F, Yasui D, Yamagu-chi H, Ueda T, Onozawa S, Kumita S. Interven-tional treatment for unresectable hepatocellu-lar carcinoma. World J Gastroenterol; 20: 13453-65, 2014. DOI: https://doi.org/10.3748/wjg.v20.i37.13453
  4. Ngan H, Peh WC. Arteriovenous Shunting in Hepatocellular Carcinoma: Its Prevalence and Clinical Significance. Clin Radiol ; 52: 36-40, 1997. DOI: https://doi.org/10.1016/S0009-9260(97)80303-0
  5. DeLeve LD, Valla DC, Garcia-Tsao G. Vascular disorders of the liver. Hepatology ; 49: 1729-1764, 2009. DOI: https://doi.org/10.1002/hep.22772
  6. Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet ; 362: 1907-17, 2003. DOI: https://doi.org/10.1016/S0140-6736(03)14964-1
  7. Kumar A, Ahuja CK, Vyas S, Kalra N, Khandel-wal N, Chawla Y, Dhiman RK. Hepatic arterio-venous fistulae: role of interventional radiolo-gy. Dig Dis Sci; 57: 2703-12, 2012. DOI: https://doi.org/10.1007/s10620-012-2331-0
  8. Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg; 69: 412-422, 1982. https://doi.org/10.1097/00006534-198203000-00002
  9. Kollipara R, Odhav A, Rentas KE, Rivard DC, Lowe LH, Dinneen L. Vascular anomalies in pediatric patients: updated classification, imaging, and therapy. Radiol Clin North Am; 51: 659-672, 2013. DOI: https://doi.org/10.1016/j.rcl.2013.04.002
  10. Lowe LH, Marchant TC, Rivard DC, Scherbel AJ. Vascular malformations: classification and terminology the radiologist needs to know. Semin Roentgenol; 47: 106-117, 2012. DOI: https://doi.org/10.1053/j.ro.2011.11.002
  11. Legiehn GM, Heran MK. A Step-by-Step Practical Approach to Imaging Diagnosis and Interventional Radiologic Therapy in Vascular Malformations. Semin Intervent Radiol; 27: 209-231, 2010. DOI: https://doi.org/10.1055/s-0030-1253521
  12. Donnelly LF, Adams DM, Bisset GS 3rd. Vascular malformations and hemangiomas: a practical approach in a multidisciplinary clinic. AJR Am J Roentgenol; 174: 597-608, 2000. DOI: https://doi.org/10.2214/ajr.174.3.1740597
  13. Burrows PE, Mulliken JB, Fellows KE, Strand RD. Childhood hemangiomas and vascular malformations: angiographic differentiation. AJR Am J Roentgenol; 141: 483-488, 1983. DOI: https://doi.org/10.2214/ajr.141.3.483
  14. Alomari A, Dubois J. Interventional management of vascular malformations. Tech Vasc Interv Radiol; 14: 22-31, 2011. DOI: https://doi.org/10.1053/j.tvir.2010.07.006
  15. Guevara CJ, Alomari AI. Interdisciplinary approach to treatment of vascular anomalies. Tech Vasc Interv Radiol; 16: 55-58, 2013. DOI: https://doi.org/10.1053/j.tvir.2013.01.008