Arterial and biliary complications after transarterial chemoembolization for hepatocellular carcinoma

Transarterial chemoembolization is a common treatment modality that significantly improves prognosis in patients with intermediate-advanced hepatocellular carcinoma. However, this procedure is associated with a spectrum of potential arterial and biliary complications, ranging from mild self-limiting ones to those severely affecting patient outcomes. This review systematically integrates recent studies to explore the epidemiological characteristics, risk factors, and management strategies of these two groups of complications. Arterial complications, primarily hepatic artery stenosis, pseudoaneurysm, and arterial rupture hemorrhage, exhibit a biphasic distribution pattern with the majority occurring within 72 hours postoperatively, while a notable portion occurs within 1-4 weeks. Biliary complications, including biliary fistulas, biliary strictures, and ischemic cholangitis, exhibit higher incidence rates and more insidious clinical manifestations than arterial complications. Risk factors include the severity of cirrhosis, tumor location, procedural technique, and chemotherapeutic drug toxicity. Management strategies emphasize careful preoperative planning (primarily with computed tomography angiography), standardized intraoperative procedures (like superselective embolization), and multi-pronged postoperative monitoring (imaging combined with laboratory indicators of liver function). Interventional embolization or surgical reconstruction is used for arterial complications, while endoscopic therapy or surgical drainage is selected based on the severity of injury for biliary complications. Future research should further explore individualized treatment regimens and novel embolic materials to reduce complication rates and enhance the safety of transarterial chemoembolization.