Caren van Roekel

212 Chapter 8 To overcome these problems, techniques are used to reduce the number of injection positions. One of these techniques is embolizing one of the tumor- feeding arteries, leading to redistribution of blood flow through collateral pathways from adjacent hepatic arteries (Figure 1+2) (2,3). Various publications have reported on the success of redistribution in radioembolization(4–8). However, mixed results were reported in our practice. The aim of this study was to evaluate and quantify the effect of coil-embolization of tumor-feeding vessels on the redistribution of blood flow and to study patient and treatment factors that affect redistribution. FIGURE 2. Intrahepatic collateral pathways on DSA. A. Celiac trunk overview shows the native left hepatic artery (short arrow) and accessory left hepatic artery arising from the left gastric artery (long arrow). B. Selective angiography from the accessory left hepatic artery shows filling of the native left hepatic artery, demonstrating a patent connection (arrowhead) even without coil-embolization. METHODS Patient selection and data collection All patients scheduled to undergo radioembolization at our institute for primary or metastatic hepatic cancer between June 2011 and October 2017 were evaluated for inclusion. Radioembolization treatments were performed with both glass (Therasphere ® , Biocompatibles UK Ltd.) and resin 90 Y microspheres (SIR-Spheres ® , Sirtex medical Ltd.), as well as 166 Ho microspheres