Angio-architectural changes in hepatic arteries following conventional transarterial chemoembolization for hepatocellular carcinoma and the factors influencing them: a retrospective observational study

Abstract Purpose Transarterial chemoembolization (TACE) is a standard endovascular procedure in the management of hepatocellular carcinoma. However, there is a lack of comprehensive literature on the microangiographic changes in native hepatic vasculature and the factors influencing these changes following TACE. Materials and methods A retrospective cohort study was done in consecutive patients with chronic liver disease and hepatocellular carcinoma who underwent more than one sitting of TACE between January 2018 and June 2023. The hepatic vasculature was divided into proximal (common hepatic artery and hepatic artery proper), intermediate (lobar and segmental) and distal (sub-segmental) zones on angiographic images. Injury to hepatic microvasculature was graded on a 4-point ordinal grading scale on paired angiographic images obtained at least 6 weeks apart. Demographic, biochemical, clinical and radiological data were collected from hospital records at the initial presentation and during follow-up visits at 6 weeks, 3 months, 6 months and 1 year after intervention. Results There is no significant change in the grade of injury to proximal hepatic arteries after TACE. Angiographic assessment of lobar and segmental arteries, as well as subsegmental arteries after TACE, showed a significant difference in the grade of hepatic arterial injury on Mann–Whitney U -test ( p — 0.002). A strong inter-rater correlation coefficient of 0.913 (Cohen’s kappa) was observed. Multinomial logistic regression analysis identified Child–Pugh score, the presence of diabetes and Delta time between repeat interventions as independent predictors of high-grade hepatic arterial injury involving hepatic microvasculature. Conclusion TACE causes a significant change in the angioarchitecture of segmental and subsegmental distal hepatic vasculature in the short term. The extrahepatic vessels showed no changes following conventional TACE. Level of evidence 3 Non-randomized cohort follow-up study.