Adverse events following transarterial chemoembolization for hepatocellular carcinoma and factors predicting such events.

OBJECTIVE: To document the adverse events after transarterial chemoembolisation and factors predicting such events. METHODS: The prospective observational study was conducted at the Sindh Institute of Urology and Transplantation, Karachi, from November 2009 to November 2011. All patients diagnosed as hepatocellular carcinoma were included in this study. Complications developing within the first 6 weeks of the procedure were recorded. SPSS version 16 was used for statistical analysis. RESULTS: Of the total 80 patients, 59 (73.8%) were male. The overall mean age was 52.25 +/- 9.24 (range: 28-76 years). Most common etiology was hepatitis C related cirrhosis in 55 (68.8%). Adverse events developed in 46 (57.5%) patients. Post transarterial chemoembolisation syndrome was seen in 37 (46.3%). Of those with the syndrome, 24 (64.8%) patients had no additional complications, while 3 (8%) had renal dysfunction, 2 (5%) hypertensive crisis, and 1 (2.7%) patient each had urinary tract infection, pneumonia and sepsis. Decompensation of cirrhosis occurred in 6 (7.5%) patients of whom 3 (50%) developed sepsis and died. The syndrome was associated with tumour size > 5cm (p = 0.001) and higher dose of lipoidol (p = 0.0001). Decompensation of cirrhosis was associated with low basal albumin (p = 0.002), advanced basal child turcotte pugh (p = 0.005) and model for end-stage liver disease (p = 0.006) scores. CONCLUSION: Transarterial chemoembolisation, though generally safe, may lead to serious complications in patients with advanced liver disease. Post-procedure syndrome was associated with increased tumour size and lipoidol dose.

Thalamic and midbrain infarct during transarterial chemoembolization of hepatocellular carcinoma.

Transarterial chemoembolization (TACE) is a well accepted and a relatively safe procedure, however certain rare and serious complications may occur during or after the procedure with profound morbidity and mortality. Only a few cases have been reported describing cerebral embolization during the procedure. We are reporting a case in which cerebral lipiodal embolization occurred in the second session of TACE, during the procedure and without any evidence of pulmonary embolism causing midbrain and thalamic infarct. The possible explanation could be an aberrant connection between the hepatic and pulmonary vessels which might have developed due to the involvement of the diaphragm, pleura and pulmonary vessels after the first session of TACE.