Pulmonary complications after hepatic artery chemoembolization or infusion via the inferior phrenic artery for primary liver cancer

PURPOSE: The purpose of this study was to determine the frequency, patterns of disease, and risk factors for development of pulmonary complications after liver chemoembolization via the inferior phrenic artery (IPA). MATERIALS AND METHODS: Forty-four selective transcatheter hepatic chemoembolization (THCE) procedures via the IPA were performed in patients with primary liver cancers with use of a mixture of anticancer agents and iodized oil (Lipiodol) with or without transcatheter arterial embolization. The grades of pulmonary complications were assessed on triphasic helical computed tomographic (CT) images after THCE and were correlated with angiographic findings of the IPA, infused dosages of Adriamycin and Lipiodol, and hepatic venous tumor thrombus on triphasic CT images before THCE. RESULTS: THCE via the IPA frequently resulted in lung CT changes: Lipiodol accumulation in the lung field (52%), consolidation (68%), and pleural effusion (41%). Among 44 patients, two (5%) developed respiratory symptoms. An excellent correlation was shown between Lipiodol accumulation and the presence of angiographic abnormalities of the IPA (P < .005). A significant correlation was also shown between the grades of pulmonary complications and the numbers of angiographic abnormalities (P < .01). The grades of pulmonary complications increased according to the infused dosage of Adriamycin and Lipiodol (P < .05). CONCLUSIONS: Angiographic abnormalities such as arteriovenous shunts, dilated anastomotic branches, and dense pleural staining are important risk factors for pulmonary complications of THCE via the IPA. Embolization for shunts may be required to prevent such complications, especially in cases with shunts to pulmonary vessels or hepatic veins.