A 65-year-old man with hepatocellular carcinoma unsuitable for surgery undergoes transarterial chemoembolization (TACE). The rationale for using the hepatic artery route for this procedure is based on the fact that:

• A The portal vein is too small to cannulate selectively
• B The hepatic artery carries chemotherapy more efficiently due to higher velocity
• C HCC derives its blood supply predominantly from the hepatic artery, while normal hepatocytes rely mainly on portal venous blood ✓
• D Portal vein embolization causes fewer complications than arterial embolization

Explanation

Normal liver parenchyma receives approximately 75-80% of its blood supply from the portal vein and only 20-25% from the hepatic artery. HCC, however, is almost exclusively supplied by the hepatic artery due to tumor neovascularization from arterial branches. This differential blood supply is the physiological basis for TACE: selective intra-arterial delivery of chemotherapy (doxorubicin) mixed with lipiodol (which is retained by tumor cells) followed by embolic agents preferentially ischemic the tumor while relatively sparing the surrounding liver. This results in high local drug concentrations and ischemic necrosis.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.