Surreal image of a liver with reversed river flow

Liver Cancer Treatment: Is Retrograde Portal Vein Flow a Red Flag?

Theo Raines in Health & Wellness August 2025 • 4 min read.

"Decoding the Impact of Portal Vein Flow on TACE Outcomes in Hepatocellular Carcinoma Patients"

Hepatocellular carcinoma (HCC), the most common type of liver cancer, poses a significant global health challenge. Often diagnosed at advanced stages, HCC requires complex treatment strategies. Transarterial chemoembolization (TACE) has emerged as a primary treatment for intermediate-stage HCC, offering a lifeline to many. But what happens when the liver's natural blood flow is disrupted?

The liver receives blood from two major vessels: the hepatic artery and the portal vein. The portal vein is responsible for around 75% of the liver's blood supply, carrying nutrient-rich blood from the digestive system. When this flow is reversed, known as retrograde portal vein flow, it can signal severe portal hypertension and advanced liver disease. This reversal can complicate HCC treatment, potentially impacting the effectiveness of TACE.

A new study published in the Scandinavian Journal of Gastroenterology investigates whether retrograde portal vein flow affects the outcomes of TACE in HCC patients. The study aims to determine if TACE in patients with reversed portal vein flow leads to a greater decline in liver function and poorer survival rates compared to those with normal (orthograde) flow. By understanding these dynamics, medical professionals can better tailor treatment approaches, especially in borderline cases.

Unpacking the Study: TACE and Portal Vein Flow

Surreal image of a liver with reversed river flow

Researchers at Hannover Medical School in Germany conducted a retrospective analysis of 407 HCC patients treated with TACE. These patients had undergone Doppler ultrasound to assess portal vein flow before treatment. The study divided participants into two groups: those with normal (orthograde) portal vein flow and those with reversed (retrograde) flow. The goal was to compare overall survival (OS) and changes in liver function between the groups.

The study found that patients with retrograde portal vein flow often had more advanced liver cirrhosis and hepatic dysfunction. Specifically, 93.5% of patients with retrograde flow had liver cirrhosis, compared to 72.7% in the orthograde group. The median overall survival was 12 months in the retrograde group and 19 months in the orthograde group.

Significantly more often liver cirrhosis.
Advanced hepatic dysfunction.
Retrograde PV flow group had a median survival of 12 months vs 19 in the orthograde group.

Following the data, the patients with reversed flow showed a trend toward shorter survival, particularly when matched for cirrhosis and liver function scores. However, the degree of liver function deterioration after repeated TACE treatments was similar in both groups. The results suggest that while retrograde portal vein flow alone may not be a definitive prognostic marker, it identifies a subgroup of patients with advanced liver disease who may experience poorer outcomes with TACE.

Clinical Implications and Future Directions

The study highlights the importance of assessing portal vein flow before TACE treatment in HCC patients, especially for those with advanced liver disease. While retrograde portal vein flow alone does not contraindicate TACE, it serves as a signal for caution and may warrant a more individualized treatment plan. Further research, including larger prospective studies, could refine our understanding of the interplay between portal hemodynamics and TACE outcomes. By identifying patients at higher risk, clinicians can explore alternative or adjunctive therapies to improve survival and quality of life. This personalized approach promises to optimize outcomes and enhance the care for those battling this challenging cancer.

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This article is based on research published under:

DOI-LINK: 10.1080/00365521.2017.1370008, Alternate LINK

Title: Retrograde Portal Vein Flow And Transarterial Chemoembolization In Patients With Hepatocellular Carcinoma – A Case–Control Study

Subject: Gastroenterology

Journal: Scandinavian Journal of Gastroenterology

Publisher: Informa UK Limited

Authors: Martha M. Kirstein, Torsten Voigtländer, Nora Schweitzer, Michael Gebel, Jan B. Hinrichs, Thomas Rodt, Michael P. Manns, Frank Wacker, Andrej Potthoff, Arndt Vogel

Published: 2017-08-28

Everything You Need To Know

What is hepatocellular carcinoma (HCC), and how is transarterial chemoembolization (TACE) used in its treatment?

Hepatocellular carcinoma, or HCC, is the most common form of liver cancer and often presents at advanced stages, necessitating complex treatment strategies. Transarterial chemoembolization, commonly known as TACE, is frequently used as a primary treatment for intermediate-stage HCC, providing a way to manage the disease. However, the effectiveness of TACE can be influenced by factors such as disruptions in the liver's normal blood flow, which can affect treatment outcomes.

What does retrograde portal vein flow mean, and why is it important in the context of liver cancer treatment?

Retrograde portal vein flow refers to the reversal of blood flow in the portal vein, which normally carries nutrient-rich blood from the digestive system to the liver. This reversal is often indicative of severe portal hypertension and advanced liver disease, potentially complicating treatments like TACE. The presence of retrograde portal vein flow can impact the liver's ability to function properly and may affect the outcomes of cancer treatments.

What were the key findings of the study regarding retrograde portal vein flow and TACE outcomes in hepatocellular carcinoma patients?

The study revealed that patients with retrograde portal vein flow often presented with more advanced liver cirrhosis and hepatic dysfunction. Specifically, a significant majority of patients with retrograde flow had liver cirrhosis compared to those with normal flow. Additionally, the median overall survival was shorter in the retrograde flow group, suggesting that reversed flow identifies a subgroup of patients with advanced liver disease who may experience poorer outcomes with TACE. These findings underscore the importance of assessing portal vein flow before initiating TACE.

If a patient has retrograde portal vein flow, does this mean they cannot receive TACE, and how should their treatment plan be adjusted?

While retrograde portal vein flow may not completely prevent the use of TACE, it acts as a signal for caution. Clinicians might consider more individualized treatment plans for these patients, potentially incorporating alternative or adjunctive therapies to improve survival and quality of life. The assessment of portal vein flow helps identify patients at higher risk, allowing for a more tailored approach to treatment.

What are the next steps in researching the connection between portal hemodynamics and TACE outcomes, and what potential benefits could these studies bring?

Future research should focus on larger, prospective studies to further understand the relationship between portal hemodynamics and TACE outcomes. By refining our understanding, clinicians can better identify patients at higher risk and explore alternative or adjunctive therapies to improve survival and quality of life. This personalized approach promises to optimize outcomes and enhance the care for individuals battling this challenging cancer. Investigating the efficacy of combining TACE with other treatments, such as targeted therapies or immunotherapy, in patients with retrograde portal vein flow could also provide valuable insights.