Spinal cord ischemia secondary to transcatheter arterial chemoembolization for hepatocellular carcinoma

Complications Related to Transarterial Treatment of Hepatocellular Carcinoma: A Comprehensive Review

Currently, various types of transarterial treatments are performed for hepatocellular carcinoma from the early to advanced stages. Its indications and efficacy have been widely investigated. However, procedure-related complications have not been updated in the literature, although new types of transarterial treatments, such as drug-eluting bead transarterial chemoembolization and transarterial radioembolization, are common in daily practice. Herein, a comprehensive literature review was carried out, and complications were organized according to the organs affected and treatment modalities.

Spinal Cord Infarction After Transarterial Chemoembolization for Hepatocellular Carcinoma

Transarterial chemoembolization (TACE) is an effective treatment for unresectable hepatocellular carcinoma (HCC). It is considered relatively safe. However, fatal complications such as pulmonary edema and liver abscesses can occur. Spinal infarction due to local embolism of the central nervous system after TACE is a very rare, but fatal complication. Here, we report a case of spinal cord infarction after TACE for ruptured HCC. Paraplegia occurred at the T10 sensory level 6 hours after the procedure. The patient received steroid megadose therapy but died 5 days later due to exacerbation of metabolic acidosis and blood loss. This case demonstrates the need for a comprehensive and extensive study of arterial blood flow prior to angiography.

Paraplegia following transarterial chemoembolisation for hepatocellular carcinoma: a case report

BACKGROUND

Transarterial chemoembolisation (TACE) is considered standard treatment for intermediate-stage hepatocellular carcinoma (HCC). Although TACE is viewed as a safe and effective procedure, it may still present with various complications, including spinal cord injury, though very rarely.

METHODS

A 74-year-old male was diagnosed with non-B, non-C HCC, segment 4, cT2N0M0, AJCC stage II, BCLC stage B. Angiography had shown a hypervascular tumour stain indicating that both T10 and T11 were tumour-feeding arteries, TACE then performed. After TACE, loss of sensation and motor functions involving the trunk below the umbilicus and both lower extremities were noted. The patient immediately underwent steroid pulse therapy. However, 100 days after TACE, the symptoms showed no improvement.

DISCUSSION

Because of anatomy and neurological distribution, it is conceivable that the embolic materials originating from the TACE procedure might have led to an embolic event with a serious manifestation, although the blood supply of the spinal cord encompasses multiple anastomoses.

CONCLUSION

Spinal cord injury is an extremely rare but grave complication of TACE. Paraplegia may result from inadvertent embolisation of spinal branches arising from intercostal or lumbar collateral vessels. This case highlights the necessity of evaluating and choosing the vessels before starting TACE to achieve a good outcome.

Paraplegia after transcatheter artery chemoembolization in a child with clear cell sarcoma of the kidney: A case report

BACKGROUND

Transcatheter arterial chemoembolization (TACE) is a common treatment for inoperable malignant renal tumors. However, a series of complications may follow the TACE treatment. Spinal cord injury caused by the embolization of intercostal or lumbar arteries is extremely rare.

CASE SUMMARY

We describe a case with quite uncommon spinal cord injury after TACE in a 3-year-old child with clear cell sarcoma of the kidney. Sensory impairment beneath the T10 dermatomes and paraplegia on the day after TACE were found in this patient. Unfortunately, sustained paraplegia still existed for more than 2 mo after TACE despite the large dose of steroids and supportive therapy.

CONCLUSION

We should draw attention to an uncommon complication of paraplegia after TACE treatment in malignant renal tumors. Although it is rare, the result is disastrous.

Ischemic Duodenal Ulceration after Transarterial Chemoembolization for Hepatocellular Carcinoma: A Case Report

Drug-eluting bead transarterial chemoembolization (DEB-TACE) is a well-established, minimally invasive interventional treatment for nonresectable hepatocellular carcinoma (HCC). Generally, TACE is regarded as safe and effective with a low complication rate. However, remote gastrointestinal ischemia due to the carryover of embolic material into visceral arteries is a rare but serious complication of TACE. In this report, we present a case of duodenal ulceration with contained perforation and severe necrotizing pancreatitis after TACE in a patient with nonresectable HCC and underlying hepatitis C virus associated with Child-Pugh stage B liver cirrhosis. This patient showed, for the first time, complete endoscopic and clinical recovery within 2 months of conservative treatment. Considering the high mortality rate from surgical intervention in all previously reported patients, the significant recovery potential demonstrated by our case suggests conservative treatment with antibiotics and parenteral nutrition combined with close clinical, radiological, and endoscopic monitoring should be considered in all clinically stable patients without signs of peritonism or septic sequelae.

Gastric and duodenal ischaemia after transarterial chemoembolisation for hepatocellular carcinoma: an unexpected but significant complication

Transarterial chemoembolisation (TACE) is commonly used for unresectable intermediate-stage hepatocellular carcinoma (HCC). TACE is usually well-tolerated. We report a case of a patient who presented with a gastrointestinal bleed from TACE. A 64-year-old man presented with chronic hepatitis C cirrhosis and multifocal bilobar HCC. He had previously undergone multiple TACE sessions, radiofrequency ablation and stereotactic body radiation therapy. In the evening of his TACE procedure, he developed abdominal pain and haematemesis. An oesophagogastroduodenoscopy (OGD) showed non-bleeding oesophageal varices and ulcerations in the stomach and duodenum, with pathology demonstrating mucosal necrosis. The patient recovered and was discharged on omeprazole. While TACE is considered safe with most patients only experiencing postembolisation syndrome, vascular complications have been reported. In our patient, OGD revealed ulcerations, with biopsies confirming ischaemic ulceration. The likely aetiology was seepage of the embolic particles into neighbouring arteries. Patients should be carefully selected for TACE and monitored post procedure.

Relationship between ADH2 Arg47His variation and hepatocellular carcinoma susceptibility: a meta analysis

BACKGROUND

To further investigate the relationship between ADH2 Arg47His variation and hepatocellular carcinoma (HCC) susceptibility through a meta-analysis.

METHODS

The related articles were searched in PubMed, Embase and CNKI databases. And finally 518 cases and 607 controls were included in our meta-analysis Odds ratios (ORs) with 95% confidence intervals (95% CIs) were used to assess the relationship between ADH2 Arg47His variation and HCC risk. A fixed-effect model or a random-effect model was applied according to the between-study heterogeneity.

RESULTS

Quantitative synthesis demonstrated that no significant association was found between ADH2 Arg47His variation and HCC susceptibility (His/His vs. Arg/Arg: OR=0.99, 95% CI=0.79-1.25; His/His + Arg/His vs. Arg/Arg: OR=1.01, 95% CI=0.86-1.20; His/His vs. Arg/Arg + Arg/His: OR=0.90, 95% CI=0.74-1.11; His vs. Arg: OR=0.98, 95% CI=0.86-1.11; Arg/His vs. Arg/Arg: OR=1.05, 95% CI=0.82-1.34).

CONCLUSION

Our analysis showed that ADH2 Arg47His vvariation may not be associated with HCC susceptibility.