The incidence and outcome of major complication following conventional TAE/TACE for hepatocellular carcinoma

Abstract

To investigate the incidence and outcome of major complication following conventional transarterial embolization/chemoembolization (TAE/TACE) therapy for hepatocellular carcinoma (HCC).From May 2010 to May 2016, all patients with major complication following conventional TAE/TACE for HCC were included. Major complication was defined as admission to a hospital for therapy, an unplanned increase in the level of care, prolonged hospitalization, permanent adverse sequelae, or death after conventional TAE/TACE therapy by Society of Interventional Radiology.During the study period, a total of 2863 TAE/TACE procedures were performed among 1120 patients, and a total of 24 patients (21 male and 3 female) developed major complication with the incidence of 2.1% (24/1120) per patient and 0.84% (24/2863) per TAE/TACE procedure. The major complications were liver rupture (n = 6), liver abscess (n = 5), femoral artery pseudoaneurysm (n = 3), cholecystitis (n = 2), biloma (n = 2), pulmonary embolism (n = 2), and 1 each of the following: cerebral lipiodol embolism, tumor lysis syndrome, partial intestinal obstruction, gallbladder perforation. The mean interval from last TAE/TACE procedure to the diagnosis of major complication was 11.1 ± 7.7 days. The treatments of the complications were conservative treatment (n = 12), conservative treatment plus percutaneous drainage (n = 3), ultrasound-guided thrombin injection (n = 3), conservative treatment plus TAE (n = 2), and conservative treatment plus surgery (n = 2). Of the 24 patients, 20 patients were recovered, and remaining 4 patients were died of major complications; therefore, the mortality rate of major complication was 16.7% (4/24).Major complication following conventional TAE/TACE therapy is uncommon; the outcomes are benign of most major complications, but some are mortality.

Conventional versus Drug-eluting Beads Trans-arterial Chemoembolization for Treatment of Hepatocellular Carcinoma at Very Early and Early Stages

“…In addition to inducing post-embolization syndrome (PES) in most patients, a lipiodol-anticancer emulsion stimulates micro-capillary damage to the peri-biliary plexus, resulting in irreversible complications such as progressive biliary injury, peri-biliary biloma, portal vein thrombosis, liver infarction, liver abscess, and even mortality from liver failure and sepsis. 5 Third, in C-TACE, gelatin sponge particles or poly-vinyl alcohol particles are used as an embolization material to block the arterial blood flow. However, it is difficult to perform compact distal embolization because its shape is irregular and the size is not constant.…”

Biliary complications after transcatheter arterial chemoembolization for hepatocellular carcinoma

“…1 In terms of biliary complications after TACE, the incidence was reported with a wide range between 0.9% and 12.5%. 10,11 Unlikely the hepatic parenchyma, the blood flow to intrahepatic bile ducts receives only from the hepatic artery branches, which form a vascular plexus known as peribiliary capillary plexus. Peribiliary capillary plexus is usually hypertrophied in patients with liver cirrhosis and known to have a protective effect on bile ducts for the ischemic insults.…”

Lipiodol brain embolism through right inferior phrenic artery-pulmonary vein shunt after transcatheter arterial chemoembolization

“…In particular, CLE is an unusual complication that has occasionally been reported. 2 In patients with CLE, the symptoms are nonspecific. The severity and type of symptoms may depend on the site of lipiodol deposition.…”

“…2 Here we report a case of CLE after TACE and reveal the associated clinical symptoms, imaging findings, as well as review of the previous literature.…”