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Although the prognosis in liver metastatic disease is usually poor, the plump thumbs use of more-aggressive treatment regimens in certain patients, such as patients with neuroendocrine tumors and colorectal metastasis, can result in a favorable outcome. Effective chemoembolization of the liver is possible because of 3 circumstances. First, the liver has a unique blood supply. The portal plump thumbs vein supplies 75% of the hepatic blood supply, whereas 25% of the blood supply is derived from the hepatic artery. This backup blood supply allows occlusion of either vessel without plump thumbs resultant liver infarction. Second, 95% of the blood of both primary and metastatic hepatic tumors is derived from the hepatic artery. Third, the development of catheter technology allows superselective placement of catheters for safe and effective delivery of therapeutic agents to hepatic tumors. Microcatheters allow safe placement, even in the face of aberrant vessels or collateral blood supply.
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