Hepatic arterial changes following iodized oil chemoembolization of hepatocellular carcinoma: Incidence and technical consequence

Objective: To describe the nature, incidence, and therapeutic consequence of hepatic arterial changes seen following transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Methods: In this retrospective study, 46 patients with HCC underwent ≥ 2 TACE treatment sessions between 2004 and 2010. All patients had hepatic angiography on days of treatment. Sequential angiographic studies were reviewed to assess for abnormalities in appearance of the hepatic vasculature. Angiographic abnormalities were graded in a binary fashion: present or absent. When present, abnormalities and effect on drug delivery were recorded. Results: 123 (mean 2.7, range 2-5) successful lobar (n = 34), segmental (n = 88), or superselective (n = 1) TACE procedures were performed in 46 patients (M:F = 36:10, mean age 59 years). TACE was performed using 1:1 chemotherapy to iodized oil mixture without (n = 102) or with (n = 21) particle embolization. An abnormal angiographic appearance was identified in 21/46 (38%) patients and in 23/123 (19%) procedures, with first appearance after mean 1.5 (range 1-3) TACE sessions and mean 176 (range 27-509) days after initial TACE. Abnormalities included new vessel attenuation or stenosis (n = 10, 43%), slow flow (n = 2, 9%), and new vascular occlusions (n = 11, 48%). These vascular changes did not result in inability to perform repeat TACE in 16/16 (100%) cases where vascular changes were present and TACE was repeated to the same liver lobe. Conclusion: While the hepatic vasculature is altered in many patients undergoing TACE, arterial abnormalities did not preclude therapy.Further investigation is warranted.