Arterial Injection for Treating Liver Tumors How the Procedure Is Performed and Its Risks

Hepatic arterial injection is one of the modern medical techniques used to treat certain liver tumors, particularly in cases where surgery is not the most suitable option for the patient. This technique involves accessing the artery supplying the tumor and delivering treatment directly to it, aiming to control tumor growth and reduce its blood supply while minimizing the impact on healthy tissues as much as possible. However, like any medical procedure, it may be associated with certain side effects and complications that vary from one patient to another, depending on the condition of the liver and the type of treatment used. So, what is hepatic arterial injection? What are its main benefits and risks? When is it recommended, and what is its success rate? In this article on Dalili Medical, we will explore these questions to provide a clear understanding of the procedure, its outcomes, and its potential risks.

What Is Hepatic Arterial Injection?

Hepatic arterial injection is a medical procedure used to treat certain liver tumors. It involves inserting a thin catheter into the artery supplying the tumor to deliver treatment directly to it, with the aim of controlling tumor growth while minimizing the impact on healthy tissues as much as possible.

Is Hepatic Arterial Injection Considered Major Surgery?

No. Hepatic arterial injection is an interventional radiology procedure and usually does not require a large surgical incision or opening the abdomen. It is typically performed under local anesthesia, with sedation when necessary, depending on the patient's condition and the type of procedure.

How Long Does Hepatic Arterial Injection Take?

The duration of the procedure varies depending on the type of treatment, the anatomy of the arteries supplying the tumor, the number of tumors, and the complexity of the case. In general, the procedure may take anywhere from one hour to several hours.

Is Hepatic Arterial Injection Painful?

The patient may experience mild pain or a brief stinging sensation when the catheter is inserted. Abdominal pain or nausea may also occur after the procedure. The severity of these symptoms varies from person to person, depending on the type of treatment and the condition of the liver. The doctor can prescribe appropriate medications to relieve discomfort.

Does the Patient Need to Repeat Hepatic Arterial Injection?

Some patients may need to undergo the procedure more than once, depending on the tumor's response to treatment, the development of new tumors, liver function, and the results of imaging studies and follow-up examinations. The treating physician determines whether additional sessions are necessary based on an assessment of the patient's condition.

When Can the Patient Eat After Hepatic Arterial Injection?

The patient can resume eating when the medical team gives permission, after confirming that the patient's condition is stable, swallowing is safe, and there is no severe vomiting. If nausea occurs, it is preferable to start with small, light meals while following the medical team's dietary instructions after the procedure.

Can the Patient Drink Plenty of Water After Hepatic Arterial Injection?

Drinking an appropriate amount of fluids after the procedure is generally recommended to help the body eliminate the contrast dye used during catheterization, provided there are no medical contraindications. However, the patient should not excessively increase water intake without consulting the doctor, particularly if they have ascites, kidney or heart disease, or require fluid restriction.

When Can the Patient Return to Normal Life After Hepatic Arterial Injection?

Recovery time varies from one patient to another depending on the type of injection, overall health, liver function, and the severity of symptoms after the procedure. Some patients may be able to resume most daily activities within a few days, while others may need a week or longer to recover. A gradual return to normal activities is recommended in accordance with the doctor's instructions.

Are Fatigue, Fever, and Nausea Normal After Hepatic Arterial Injection?

Yes. After transarterial chemoembolization (TACE), patients may experience temporary symptoms such as fatigue, nausea, abdominal pain, and a mild fever. These symptoms usually improve gradually. However, a significantly elevated or persistent fever, or worsening pain, requires contacting the doctor to assess the condition and rule out possible complications.

Does the Patient Need a Special Diet After Hepatic Arterial Injection?

A balanced diet that provides adequate energy and protein is generally recommended. Eating small, frequent meals may help when nausea or poor appetite occurs. Patients with advanced liver cirrhosis or ascites may need to restrict salt intake or manage their fluid consumption according to their medical condition and the treating physician's recommendations.

Is Hepatic Arterial Injection a Dangerous Procedure?

