Transfemoral Versus Transradial Approach in Transarterial Chemoembolization of Hepatocellular Carcinoma

Inclusion Criteria: * Patients with Hepatocellular carcinoma of BCLC (Barcelona Clinic Liver Cancer) stage B * Also for BCLC stage A patients, in whom ablative therapy has technical limitations. * Downsizing tumor for resection or transplantation. Exclusion Criteria: * Factors related to liver cirrhosis: * Decompensated cirrhosis (Child-Pugh B and C, score \>8), including jaundice, clinical hepatic encephalopathy, and refractory ascites and/ or hepatorenal syndrome * Impaired portal-vein blood flow (portal-vein thrombus, hepatofugal blood flow) * Factors related to HCC: * Extensive tumor involving the entirety of both lobes of the liver * Malignant portal vein thrombosis * Extra-hepatic metastases * Impaired renal function: * Creatinine ≥2 mg/dl or creatinine clearance \<30 ml/min * Factors related to procedure (Radial artery access): * Existing AV (arteriovenous) fistula or graft * Pervious major surgery to forearm or wrist * Vasculitis * Pervious access failure * Skin infection or compromised integrity * Artery size \<2mm * Intolerance of hyperextended wrist positioning * Severe vasospasm * Vessel tortuosity * Radial loops * Absent or occluded radial artery * Atherosclerotic or calcific PAD (peripheral artery disease) * Coagulopathy INR\>1.5 platelets count \<50.000/mmc