Re: Hepatotoxicity after Transarterial Chemoembolization and Transjugular Intrahepatic Portosystemic Shunt: Do Two Rights Make a Wrong?

Safety and efficacy of transarterial chemoembolization in patients with transjugular intrahepatic portosystemic shunts

“…To date, there have been five series that have investigated the safety of TACE in HCC patients that possess a TIPS (Table 3). 6,[11][12][13][14] However, a common theme shared among published series, and further demonstrated in the present study, was the assessment of TIPS patency prior to performing TACE. While no patient in the current series had evidence of a non-functional TIPS before TACE, in the absence of clinical symptoms (gastrointestinal bleeding, ascites), routine interrogation by venography to assess TIPS patency, or determination of portal pressure gradients is unnecessary.…”

“…Owing to the decrease in portal venous flow, TACE possesses the theoretical risk of causing further hepatic dysfunction through the disruption of the arterial vasculature, which the normal hepatic parenchyma is dependent upon. To date, there have been five series that have investigated the safety of TACE in HCC patients that possess a TIPS (Table ) . However, a common theme shared among published series, and further demonstrated in the present study, was the assessment of TIPS patency prior to performing TACE.…”

“…While neither patient experienced a complication, the overall morbidity rate of the collective cohort was low (25%) and comparable to the series by Wang (31.6%). 12 Similarly, the study by Gaba et al 13 abandoned the use of embolic material in their series and demonstrated an 11% morbidity rate. In contrast, the study by Kohi et al 11 reported the highest frequency of complications (70%).…”

“…Unfortunately with the rising incidence of HCC among western countries, there has been a corresponding increase in the number of HCC cases with TIPS in need of loco‐regional therapy . In recent years, several studies have investigated the feasibility of TACE in patients with a functional TIPS . While all the studies were limited by a small sample size, the rates of TACE‐related complications are variable (5–70%).…”

“…8 In recent years, several studies have investigated the feasibility of TACE in patients with a functional TIPS. 6,[9][10][11][12][13][14] While all the studies were limited by a small sample size, the rates of TACE-related complications are variable (5-70%).…”