Hepatic arterial injection is used to treat certain liver tumors and may achieve good results in appropriately selected patients. However, it is not without risks. Potential complications include deterioration of liver function, infection or abscess formation, and injury to blood vessels or nearby organs. The likelihood of these complications varies depending on the type of procedure, the severity of liver cirrhosis, and the patient's overall health.

What Signs Require Hospital Evaluation After Hepatic Arterial Injection?

Certain symptoms require urgent medical evaluation after the procedure. The most important warning signs include:
Severe or worsening abdominal pain.
A fever of 38°C (100.4°F) or higher, especially if it persists or is accompanied by chills.
Increasing yellowing of the skin or eyes (jaundice).
Confusion or unusual drowsiness.
Persistent vomiting or a significant decrease in urine output.
Persistent bleeding from the catheter insertion site.
These symptoms may indicate complications that require prompt medical attention and should not be ignored or managed at home without medical advice.

Does Hepatic Arterial Injection Affect Liver Function?

Yes. Hepatic arterial injection may cause a temporary increase in liver enzyme levels due to the effects of treatment on the liver tissue and tumor. In some cases, particularly in patients with advanced cirrhosis or pre-existing impaired liver function, more severe deterioration in liver function may occur.

For this reason, the doctor evaluates liver function before the procedure and monitors it afterward through appropriate blood tests and examinations.

Can a Liver Abscess Develop After Hepatic Arterial Injection?

Yes. A liver abscess may develop after hepatic arterial injection, although it is an uncommon complication. The risk may be higher in certain patients, particularly those with previous changes to the bile ducts or a history of biliary surgery or interventions.

Symptoms may appear several days or weeks after the procedure and include persistent fever, abdominal pain, chills, and severe fatigue. If these symptoms occur, the patient should seek medical evaluation to undergo the necessary tests and receive appropriate treatment.

Can a Tumor Return After Hepatic Arterial Injection?

Yes. A tumor may grow again, or new tumor lesions may develop in the liver after hepatic arterial treatment. This depends on the tumor's characteristics, its response to treatment, and the condition of the liver.

Regular follow-up with imaging studies and laboratory tests is essential to detect changes early. Some patients may require additional treatment sessions or alternative therapies, depending on the follow-up results.

Which Is Better: Conventional Transarterial Chemoembolization or Radioembolization?

There is no single technique that is best for every patient. The choice between conventional transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) depends on several factors, including:

Tumor size, location, and stage.

Liver function.

The condition of the blood vessels.

The patient's overall health.

However, the benefits depend on the nature of the symptoms and the tumor's response to treatment.

. Treating Certain Tumors That Are Difficult to Remove Surgically

Hepatic arterial injection may be an option for patients whose tumors cannot be surgically removed or whose health does not permit major surgery.

Suitability depends on tumor size, location, stage, liver function, and the patient's overall health.

. The Possibility of Repeating or Adjusting Treatment

In some cases, hepatic arterial treatment can be repeated, or another treatment approach can be considered based on imaging results, liver function, and the tumor's response.

The doctor determines the appropriate timing for any additional procedure to minimize risks and maximize potential benefits.

The medical team determines the most appropriate option after evaluating the patient's condition and treatment goals.

Does Radioembolization Cause Hair Loss?

Hair loss is not a typical side effect of selective internal radiation therapy, also known as transarterial radioembolization (TARE), because the treatment targets the blood vessels supplying the tumor within the liver.

However, patients may experience side effects such as fatigue, abdominal pain, and nausea. In some cases, radiation-induced injury to the liver or bile ducts may occur.

Does the Patient Need Isolation After Radioembolization (TARE)?

Most patients do not require prolonged home isolation after radioembolization. However, temporary radiation safety precautions may be necessary depending on the radioactive material used, the administered dose, and the specific treatment protocol.

Patients should follow the instructions provided by their treatment center regarding contact with other people and any precautions required after treatment.

How Can the Success of Hepatic Arterial Injection Be Confirmed?

Treatment success is evaluated using contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) at intervals determined by the doctor. Blood tumor markers may also help assess the response to treatment.

