Transcatheter arterial chemoembolization for hepatocellular carcinoma: anatomic and hemodynamic considerations in the hepatic artery and portal vein.

Hepatocellular carcinoma (HCC) is the most common malignant tumor of the liver. Although several therapeutic options have been advocated, transcatheter arterial chemoembolization (TACE) in particular has been widely performed in the treatment of HCC. Still, hepatic arteriography and portography are mandatory for evaluation of (a) the resectability and multiplicity of HCCs and (b) the hemodynamic status of the portal vein. Thereafter, TACE can be considered as the initial therapeutic modality. The possibility of nontarget organ complications during TACE (eg, ischemic cholecystitis, splenic infarction, gastrointestinal mucosal lesions, pulmonary embolism and infarction, spinal cord injury, ischemic skin lesions) should be taken seriously. A thorough understanding of the anatomic variants and hemodynamic features of the hepatic artery and portal vein is the first step in performing effective and safe TACE for HCC.