Page 57 - Read Online

Page 8 of 10 Puppala. Hepatoma Res 2019;5:44 I http://dx.doi.org/10.20517/2394-5079.2019.28

A B

Figure 6. Catheter angiogram before (A) and after (B) transcatheter arterial chemoembolization performed via radial access due to steep
downward angulation of the coeliac axis and upward of the hepatic artery

patients with a steeply angled coeliac axis, challenging or occluded iliac and femoral arteries, or due to an
unstable catheter position via the femoral access.

More recently, the benefits of early mobilization and superior patient satisfaction via radial artery access
[39]
have made radial access a routine rather than an alternative . Radial access has been studied extensively
[40]
for coronary intervention with additional benefits in an acute setting . The medical device industry also
[41]
responded by developing longer shaft length catheter systems to reach the tumors in the liver . A small
risk of posterior fossa stroke and hand ischemia exists, and this should be clearly explained to the patients
as part of the informed consent. A Barbeau test is a modification of Allen’s test and is a requirement to
ensure enough collateral flow via the ulnar artery to the hand. Vasodilators are used to prevent spasm of
the radial artery but can be beneficial in the hepatic circulation during catheter manipulation.

COMPLICATIONS
The incidence of post-TACE complications is unchanged and liver ischemia; infarction and failure continue
to be the major risks. However, in comparison to cTACE, the severity of post-embolization syndrome
can be less with DEM-TACE due to the highly selective technique of embolization. The newer starch
microspheres (DSM-TACE) are biodegradable and better-tolerated, making them ideal in unresectable
large HCCs and patients requiring multiple episodes of TACE.

CONCLUSION
TACE continues to be an important treatment option to improve survival for a chosen group of patients
with HCC who are unsuitable for other modern image-guided techniques or are unfit for surgery. It is
largely a palliative procedure and to a lesser extent curative. The advances in catheters, embolic technology,
and catheter skills over the last two decades have made it a safe, effective, and well-tolerated procedure.
Standardization of type of TACE, size of bead, and the type and volume of a chemotherapy agent is not yet
[42]
available. Magnetic nanoparticle as a carrier is ongoing research .

DECLARATIONS
Authors’ contributions
The author contributed solely to the article.

Availability of data and materials
Not applicable.