A 60-year-old male undergoes transarterial chemoembolization (TACE) for hepatocellular carcinoma. Post-procedure, he develops severe abdominal pain, fever, and elevated liver enzymes, followed by signs of liver failure. Which of the following is the most serious and potentially life-threatening complication of TACE that could explain this presentation?

Explanation

While post-embolization syndrome (A) is common (fever, pain, nausea) and usually self-limiting, it typically does not lead to severe liver failure. Non-target embolization (B) to the gastroduodenal artery can cause complications like cholecystitis, pancreatitis, or gastric ulceration, but severe liver failure is less likely unless a major collateral to the liver is inadvertently occluded. Hepatic artery dissection (C) is a procedural complication that can lead to acute vessel occlusion but doesn't directly explain the subsequent fever, signs of infection, and liver failure. Liver infarction and subsequent abscess formation (D) is a severe and potentially life-threatening complication of TACE. It occurs due to excessive or complete occlusion of the hepatic arterial supply, leading to ischemic necrosis of liver parenchyma, which can then become superinfected, resulting in abscess formation and progressive liver failure, especially in patients with compromised liver function or portal vein thrombosis.