The evaluation focuses on how the tumor responds, including whether signs of tumor activity have disappeared or decreased. Improvement in symptoms alone is not sufficient to confirm treatment success.

When Do the Results of Hepatic Arterial Injection Appear?

The time required to evaluate treatment results varies depending on the technique used and the characteristics of the tumor. Follow-up imaging is generally performed several weeks after treatment, according to the doctor's plan.

After radioembolization (TARE), the response may take longer to become clearly visible on imaging because the effects of radiation and the resulting changes in the tumor can develop gradually.

Can Hepatic Arterial Injection Be Combined With Other Treatments?

Yes. In selected cases, hepatic arterial injection can be combined with other treatments, such as targeted drug therapy, immunotherapy, or other local treatments.

The choice and timing of each treatment depend on the tumor type and stage, liver function, and the patient's response to therapy. A multidisciplinary team involving oncologists, hepatologists, and interventional radiologists should determine the most appropriate treatment plan for each patient.

What Are the Benefits of Hepatic Arterial Injection for Liver Tumors?

Hepatic arterial injection is a treatment technique used for certain liver tumors, particularly primary liver cancer and some tumors that have spread to the liver. The technique delivers treatment through the artery supplying the tumor, helping target cancer cells while potentially reducing the effects of treatment on the rest of the body, depending on the procedure used and the patient's condition.

What Are the Main Benefits of Hepatic Arterial Injection for Liver Tumors?

1. Direct Delivery of Treatment to the Tumor

Hepatic arterial injection delivers treatment to the blood vessels supplying the tumor, allowing the therapy to be concentrated in the targeted area. Compared with some forms of intravenous chemotherapy, this approach may reduce exposure of the rest of the body to chemotherapy drugs.

2. Reducing the Tumor's Blood Supply

During transarterial chemoembolization (TACE), chemotherapy is combined with materials that help block the blood vessels supplying the tumor. This reduces blood flow to the tumor and helps limit its growth.

3. The Option of Targeted Internal Radiation Therapy

In transarterial radioembolization (TARE), tiny radioactive beads containing a substance such as yttrium-90 are delivered through the arteries to the targeted area of the liver. The aim is to deliver radiation to the tumor while limiting exposure of surrounding tissues.

4. Avoiding Open Surgery in Many Cases

Hepatic arterial injection is performed using a thin catheter, usually inserted through an artery in the groin or wrist and guided toward the vessels supplying the tumor using medical imaging.

As a result, the procedure generally does not require opening the abdomen, and recovery may be shorter than after major surgery.

5. Helping Control Tumor Growth

Hepatic arterial treatment may slow tumor growth or reduce tumor activity, depending on the treatment method, tumor characteristics, and response to therapy.

This can be particularly important for patients who are not suitable candidates for surgery or who need other local treatment options.

6. Potentially Reducing Tumor Size or Activity

Treatment may reduce tumor size or decrease its activity. The response is assessed through contrast-enhanced CT or MRI scans after treatment.

Not all patients respond in the same way, as outcomes vary according to tumor characteristics and liver function.

7. Integration Into a Comprehensive Treatment Plan

Hepatic arterial injection can form part of a broader treatment plan that includes systemic medications or other local therapies.

In selected cases, it may help prepare a patient for liver transplantation or surgical tumor removal, depending on the assessment of the multidisciplinary medical team.

8. Potential Relief of Certain Symptoms

Treatment may help relieve some tumor-related symptoms in selected patients, particularly when controlling tumor growth improves their condition.

Is Hepatic Arterial Injection the Best Option for All Patients With Liver Tumors?

No. The choice of treatment depends on the type, stage, size, and location of the tumor, the extent of disease spread, liver function, and the presence of cirrhosis or vascular problems. Therefore, each case must be evaluated individually to determine whether hepatic arterial treatment is appropriate or whether surgery, liver transplantation, systemic drug therapy, or other treatment options may be more suitable.

What Is the Difference Between Conventional Transarterial Chemoembolization and Radioembolization (TARE)?

