The most common indication of this therapy is for treatment of unresectable primary hepatocellular carcinoma, based on anatomic distribution of disease, vascular invasion, underlying hepatic function or a combination of these factors. The majority of patients with HCC have underlying liver disease with resultant cirrhosis. Patients with normal liver function and, presumably, normal hepatic parenchyma may undergo resection of 75% to 80% of their liver without developing postoperative hepatic failure. Patients with underlying liver disease require a greater volume of liver remnant to maintain hepatic function, thus, tumors that might normally be resectable in patients with normal liver parenchyma may not be resectable in the presence of cirrhosis. The Child-Pugh nominal liver staging system is the most accurate in predicting survival of patients with unresectable HCC treated with TACE and TAE. Patients with Child-Pugh class C cirrhosis may be more likely to die of their underlying liver disease than of their HCC and are unlikely to tolerate arterial<unk>  well and therefore,<unk>  therapy is only indicated in patients with Child A or B cirrhosis. When evaluating a patient for<unk> , both the severity of the underlying liver disease and the extent of the tumor being treated should be considered. In 1999, Llovet et al, proposed the Barcelona Clinic Liver Cancer (BCLC) staging classification as a means of both classifying patients and linking their stage to a specific treatment. Although selective<unk>  of a solitary well circumscribed HCC in a patient with Child Class B cirrhosis might be well tolerated,<unk>  of a hemi-liver in a Child A patient with multifocal hepatoma involving more than 75% of the liver and with portal vein tumor thrombus may result in hepatic failure and severe death. Patient with hepatic metastatic disease from neuroendocrine tumors, gastrointestinal stromal tumors other sarcomas, ocular melanoma, and a variety of “hypervascular” metastases (eg from breast cancer or renal cell cancer) may also be candidates for<unk> , assuming the liver is the only site of disease, or when the procedure is being performed for palliation of symptoms. Since the purpose of hepatic<unk>  in these cases is to either treat symptoms or extend survival, patient who are asymptomatic from their secondary hepatic disease and who have disease elsewhere should probably not be considered candidates. Intra-arterial therapy based on ischemia induced by terminal vessel blockade should not be expected to be efficacious in patients with hypovascular tumors and has no proven role in the treatment of typical metastatic adenocarcinoma from most gastrointestinal malignancies.
Bland embolization
Venous cutdown
Duret haemorrhages
Pseudoaneurysm
Angiomatosis
Splinter hemorrhage
Hydrodissection
Neovascularization