J Korean Soc Radiol.  2019 May;80(3):562-567. 10.3348/jksr.2019.80.3.562.

Necrosis of Hepatocellular Carcinoma Caused by Iatrogenic Hepatic Artery Dissection during Transcatheter Arterial Chemoembolization

• Jeong GS
• Seo JW
• Bae SH
• Shin W

• KMID: 2454036
• DOI: http://doi.org/10.3348/jksr.2019.80.3.562

Abstract

Transcatheter arterial chemoembolization (TACE) improves the survival rate in patients with hepatocellular carcinoma (HCC). Despite the low probability, iatrogenic hepatic arterial dissections during interventional procedure are rarely created by the technical difficulties. Direct trauma from the guidewire, the tip of the catheter, or the jet of contrast injection can contribute to iatrogenic hepatic arterial dissections. We report one case of a female who had HCC necrosis caused by iatrogenic hepatic arterial dissection during TACE. Ischemia resulting from iatrogenic hepatic arterial dissection during TACE was smilar to the result of transarterial embolization for HCC on our case. To our knowledge, none of the similar cases was reported in previously published literatures.

MeSH Terms

Carcinoma, Hepatocellular*
Catheters
Chemoembolization, Therapeutic
Female
Hepatic Artery*
Humans
Intraoperative Complications
Ischemia
Necrosis*
Survival Rate
Vascular System Injuries

Figure

• 

  Fig. 1 Necrosis of HCC caused by iatrogenic hepatic artery dissection during TACE in a 67-year old female patient. A. Three-phase abdominal CT shows a nodular lesion with subtle centripetal arterial enhancement and portal/delayed wash-out is between S6 and S7, compatible with HCC (3.0 × 2.5 cm, arrows). B. Celiac angiography shows a tumor staining in right hepatic lobe of liver with several aneurysms in splenic artery. Posterior divisional HA angiography shows arterial staining target lesion feeding from A7 (arrowheads). After trying to advance microcatheter into A7, angiography shows no arterial flow to A7 due to HA dissection. The previous staining target lesion is no longer visible (arrow). C. One month later, posterior divisional HA angiography shows recanalization of previously dissected A7 without tumor staining, making us suspend TACE. Three-phase abdomen CT immediately taken after angiography shows HCC necrosis with decrease in size (2.5 × 2.2 cm) (thick arrow). Follow-up liver MRI taken two months after the event of HCC necrosis shows HCC recurrence along the margin of HCC necrosis (thin arrows). D. Segmentally selective TACE via A7 was done for recurred HCC, and the procedure ended after confirming the lipiodol uptake (arrowheads). The latest follow-up 3-phase abdomen CT shows partial lipiodol uptake around the HCC without the evidence of arterial enhancing viable tumor. A7 = hepatic arterial branch for Couinaud's segment VII, HA = hepatic artery, HCC = hepatocellular carcinoma, S6 = Couinaud's segment VI, S7 = Couinaud's segment VII, TACE = transcatheter arterial chemoembolization

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