Conventional transarterial chemoembolization (TACE) differs from radioembolization (TARE) in how liver tumors are targeted and how treatment works. TACE delivers chemotherapy to the tumor while reducing its blood supply, whereas TARE delivers radiation directly to the targeted area of the liver. Both procedures are performed using a thin catheter that reaches the arteries supplying the tumor.

First: Conventional Transarterial Chemoembolization (TACE)

Treatment used: A chemotherapy drug combined with a material that helps block the blood vessels supplying the tumor.
Mechanism of action: Chemotherapy is delivered to the tumor while its blood supply is reduced, helping limit tumor growth.
Side effects: These may include abdominal pain, nausea, vomiting, fatigue, and a temporary increase in body temperature.
Number of sessions: Patients may require repeated sessions depending on tumor response and liver function.

Second: Radioembolization With Radioactive Beads (TARE or Y-90)

Treatment used: Tiny radioactive beads, usually containing yttrium-90.
Mechanism of action: Radiation is delivered to the tumor through the arteries supplying it, with the aim of damaging cancer cells while limiting radiation exposure to surrounding tissues.
Side effects: These may include fatigue, abdominal pain, and nausea. Liver or bile duct complications may occur in some cases.
Number of sessions: One session may be sufficient to treat a specific area of the liver, while other cases may require additional sessions depending on the treatment plan.

What Is the Main Difference Between TACE and TARE?

The main difference is that TACE uses chemotherapy combined with reduced blood flow to the tumor, whereas TARE relies on targeted internal radiation.

Neither technique is universally superior. The choice depends on the tumor type, size, location, and stage, as well as liver function and the patient's overall health.

The medical team, including oncologists, hepatologists, and interventional radiologists, determines the most appropriate treatment to maximize potential benefits while minimizing risks.

What Are the Types of Hepatic Arterial Treatment?

Several arterial treatment techniques are used for liver tumors. The choice depends on the tumor's characteristics and the patient's condition.

1. Conventional Transarterial Chemoembolization (cTACE)

Chemotherapy is delivered locally, often using a carrier material such as lipiodol, followed by the blockage of tumor-feeding blood vessels using embolic materials.

2. Drug-Eluting Bead Transarterial Chemoembolization (DEB-TACE)

Tiny beads loaded with chemotherapy are delivered into the blood vessels supplying the tumor. These beads gradually release the drug while reducing blood flow to the tumor.

3. Transarterial Embolization Without Chemotherapy (TAE)

Materials are used to block the blood vessels supplying the tumor without adding a chemotherapy drug to the embolic material.

4. Selective Internal Radiation Therapy (TARE or Y-90)

Radioactive beads, usually containing yttrium-90, deliver radiation to the tumor through the hepatic arteries.

How Is Hepatic Arterial Injection Performed?

Most hepatic arterial procedures involve several basic stages.

Pre-procedure assessment: Liver and kidney function tests, a complete blood count, coagulation tests, and a review of CT or MRI scans are performed.
Catheter insertion: The insertion site, usually in the femoral artery in the groin or the radial artery in the wrist, is numbed before a thin catheter is inserted.
Angiographic imaging: X-ray imaging and contrast dye are used to identify the arteries supplying the tumor.
Treatment delivery: Chemotherapy, embolic materials, or radioactive beads are delivered according to the selected technique.
Post-procedure monitoring: The medical team monitors the patient's condition, pain, and catheter insertion site and arranges any necessary follow-up tests.

How Does the Doctor Choose the Appropriate Type of Treatment?

The choice depends on the tumor type, stage, size, number of lesions, extent of disease spread, and liver function.

TACE or DEB-TACE: These are treatment options for selected cases of hepatocellular carcinoma.
TAE: This may be used in specific cases when blocking blood vessels without chemotherapy is considered appropriate.
TARE or Y-90: This may be suitable for selected cases of primary liver cancer or tumors that have spread to the liver, depending on specialist assessment.

These techniques are not interchangeable alternatives for every patient. Selecting the most appropriate treatment requires an individualized assessment of the expected benefits, potential risks, and available alternatives.

