As part of the pre-procedure work-up, every patient has a triple-phase CT scan within a month of the scheduled<unk> . Triple-phase CT is essential for documenting the extent of disease, demonstrating arterial anatomy, evaluating the portal venous system, and looking for non-hepatic blood supply to the tumor. This study serves as the basis for a treatment plan. The extent and distribution of the tumors are laid out, arterial blood supply to the tumor is evident and any contribution from the extra hepatic vasculature such as the phrenic or internal mammary arteries, should be seen. Celiac and mesenteric angiography is performed to document arterial anatomy, demonstrate the hypervascular tumor and evaluate the direction of blood flow, which cannot be determined by conventional triple-phase CT. At the same time, selective angiography should be undertaken by injecting vessels known to supply the tumor by previous triple-phase CT. If multifocal bilobar disease is present, one side of the liver is selected for treatment at the first sitting, usually the side with the largest tumor burden. The catheter is placed selectively into the right or left hepatic artery and arteriography is performed. The target vessel is subsequently embolized with embospheres suspended in contrast material until stasis is evident. Stasis is defined as lack of antegrade flow, with evidence of reflux on injection of even small amounts of contrast material. When stasis occurs, the procedure is terminated and a final arteriogram is performed to document occlusion of the target vessel and preservation of the blood flow to non-target vessels. For solitary tumors, an attempt is made to embolize the tumor as selectively as possible. The initial arteriogram is reviewed to determine which vessel or vessels are feeding the tumor. Each vessel is then selected, typically with a coaxial 2F or 3F catheter, and that vessel is embolized with up to 10 mL of the smallest-size particles. if antegrade flow persists after 10 mL of the smallest particle have been used, treatment is continued with the next size particle, and so on until stasis occurs and persists. If additional vessels are identified supplying the tumor, these vessels are sequentially catheterized and treated beginning with the smallest particle and continuing until stasis is evident. When<unk>  of the target vessel or vessels is complete, a final angiogram is performed to document the result. When appropriate, angiography of non-hepatic vessels potentially supplying the tumor (e.g. phrenic, internal mammary or intercostal arteries) is performed. If the patient is doing well, use of contrast material has not been excessive and<unk>  of additional vessels is thought to be safe, the procedure continues. Once the entire tumor or hemiliver has been treated, the procedure is terminated and an immediate CT scan is then performed. This scan will demonstrate uptake of contrast in the treated tumor with circumferential coverage, assuming appropriate vessels have been targeted. The treatment plan for the next<unk>  is outlined.
Bland embolization
Venous cutdown
Duret haemorrhages
Pseudoaneurysm
Angiomatosis
Splinter hemorrhage
Hydrodissection
Neovascularization