A patient with unresectable hepatocellular carcinoma undergoes Transarterial Chemoembolisation (TACE). The rationale for selective hepatic arterial embolisation in HCC is based on which vascular principle?

• A HCC is supplied predominantly by the portal vein; portal embolisation starves the tumour
• B HCC is avascular and TACE delivers chemotherapy by direct diffusion
• C HCC has dense hepatic venous drainage that is targeted by TACE
• D HCC derives >80% of its blood supply from the hepatic artery, while normal liver receives 75% from the portal vein — arterial embolisation targets tumour preferentially ✓

Explanation

Normal hepatic parenchyma receives approximately 75% of its blood supply from the portal vein and 25% from the hepatic artery. In contrast, HCC is parasitised by hepatic arterial neovascularisation and derives >80–90% of its blood supply from the hepatic artery. This arteriovenous imbalance is the physiological basis for TACE: selective hepatic arterial embolisation preferentially ischaemises the tumour while largely sparing the surrounding liver parenchyma. The lipiodol-chemotherapy mixture is retained selectively in hypervascular HCC.

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

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Written and medically reviewed by the StethoPrep medical team.