Trans arterial embolisation (TAE)

Trans arterial embolisation means having a substance such as a gel or tiny beads to block the blood supply to the liver NET. It is also called hepatic artery embolisation.

You might have it as a treatment for a neuroendocrine tumour (NET) that has spread to the liver.

How TAE works

TAE works by reducing the blood supply to the liver tumour. The blood supply brings oxygen and nutrients that cells need to survive and grow. Blocking the blood supply also stops the NET releasing its hormones into the bloodstream. 

Doctors may only block the blood supply to the liver or also give a chemotherapy drug to the liver at the same time. This is called trans arterial chemoembolisation (TACE).

When you might have TAE

You might have TAE if the NET has spread to the liver and:

• you can’t have surgery to remove the liver tumour
• other treatments have not controlled your symptoms
• the NET is making a lot of hormones

TAE can help to reduce the size of the NET in the liver. It can also reduce the amount of hormones the tumour makes. This won’t get rid of the cancer but can control the symptoms and help you feel better. 

In some cases, TAE might shrink a tumour so that surgery is possible. You might have TAE more than once. 

How you have TAE

Before TAE

You usually can’t eat for 4 to 6 hours before having treatment. This is because you might have a drug that makes you sleepy (sedation). You can usually drink water up to 2 hours beforehand. 

You also have a drug called octreotide as a drip into a vein for 8 to 12 hours before the start of treatment. This is to prevent a carcinoid crisis which can happen when people with NETs have sedation. 

Having TAE

You usually have the treatment in the x-ray (radiology) department. It takes up to an hour and a half. 

A specialist doctor called an interventional radiologist does the treatment. A nurse will also be with you in the room. 

First you get changed into a hospital gown. You lie on your back on the x-ray table. Your doctor or nurse puts a small tube (cannula) into your arm or back of your hand. They use this to give you sedation and other drugs you might need, such as anti sickness. Your nurse regularly checks your heart rate and blood pressure. They may give you some oxygen to breathe as well. 

Your doctor cleans the area at the top of your leg (groin) and injects a local anaesthetic to numb the area. They make a small cut and put a long tube called a catheter into one of the blood vessels (femoral artery). They then thread the catheter along the artery until it reaches the hepatic artery that supplies blood to the liver.  

They inject a type of dye that shows up on x-rays (contrast medium). You might have a warm sensation through your body for a few seconds. This is normal. 

Your doctor takes a series of x-rays which show the blood vessels that feed the tumour in the liver. They inject the substance they use to block the blood vessels.

After TAE

Your radiologist removes the catheter and puts a pressure dressing onto the site in your groin. You need to stay lying down for about 4 to 6 hours afterwards. Your nurse checks the site for bleeding before you get up. 

You can usually eat and drink as normal after the test. Drink plenty afterwards to help flush the dye out of your body. 

You usually stay in hospital for a night or two.

Side effects

TAE can cause side effects. These include:

• feeling or being sick
• pain in your tummy (abdomen)
• high temperature

These side effects are called post embolisation syndrome and are common. They usually last for 2 to 3 days. Your doctor will give you painkillers and anti sickness drugs to help with this. 

Tiredness is also a common side effect of TAE and can last for a couple of weeks. 

Other side effects include:

• a small bruise where the catheter was put in
• infection – you might need antibiotics through a drip
• damage to the blood vessel by the catheter – this is very rare
• leakage of the contrast medium out of the blood vessels
• an allergic reaction to the contrast medium

Rarely, TAE can cause liver failure. Because of this you usually won’t be able to have TAE if you have moderate or severe liver damage (cirrhosis). 

Contact the hospital if you have an increase in pain and get a temperature when you are at home.

Coping

Treatment for neuroendocrine tumours can be difficult to cope with for some people. Your nurse will give you phone numbers to call if you have any problems at home.