Predisposing factors of bile duct injury after transcatheter arterial chemoembolization (TACE) for hepatic malignancy

The purpose of this study was to investigate the predisposing factors of bile duct injury after transcatheter arterial chemo-embolization (TACE) for treatment of hepatic malignancy. For patients (n = 31) with TACE-related bile duct injuries during a 36-month period, final diagnoses of the tumor, the liver profile, presence of portal vein thrombosis, total number and mode of the TACE just before the development of bile duct injury were compared, respectively with those of patients without bile duct injury (n = 234) after TACE. The incidence of bile duct injury was higher in the patients with non-hepatocellular tumors than in patients with hepatocellular carcinoma (p < 0.01), and higher in Child-Pugh class A patients than in B or C patients (p < 0.01). Segmental or subsegmental TACE tended to induce bile duct injury more frequently than the proximal TACE (p = 0.01). Portal vein thrombosis, the total number of TACEs, total amount of iodized oil, and the usage of gelatin sponge were not closely related to bile duct injuries after TACE (p > 0.05). It was concluded that the chance of bile duct injury after TACE is increased in non-cirrhotic livers with good liver profile and to the more selective embolization of distal arterial branches.