Angiographic evaluation of hepatic arterial damage after transarterial chemoembolization for hepatocellular carcinoma

Purpose. The aim of this study was to assess the incidence, degree, and predictors of hepatic arterial damage ( HAD) after transarterial chemoembolization ( TACE) for hepatocellular carcinoma ( HCC). Materials and methods. A total of 33 patients with unresectable HCC underwent TACE alone using a mixture of iodized oil, epirubicin, and gelatin sponge. A follow-up angiogram was available for 76 of 109 sessions, and HAD was evaluated at each subsegment of the hepatic artery using a three-grade scale ( 1, no or slight wall irregularity; 2, overt stenosis; 3, occlusion). Grades 2 and 3 were considered to indicate significant HAD. The predictors of HAD were analyzed by multivariate analysis. Results. A total of 161 hepatic arteries were embolized from the lobar ( n = 43), segmental ( n = 40), subsegmental ( n = 72), or more distal ( n = 6) level. The follow-up period between the initial and last sessions ranged from 70 to 1505 days ( median 497 days). Significant HAD occurred in 37 of 231 subsegmental hepatic arteries ( 16%) and in 16 of 33 patients ( 48%). The accumulated dose of epirubicin per artery ( P = 0.001) and Child-Pugh score ( P < 0.001) were significant predictors. Conclusion. TACE is more likely to induce HAD in cirrhotic patients with impaired liver function and when a high dose of the chemotherapeutic agent was used.