Double Balloon-Occluded Transarterial Chemoembolization (Double B-TACE) for Hepatocellular Carcinomas Located in the Caudate Lobe

  • Shigeyoshi SogaEmail author
  • Hiroshi Kuwamura
  • Hiromi Edo
  • Yohsuke Suyama
  • Fumiko Hamabe
  • Hiroaki Sugiura
  • Takahiro Einama
  • Hiroshi Shinmoto
Letter to the Editor

To the Editor,

Superselective micro-catheter insertion is necessary for enhancing the therapeutic effect of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) [1]. However, individual selection of tumor-feeders with micro-catheters can be impossible, especially when the branches are very small or tortuous [2]. Moreover, TACE in the caudate lobe is challenging owing to its location and complex vascular supply [2, 3]. We report a novel double-balloon technique for TACE of difficult-to-treat HCCs supplied by an unselectable artery.

An 86-year-old man with a history of extended right hepatectomy for HCC was referred for treating recurrent HCC. TACE was planned for two HCCs in the caudate lobe (Fig.  1). Because of the small residual liver volume, superselective TACE was necessary to avoid hepatic failure.


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standard of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was provided by the patient.

Consent for Publication

Consent for publication was obtained for every individual person’s data included in the study.


  1. 1.
    Miyayama S, Matsui O, Yamashiro M, Ryu Y, Kaito K, Ozaki K, et al. Ultraselective transcatheter arterial chemoembolization with a 2-f tip microcatheter for small hepatocellular carcinomas: relationship between local tumor recurrence and visualization of the portal vein with iodized oil. J Vasc Interv Radiol. 2007;18(3):365–76.CrossRefGoogle Scholar
  2. 2.
    Kim H-C, Miyayama S, Chung JW. Selective chemoembolization of caudate lobe hepatocellular carcinoma: anatomy and procedural techniques. RadioGraphics. 2019;39(1):289–302.CrossRefGoogle Scholar
  3. 3.
    Yu WB, Rao A, Vu V, Xu L, Rao JY, Wu JX. Management of centrally located hepatocellular carcinoma: update 2016. World J Hepatol. 2017;9(13):627–34.CrossRefGoogle Scholar
  4. 4.
    Shimohira M, Ogino H, Kawai T, Sakurai K, Nakagawa M, Shibamoto Y. Clinical usefulness of the triaxial system in super-selective transcatheter arterial chemoembolization for hepatocellular carcinoma. Acta Radiol. 2012;53(8):857–61.CrossRefGoogle Scholar
  5. 5.
    Irie T, Kuramochi M, Takahashi N. Dense accumulation of lipiodol emulsion in hepatocellular carcinoma nodule during selective balloon-occluded transarterial chemoembolization: measurement of balloon-occluded arterial stump pressure. Cardiovasc Interv Radiol. 2013;36(3):706–13.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  1. 1.Department of RadiologyNational Defense Medical CollegeTokorozawaJapan
  2. 2.Department of SurgeryNational Defense Medical CollegeTokorozawaJapan

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