Hepatic Artery Embolization / Chemoembolization
What the Examiner Expects
Selective catheterization and embolization of hepatic arterial branches supplying liver tumors, either alone (bland embolization/TAE) or combined with chemotherapy (TACE) or radiation-loaded microspheres (TARE/Y-90). The examiner expects you to understand the dual blood supply of the liver (75% portal vein, 25% hepatic artery), that liver tumors are preferentially supplied by the hepatic artery, and that embolizing arterial supply induces tumor ischemia while sparing normal liver parenchyma fed by the portal vein. TACE is indicated for intermediate-stage HCC (BCLC B) — multinodular tumors without vascular invasion or extrahepatic spread, in patients with preserved liver function (Child-Pugh A or early B).
Key Examiner Focus Points
- TACE (transarterial chemoembolization) for intermediate-stage HCC (BCLC stage B)
- Exploits dual blood supply: tumors fed primarily by hepatic artery; normal liver fed by portal vein
- Contraindicated in portal vein thrombosis (liver relies entirely on hepatic artery)
- Post-embolization syndrome: fever, pain, nausea — expected and self-limited
- Also used for bleeding hepatic tumors or traumatic hemorrhage (TAE)
Common Curveballs
Patient has main portal vein thrombosis — is TACE safe?
No. Main portal vein thrombosis is a contraindication to TACE. With the portal vein occluded, the liver relies entirely on hepatic artery flow — embolizing it causes hepatic infarction and liver failure. Consider sorafenib/lenvatinib (systemic therapy) or TARE (Y-90) which is less ischemic.
After TACE, the patient develops fever, RUQ pain, and elevated transaminases
Post-embolization syndrome — an expected inflammatory response occurring in 60–80% of patients. Supportive care with fluids, analgesics, and antiemetics. Usually self-limited over 3–5 days. However, if fever persists > 7 days or clinical deterioration occurs, evaluate for liver abscess or hepatic infarction.