Tips for Faster Recovery After Hepatic Arterial Injection

After hepatic arterial treatment, patients should follow medical instructions to support recovery, relieve side effects, and reduce the risk of complications. Recovery time varies according to the technique used, the patient's general health, and liver function.

First: Tips Before Hepatic Arterial Injection

Inform the doctor about all medications. Tell the doctor about every medication being taken, especially blood thinners and medications for diabetes or high blood pressure. Do not stop any medication without medical instructions.

Complete the required tests. These usually include liver and kidney function tests, a complete blood count, coagulation tests, and the necessary imaging studies.

Report any allergies. Inform the medical team about previous reactions to contrast dye or any history of kidney problems.

Follow pre-procedure instructions. Follow the instructions regarding fasting and medication use, and arrange suitable transportation home after the procedure.

Second: Tips During the First Few Hours After Treatment

Rest and avoid strenuous activity. Rest after the procedure and follow the medical team's instructions about when to sit up, stand, and walk.

Care for the catheter insertion site. If the catheter was inserted through the femoral artery, avoid bending or moving the affected leg until the medical team allows it. Monitor the insertion site for bleeding or swelling.

Drink fluids in moderation. Water and other fluids may be consumed when permitted by the doctor to help eliminate contrast dye, while taking into account any restrictions related to kidney disease, heart disease, or ascites.

Resume eating gradually. Start with light meals if nausea occurs, then gradually return to the usual diet as tolerated.

Take prescribed medications as directed. Use pain relievers and anti-nausea medications according to medical instructions. Avoid taking any additional medication without consulting the doctor.

Third: Tips During the First Week After Treatment

Follow a balanced diet. Eat varied meals containing sufficient protein and calories, while taking into account liver health and any dietary restrictions recommended by the doctor.

Get adequate sleep. Rest and sufficient sleep can help restore energy and reduce fatigue.

Avoid strenuous physical activity. Avoid heavy lifting and demanding activities until the doctor approves their resumption. Follow any additional restrictions related to the catheter insertion site.

Avoid alcohol. Alcohol should be avoided, particularly in patients with liver disease, because it can cause further liver damage.

Monitor symptoms. Abdominal pain, nausea, fatigue, or a mild temporary fever may occur. Contact the doctor if symptoms persist or become more severe.

Fourth: Tips During the First Month After Treatment

Return gradually to daily activities. Resume normal activities according to your recovery and the doctor's instructions, without rushing the process.

Take light walks. Gentle walking may help restore activity levels, provided the medical team approves it and no symptoms interfere with movement.

Temporarily avoid vigorous exercise. Delay strenuous exercise and heavy lifting until recovery is adequate and the doctor gives approval.

Follow the treatment plan. Take prescribed medications on schedule and do not change doses or discontinue treatment without consulting the doctor.

Attend follow-up appointments. The doctor will determine when liver and kidney function tests and imaging studies are needed, depending on the treatment method and the patient's condition. Follow-up imaging may take place after several weeks; it does not necessarily occur exactly one month after treatment in every case.

Fifth: When Should You Seek Immediate Medical Attention?

Urgent medical assessment is necessary if any of the following symptoms occur:

Severe or worsening abdominal pain.
A temperature of 38°C (100.4°F) or higher, especially if persistent or accompanied by chills.
Increasing yellowing of the skin or eyes.
Persistent vomiting or an inability to keep fluids down.
A significant decrease in urine output.
Persistent bleeding or increasing swelling at the catheter insertion site.
Confusion or unusual drowsiness.

What Are the Complications of Hepatic Arterial Injection?

Complications vary according to the type of procedure, its purpose, the patient's general health, and liver function before treatment. The term hepatic arterial injection may refer to transarterial chemoembolization (TACE), arterial embolization to block the blood vessels supplying a tumor, or other treatments performed through an arterial catheter.

First: Common and Temporary Side Effects

Some symptoms may develop after hepatic arterial treatment. These are often temporary and gradually improve.

Right upper abdominal pain: This may occur because of the effects of treatment on liver tissue.

Nausea, vomiting, and loss of appetite: These symptoms may develop during the first few days after the procedure.

