Chemoembolization transcatheter arterial  (TACE) is a minimally invasive procedure performed in interventional radiology to restrict a tumor's blood supply. Small embolic particles  coated with chemotherapeutic agents are injected selectively into an artery directly supplying a tumor.

Therapeutic applications

1. Hepatocellular carcinoma
2. TACE  has also been used as an alternative to surgery for resectable early stage HCC and in patients with regional recurrence of the tumor after previous resection
3. TACE may also be used to downstage HCC in patients who exceed the Milan criteria for liver transplatation.
4. Neuroendocrine tumors
5. Ocular melanoma
6. Cholangiocarcinoma
7. Sarcoma
Transcatheter arterial chemoembolization plays a palliative role in patients with metastatic colon carcinoma. There is a possible benefit for liver-dominan metastases from other primary malignancies.

Procedure

TACE is an interventional radiology  procedure performed in the angiography suite. The procedure involves gaining percutaneous transarterial access by the Seldinger technique  to the hepatic artery with an arterial sheath, usually by puncturing the common femoral artery in the right groin and passing a catheter guided by a wire through the abdominal aorta, through the celiac trunk and common hepatic artery, and finally into the branch of the proper hepatic artery supplying the tumor.

When a blood vessel supplying tumor has been selected, alternating aliquots of the chemotherapy dose and of embolic particles, or particles containing the chemotherapy agent, are injected through the catheter. The total chemotherapeutic dose may be given in one vessel's distribution, or it may be divided among several vessels supplying the tumors.

The physician removes the catheter and access sheath, applying pressure to the entry site to prevent bleeding. The patient must lie stationary for several hours after the procedure to allow the punctured artery to heal. The patient will often be kept overnight for observation and will likely be discharged the following day. The procedure is normally followed up with a CT scan several weeks later to check the response of the tumor to the procedure.