Chemoembolization of hepatic neoplasms: Safety, complications, and when toworry

Chemoembolization of the liver for unresectable malignancy, although contro versial, is being used with increasing frequency. Chemoembolization can be difficult, and there is great potential for causing complications, There ar e also findings after chemoembolization, particularly on computed tomograph ic scans, that may appear to indicate complications but are common and of n o concern. Chemoembolization requires an understanding of the congenital an d acquired variations of arterial anatomy that may be seen supplying the li ver. Assessment of the patency of the portal vein is also required. An abno rmal portal vein demands significant changes in technique to allow safe che moembolization. Partial or complete occlusion of the portal vein is associa ted with significantly decreased survival but does not prevent a worthwhile response to chemoembolization and is not an absolute contraindication, The presence of chemoembolization material in the gallbladder is not uncommon; with the technique used by the authors, the chemoembolization material inf requently causes cholecystitis or gallbladder infarction, Extrahepatic chem oembolization material is commonly seen in other organs but usually does no t cause problems, presumably because the dose deposited outside the liver i s small compared with the dose delivered to the liver. Other complications include pseudocirrhosis, liver infarction and abscess formation, carcinoid crisis, hepatorenal syndrome, and liver rupture.