Complications of intra-arterial regional liver therapy

Abstract

Multiple complications have been described after or during intra-arterial regional liver treatments. These complications are caused either by the angiographic/surgical procedure itself (i.e., arterial thrombosis), by the embolic/infusion effect (i.e., post-embolization syndrome and chemical hepatitis), by nontarget embolization/infusion to normal liver parenchyma (i.e., radioembolization-induced liver disease and biliary sclerosis), by nontarget embolization/infusionto extrahepatic sites (i.e., gastroduodenal ulceration), and by device malfunction in the case of intra-arterial infusion pump. The most common complications resulting from transarterial chemoembolization (TACE) and transarterial embolization (TAE) are post-embolization syndrome, arterial injuries, nontarget embolization, biliary ischemia and bilomas, and liver abscesses. Radioembolization is also associated with nontarget embolization and post-embolization syndrome, and withradiation-specific complications, such as radioembolization-induced liver disease (REILD) and radiation pneumonitis. Finally, hepatic artery infusion (HAI) treatments may be complicated by gastroduodenal toxicity, chemical hepatitis, biliary sclerosis, and pump/catheter malfunction.