Fever and fatigue: Patients may experience fever and tiredness for several days. These symptoms are commonly associated with post-embolization syndrome.

Temporary elevation of liver enzymes: This may occur as the liver tissue responds to treatment.

Pain or bruising at the catheter insertion site: The catheter is commonly inserted through the femoral artery in the groin or the radial artery at the wrist.

Second: Less Common Complications

Some complications require medical monitoring, particularly in patients with chronic liver disease or impaired liver function.

Deterioration of liver function: The risk is higher in patients with cirrhosis, particularly in advanced stages.

Gallbladder inflammation or reduced blood supply: This may occur if the treatment material affects the blood vessels supplying the gallbladder.

Gastritis, duodenitis, or ulcers: These complications may result from treatment material reaching blood vessels supplying the digestive tract.

Arterial injury or blood clot formation: Injury may occur to the blood vessel used for catheter insertion, or a hematoma may develop at the insertion site.

Infection or liver abscess: The risk may be higher in certain patients, particularly those with a history of biliary surgery or previous interventions involving the bile ducts.

Third: Serious and Rare Complications

Although uncommon, some complications can be serious and require urgent medical treatment.

Acute liver failure: This may occur if a substantial amount of liver tissue is damaged, particularly in patients with advanced cirrhosis or severely impaired liver function before treatment.

Liver abscess formation: This may cause fever, pain, and deterioration in the patient's overall condition.

Bile duct injury: This may interfere with bile drainage or lead to the formation of bile collections within the liver.

Pancreatitis: In rare cases, inflammation of the pancreas may occur if its blood supply is affected.

Gastrointestinal bleeding: This may be associated with stomach or duodenal ulcers caused by treatment material reaching unintended blood vessels.

Injury to nearby organs: This may occur if the injected material reaches arteries that are not intended targets of treatment.

Impaired kidney function: This may result from contrast dye used during catheterization, particularly in patients with pre-existing kidney disease.

When Should the Patient Go to the Hospital Immediately?

Patients who undergo hepatic arterial treatment should watch for symptoms that may indicate complications requiring urgent assessment, including:

Severe abdominal pain or a significant increase in pain.
A high or persistent fever, or fever that develops several days after the procedure.
New or worsening yellowing of the skin or eyes.
Persistent vomiting, vomiting blood, or passing black stools.
Severe dizziness or fainting.
Persistent bleeding from the catheter insertion site.
A significant decrease in urine output or changes in consciousness.

These warning signs require urgent medical assessment. Patients should not wait until their next scheduled follow-up appointment if they develop any of them.

Important Tips for Reducing the Risk of Complications

The risk of complications can be reduced through careful medical assessment before treatment and adherence to post-procedure instructions.

1. Consult a Specialist

Consult a hepatologist or an interventional radiologist to evaluate the patient's condition, determine whether hepatic arterial treatment is appropriate, and select the most suitable technique based on liver function and tumor characteristics.

2. Follow Post-Procedure Instructions

Follow medical instructions regarding rest, prescribed medications, and care of the catheter insertion site. Avoid strenuous physical activity for the period specified by the doctor.

3. Monitor Side Effects

Monitor your condition after treatment and watch for unusual symptoms, such as worsening pain, persistent fever, or jaundice. If warning signs develop, contact the doctor immediately or go to the hospital, depending on the severity of the symptoms.

4. Attend Regular Follow-Up Appointments

Regular testing helps assess treatment response and monitor liver and kidney function. Tests may include liver enzymes, bilirubin, and kidney function measurements, along with imaging studies scheduled according to the patient's condition.

5. Follow a Balanced Diet

Choose balanced, easily digestible meals and avoid foods that worsen nausea or digestive discomfort. There is no single diet suitable for every patient; nutritional recommendations should take liver function and individual needs into account.

6. Maintain Appropriate Hydration

Drinking appropriate amounts of fluid helps maintain the body's fluid balance and may support kidney function, particularly after contrast dye has been used. However, patients should follow their doctor's recommendations regarding fluid intake, especially if they have ascites, kidney disease, or heart disease.