Peribiliary plexus

The IPSO microdroplets injected into the hepatic artery inevitably flow into the peripheral branch of the artery, which runs through bile duct wall as a network called peribiliary plexus and finally connects to the portal vein or sinusoid (Kan, 1989) (see Figure 10.11). In the case of the liver bearing HCC, the tumor tissue is supplied with blood only by the hepatic artery, and not by the portal vein. Therefore immediately after the TACE with the W/OAV emulsion, the IPSO microdroplets accumulate in the hepatic artery along bile duct wall in nontumorous tissue and in tumor vessels in HCC tissue. 

NO- is a product of the conversion by nitric oxide synthase (NOS) of 1-arginine to 1-citruUine (Fig. 17.1). Three different classes of NOS can be found in the liver, the neuronal isoform (nNOS), present in the peribiliary plexus, the calcium-dependent endothelial (eNOS) in endothelial cells, and the calcium-independent... 

The blood of the hepatic artery supplies five regions of the liver (7.) peribiliary vascular plexus as the greatest arteriolar compartment, (2.) interstitium of the portal... 

Washington K, Clavien PA, Killenberg P. Peribiliary vascular plexus in primary sclerosing cholangitis and primary biliary cirrhosis. Hum Pathol. 1997 28 791-795. 

Kobayashi S, Nakanuma Y, Matsui O. Intrahepatic peribiliary vascular plexus in various hepatobiliary diseases a histological survey. Hum Pathol. 1994 25 940-946. 

Background. Biliary complications both intra- and extrahepatic following administration are due to the embolic and radiation induced necrosis of the biliary ducts [29]. In contrast to the normal liver parenchyma, the intrahepatic bile ducts do not have a dual blood supply and are fed exclusively from the hepatic arterial branches that give off a vascular plexus (peribiliary capillary plexus) around the bile ducts. This microscopic peribiliary arterial plexus has a similar diameter to that of the microspheres (10-60 pm, mean 35 pm). Therefore, ischaemia of the intrahepatic bile ducts can occur after radioembolization [25]. 

Kabayashi S, Nakamura Y, Terada T et al (1993) Postmortem survey of bile duct necrosis and biloma in hepatocellular carcinoma alter transcatheter arterial chemoembolization therapy relevant to microvascular damages of peribiliary capillary plexus. Am J Gastroenterol 88 1410-1415... 

This glue, first used for bleeding control, has been successfully utilized for preoperative portal vein embolization [15]. This adhesive, that polymerizes on contact with blood and endothelium, does not affect the peribiliary arterial plexus, and this property led to the assumption that it can be used for transcatheter arterial embolization [55]. Mixed with radiopaque lipiodol, the polymerization time can be prolonged to 10-15 s, depending on dilution. Therefore, a more peripheral and permanent embolization can be achieved. 

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