The road less traveled: importance of the lesser branches of the celiac axis in liver embolotherapy.

Effective treatment of unresectable hepatic neoplasms depends on the appropriate identification of tumor arterial supply. Because hepatic tumors derive more than 90% of their blood supply from the hepatic arteries, awareness of common hepatic arterial anatomic variants (e.g., replaced or accessory left or right hepatic artery), as well as parasitized collateral vessels originating from the celiac axis (e.g., right inferior phrenic, omental, and cystic arteries) that can supply hepatic neoplasms-particularly those with a surface location-is important for safe and effective interventional therapy for these tumors. Moreover, recognition of certain nonhepatic branches arising from the hepatic arterial circulation is important for optimizing transarterial therapy and blocking the passage of treatment particles into sensitive structures, thereby preventing unwanted clinical sequelae such as gastrointestinal ulceration, skin ulceration or pain, and, rarely, ischemic cholecystitis.