Transarterial Ethanol Ablation of Cirrhotic Liver with Lipiodol-Ethanol Mixture Safety and Efficacy Study in Rats

Simon C. H. Yu and Charles T. P. Chan


Purpose: The intra-arterial administration of lipiodol-ethanol mixture (LEM, mixed in 4:1 by volume) through the hepatic artery is known to produce dual hepatic-arterial and portal-venous embolization that could be a potent treatment of hepatocellular carcinoma. The aim of this animal experiment was to study the effectiveness and safety of such transarterial ethanol ablation in cirrhotic livers. 

Methods: The study model consisted of a control group of 6 normal rats and a study group of 6 cirrhotic rats. LEM was infused intra-arterially into the right lobe of all 12 rats after selective catheterization under microscopic observation. LEM distribution within the hepatic vasculature, liver function tests, change in liver volume, and histology of the embolized lobe were studied.

Results: The radiographs showed peripheral distribution of LEM within the portal venule in the right lobe of all rats. There was a marked reduction in the volume of right lobe 14 days after LEM, with an average reduction of 63.4 ± 16.9% and 59.4 ± 20.6% observed in the control group and study group, respectively. The difference between the 2 groups was not statistically significant. Before LEM treatment, there was a difference between the 2 groups (P = 0.002) regarding the plasma level of albumin and bilirubin, indicating that the blood test was sensitive enough to differentiate the liver function status between the normal rats and cirrhotic rats. On day 14, there was no difference between the 2 groups in plasma albumin, bilirubin, and ALT levels (P = 0.065, 0.818, 0.589), indicating almost equal extent of hepatic reaction towards LEM administration in normal and cirrhotic rats. On day 14, histologic study showed complete vascular infarction in 90% to 100% of the right lobe in both groups.

Conclusion: Intraarterial ethanol ablation with LEM is equally effective in causing infarction of hepatic tissue in both normal and cirrhotic liver; it can be tolerated with equal safety by both normal and cirrhotic rats in this animal experiment.