This article is about a medical procedure

Medical procedure

A medical procedure is a course of action intended to achieve a result in the care of persons with health problems.A medical procedure with the intention of determining, measuring or diagnosing a patient condition or parameter is also called a medical test...

. See also Tumor Necrosis Factor Alpha Converting Enzyme

Transcatheter arterial chemoembolization / Transarterial Chemoembolization (TACE) is a minimally invasive medical procedure to restrict a tumor's blood supply.

TACE has been used extensively to delay the progression of hepatocellular carcinoma

Hepatocellular carcinoma

Hepatocellular carcinoma is the most common type of liver cancer. Most cases of HCC are secondary to either a viral hepatitide infection or cirrhosis .Compared to other cancers, HCC is quite a rare tumor in the United States...

 (HCC), a type of liver cancer. With continuing TACE, the life span

Life expectancy

Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...

 for a patient with unresectable HCC could reasonably be extended for 1–2 years, although the exact benefit would depend heavily on the patient's medical condition (see Child-Pugh score

Child-Pugh score

In medicine , the Child-Pugh score is used to assess the prognosis of chronic liver disease, mainly cirrhosis...

).

Procedure

TACE is an interventional radiology

Interventional radiology

Interventional radiology is a specialty of radiology, in which image-guided procedures are used to diagnose and treat a multitude of diseases across all body systems...

 procedure. The procedure involves gaining percutaneous

Percutaneous

In surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an "open" approach where inner organs or tissue are exposed .The percutaneous approach is commonly used in vascular procedures...

 access to the hepatic artery

Hepatic artery

Hepatic artery can refer to:* Common hepatic artery * Hepatic artery proper...

, usually by puncturing the common femoral artery in the right groin and passing a catheter

Catheter

In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...

 through the abdominal aorta

Aorta

The aorta is the largest artery in the body, originating from the left ventricle of the heart and extending down to the abdomen, where it branches off into two smaller arteries...

, through the celiac trunk and common hepatic artery, into the proper hepatic artery (which supplies the liver).

The interventional radiologist

Interventional radiology

Interventional radiology is a specialty of radiology, in which image-guided procedures are used to diagnose and treat a multitude of diseases across all body systems...

 then performs an arteriogram

Angiogram

Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins and the heart chambers...

 to identify the branches of the hepatic artery supplying the tumor(s) and threads smaller catheters into these branches. This position is called a superselective position. This is done to maximize the amount of the chemotherapeutic dose that is directed to the tumor and minimise the amount of the chemotherapeutic agent that could damage the normal liver tissue.

When a blood vessel supplying tumor has been selected, alternating aliquots of the chemotherapy dose and of embolic particles, or particles containing the chemotherapy agent, are injected through the catheter. The total chemotherapeutic dose may be given in one vessel's distribution, or it may be divided among several vessels supplying the tumor(s).

TACE derives its beneficial effect by two methods. Since most tumors are supplied by the hepatic artery, arterial embolization interrupts their blood supply and postpones growth until replaced by neovascularity. Secondly, focused administration of chemotherapy allows a higher dose to the tissue while simultaneously reducing systemic exposure, which is typically the dose limiting factor. This effect is potentiated by the fact that the chemotherapeutic drug is not washed out from the tumor bed after embolization. This way, in contrary with systemic chemotherapy, the therapic effect is focused in the liver, diminishing the systemic side effects of the agents.

Complications

As with any interventional

Interventional radiology

Interventional radiology is a specialty of radiology, in which image-guided procedures are used to diagnose and treat a multitude of diseases across all body systems...

 procedure, there is a small risk of hemorrhage and/or damage to blood vessels. Pseudoaneurysm

Pseudoaneurysm

A pseudoaneurysm, also known as a false aneurysm, is a hematoma that forms as the result of a leaking hole in an artery. Note that the hematoma forms outside the arterial wall, so it is contained by the surrounding tissues. Also it must continue to communicate with the artery to be considered a...

 can develop due to the puncture in the femoral artery. During this procedure contrast media is utilized, people may develop allergy to it. Also this contrast media can use Hyperthyroidism

Hyperthyroidism

Hyperthyroidism is the term for overactive tissue within the thyroid gland causing an overproduction of thyroid hormones . Hyperthyroidism is thus a cause of thyrotoxicosis, the clinical condition of increased thyroid hormones in the blood. Hyperthyroidism and thyrotoxicosis are not synonymous...

.

The goal of the procedure is to kill tumor. The resulting necrotic material releases cytokines and other inflammatory chemicals into the blood stream, and patients are routinely kept in a hospital for one to several days following the procedure.

A concerning complication of TACE is the development of an abscess

Abscess

An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...

within the necrotic tissue. This is a potentially fatal event, although percutanous drainage can take place in order to prevent the septicaemia and sepsis.