Objective: Rupture of hepatocellular carcinoma (HCC) following transarterial embolization/chemoembolization (TAE/TACE) is a rare but life-threatening complication. The aim of the study was to explore the incidence, risk factors, clinical characteristics, treatment, and outcomes of this complication. Methods: We described two cases and reviewed all cases of ruptured HCC after TAE/TACE reported in the literature. Results: Our search yielded 32 cases of ruptured HCC after TAE/TACE. The overall incidences were 0.45% per patient and 0.21% per session. The mean age of the patients was 57.4 years (range 28-90 years, n=26, No. of cases with available information). Males accounted for 81% of cases (21/26). The 50% of the cases had histories of primary hypertension, diabetes or peripheral artery disease (6/12). Mean diameter of the tumors was 11.4 cm (range 3-20 cm, n=27). The 100% of cases had superficial or exophytic tumors (23/23). Portal vein thrombosis was presented in 61.5% of patients (8/13). The median interval between TAE/TACE and rupture was 2 days (range 0 hour-30 days, n=31). Management choices included emergency TAE, surgery, and conservative treatment. The overall median survival time was 7 days (n=19). Conclusion: Rupture of HCC following TAE/TACE is relatively rare but potentially life-threatening. The management is difficult and prognosis is poor. Large tumor size, superficial or exophytic tumors as well as portal vein thrombosis and comorbidities such as primary hypertension, diabetes or peripheral artery disease may be predisposing factors for rupture.
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