Background: Transcatheter arterial chemoembolization (TACE) has been widely used for the treatment of the unresectable hepatocellular carcinoma (HCC). Extrahepatic collateral arteries (ECAs) that supply to HCCs often develop in such cases as interruption of hepatic artery by repeated TACE. However TACE for HCCs supplied by ECAs is an effective option, it sometimes induces major complications such as skin necrosis, nerve injury and gastrointestinal perforation. To avoid these complications in the treatments of TACE via ECAs is very important to maintain the quality of life in the patients with advanced malignant liver tumors. So it is desirable to predict the embolized area and to prevent the complication in the treatments of TACE via ECAs. The topic of this case presentation is whether the computed tomography during extrahepatic collateral arteriography (CTECA), especially from the catheter position that we intend to perform embolization, is effective or not to obtain the good therapeutic effect and to avoid the major complications from this case presentation.

Methods: The patient had recurred HCC located at the ventricle surface of the lateral segment of the liver, which size was 3 cm in diameter. The tumor was fed by left internal thoracic (LITA) artery. Firstly we advanced microcatheter into the deep portion of LITA and performed CTECA to predict the emobolized area.
CTECA showed not only the tumor stain but also the anterior chest wall. We advanced the microcatheter into the deeper portion of LITA and once again we confirmed the embolized area with CTECA. This CTECA showed only the tumor stain and no extrahepatic stain including the anterior chest wall.

Results: So we actually perfomed TACE using iodized oil mixed with anticancer agent and gelatine sponge particles. After TACE, we obtained the good local control and did not find any skin complications.

Conclusions: CTECA might be very useful to adopt the better treatment and reduce the severe complication related to TACE via ECAs.