Superselective vs. lobar transarterial ethiodized oil-chemoembolization - occurrence and clinical significance of non-target embolization

Olga R. Brook, Alexander Brook, Muneeb Ahmed, Rebecca Miksad, Andrea Bullock, Ammar Sarwar, Salomao Faintuch


Purpose: To determine occurrence and clinical significance of non-target embolization (NTE) after superselective and lobar transarterial chemoembolization (TACE) with ethiodized oil.

Material and Methods: Consecutive patients who underwent ethiodized oil-based TACE from 2000 to 2013 were evaluated. NTE was defined as the presence of ethiodized oil in organs other than the liver, as seen on non-contrast CT performed day after TACE. Medical records were retrospectively reviewed for NTE symptoms.

Results: 583 TACEs were performed in 360 patients. Superselective TACE had lower overall rate of NTE than non-selective TACE: 21% (34/164) vs. 38% (160/419), p<0.001, as well as lower rates of gallbladder NTE 4% (7/164) vs. 16% (67/419), p<0.001 and stomach NTE 1% (2/164) vs. 6% (25/419). The overall incidence of NTE was 33% (194/583): 20% (114/583) lung; 13% (74/583) gallbladder; 5% (27/583) stomach; 1% (8/583) pancreas; 1% (6/583) spleen; 0.5% (3/583) duodenum; and 0.3% (2/583) adrenal. The incidence of pulmonary symptoms was 7% (32/448) and higher in patients with lung oil deposition (17/88; 19%) than those without (15/360; 4%; p<0.001). Oil deposition in pancreas was associated with clinical pancreatitis in 38% (3/8); all patients with pancreatitis were treated with a lobar approach. The length of hospital stay was longer for patients with non-target embolization: 2.6 ± 1.5 days vs. 1.9 ± 1.0 days in patients without non-target embolization, p=0.01.

Conclusion: Transarterial chemoembolization with a superselective approach results in decreased incidence of non-target embolization.


TACE; non-targeted embolization; hepatocellular carcinoma; clinical outcome; ethiodized oil

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Alba E, Valls C, Dominguez J, et al. Transcatheter arterial chemoembolization in patients with hepatocellular carcinoma on the waiting list for orthotopic liver transplantation. AJR Am J Roentgenol. 2008; 190(5): 1341-1348.

Buijs M, Vossen JA, Frangakis C, et al. Nonresectable hepatocellular carcinoma: Long-term toxicity in patients treated with transarterial chemoembolization-single-center experience. Radiology 2008; 249(1): 346-354.

Boitard J, Decaens T, Boleslawski E, et al. Comparison of Two Techniques of Transarterial Chemoembolization Before Liver Transplantation for Hepatocellular Carcinoma: A Case-Control Study. Liver Transplant. 2007; 13(5): 665-671.

Gates J, Hartnell GG, Stuart KE, et al. Chemoembolization of hepatic neoplasms: Safety, complications, and when to worry. Radiographics 1999; 19(2): 399-414.

Chan AO, Yuen M-F, Hui C-K, et al. A prospective study regarding the complications of transcatheter intraarterial lipiodol chemoembolization in patients with hepatocellular carcinoma. Cancer 2002; 94(6): 1747-1752.

Hirakawa M, Iida M, Aoyagi K, et al. Gastroduodenal lesions after transcatheter arterial chemo-embolization in patients with hepatocellular carcinoma. Am J Gastroenterol 1988; 83(8): 837-840.

Kuroda C, Iwasaki M, Tanaka T, et al. Gallbladder infarction following hepatic transcatheter arterial embolization. Angiographic study. Radiology 1983; 149(1): 85-89.

Liang S-N, Liu L-L, Su H-Y, et al. Analysis of severe complications after transcatheter arterial chemoembolization for primary hepatocellular carcinoma. Zhonghua Zhong Liu Za Zhi 2008; 30(10): 790-792.

López-Benítez R, Radeleff B a, Barragán-Campos HM, et al. Acute pancreatitis after embolization of liver tumors: Frequency and associated risk factors. Pancreatology 2007; 7(1): 53-62.

Naorungroj T, Naksanguan T, Chinthammitr Y. Pulmonary lipiodol embolism after transcatheter arterial chemoembolization for hepatocellular carcinoma: a case report and literature review. J Med Assoc Thai 2013; 96 Suppl 2: S270-S275.

Poggi G, Pozzi E, Riccardi A, et al. Complications of Image-guided Transcatheter Hepatic Chemoembolization of Primary and Secondary Tumours of the Liver. Anticancer Res 2010; 30(12): 5159-5164.

Takayasu K, Moriyama N, Muramatsu Y, et al. Gallbladder infarction after hepatic artery embolization. AJR Am J Roentgenol 1985; 144(1): 135-138.

Wu G-C, Perng W-C, Chen C-W, et al. Acute respiratory distress syndrome after transcatheter arterial chemoembolization of hepatocellular carcinomas. Am J Med Sci 2009; 338(5): 357-360.

Xia J, Ren Z, Ye S, et al. Study of severe and rare complications of transarterial chemoembolization (TACE) for liver cancer. Eur J Radiol 2006; 59(3): 407-412.

Chung JW, Park JH, Im J-G, et al. Transcatheter of Hepatocellular after Oily Chemoembolization Carcinoma. Radiology 1993; 187: 689-693.

Wang X, Shah RP, Maybody M, et al. Cystic artery localization with a three-dimensional angiography vessel tracking system compared with conventional two-dimensional angiography. J Vasc Interv Radiol 2011; 22(10): 1414-1419.

Wu G-C, Chan ED, Chou Y-C, et al. Risk factors for the development of pulmonary oil embolism after transcatheter arterial chemoembolization of hepatic tumors. Anticancer Drugs 2014; 25(8): 976-981.

Chu HH, Kim H-C, Chung JW, et al. Repeated intra-arterial therapy via the cystic artery for hepatocellular carcinoma. Cardiovasc Intervent Radiol 2014; 37(5): 1283–1291.

Schuster R, Lindner M, Wacker F, et al. Transarterial chemoembolization of liver metastases from uveal melanoma after failure of systemic therapy: Toxicity and outcome. Melanoma Res 2010; 20(3): 191-196.


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