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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