Nontarget embolization of the hepatic falciform artery in the treatment of hepatocellular carcinoma: Case report and review of the literature

Transarterial chemoembolization (TACE) is a commonly used locoregional therapy for hepatocellular carcinoma (HCC), with rare complications related to nontarget embolization. We describe a case of hepatic falciform artery (HFA) embolization following drug-eluting bead TACE (DEB-TACE), resulting in transient ischemic injury of the anterior abdominal wall. A 71-year-old man with Child-Pugh A cirrhosis and multifocal HCC developed a livedo-reticularis-like rash over the epigastrium 2 days after DEB-TACE. Retrospective review of angiographic and cross-sectional imaging identified a hepatic falciform artery arising from the hepatic arterial system, consistent with nontarget embolization. The patient was managed conservatively, with complete resolution over several months. The HFA is an anatomically variable vessel that may be difficult to identify on angiography. Awareness of this entity is important to recognize characteristic imaging findings, guide patient counselling, and minimize procedural complications during TACE.