Celiac Artery Stenting to Facilitate Hepatic Yttrium-90 Radioembolization Therapy
(a) Aortogram demonstrates a tight stenosis of the proximal celiac axis (white arrow) with mild poststenotic dilatation. In this case, the celiac artery stenosis was assumed to be related to atherosclerosis. The stenosis limits the access of the hepatic arterial branches for radioembolization purposes. Prior surgical clips related to partial right hepatic resection are noted (black arrow). (b) Superior mesenteric artery angiogram demonstrates significant hypertrophy and enlargement of the inferior pancreaticoduodenal arcade with opacification of gastroduodenal artery, and hepatic branches in a retrograde fashion (white arrows). There was a small collateral vessel which traveled from the superior mesenteric artery in a superior direction and opacified the very distal celiac axis and splenic artery (black arrow) likely representing the Arc of Buhler. (c) The right hepatic artery was not accessible through the tortuous pancreaticoduodenal collateral arcade (white arrow).