Review for 10.1186/s12876-025-04039-y (2025)

Title: Feasibility, Efficacy, and Safety of Ventral Caudal Artery Access for Transarterial
Chemoembolization in a Rat Hepatocellular Carcinoma Model
Version: 1 Date: 13 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The study does not provide specific numbers of animals used for each group, making it difficult
to assess whether the sample size is adequate to draw robust conclusions. Small sample sizes
can undermine the statistical power of the study and may lead to unreliable results.
-While the study provides a short-term safety evaluation (3 days post-procedure), it does not
include long-term follow-up. The long-term safety and any potential delayed complications
related to VCA access (e.g., vascular occlusion, infections, or necrosis) are not addressed, which
would be crucial for a more comprehensive understanding of the safety profile.
-The study does not explicitly mention whether the animals were randomly assigned to the
different treatment groups. Randomization is essential to minimize selection bias and ensure the
groups are comparable at baseline.
-While the rat model is appropriate for preclinical studies, the findings may not be directly
applicable to larger animal models, which may have different anatomical and physiological
characteristics. Further studies in larger animals or comparisons with other models (e.g., rabbits,
swine) would be helpful.
-While the tumor necrosis rate is evaluated, there is a lack of detailed information on the overall
tumor response to TACE. For example, data on tumor size reduction, survival rates, or other
measures of therapeutic efficacy would strengthen the conclusions about the effectiveness of
VCA access for TACE.
-The study does not compare the VCA approach with the clinically standard hepatic artery access
for TACE in humans. Although this might be outside the scope of the current study, a brief
discussion or reference to how VCA compares with standard clinical procedures would add
depth to the findings.
-While the study does mention the steps involved in the VCA access procedure, there is no
mention of any difficulties or complications encountered during the procedure, which could be
relevant for assessing the feasibility of VCA access in a preclinical setting.
-While the study mentions that tail artery flow was not quantitatively assessed (e.g., using
pulsed-wave and color Doppler ultrasound), this is a crucial oversight. Quantitative evaluation of
vascular function post-procedure would add valuable information, especially regarding potential
vascular damage or insufficient collateral circulation.
-While the study reports high success rates in catheterization, it doesn't provide much detail
about the instances where catheterization was unsuccessful or any challenges faced during the
process. This information could be important for understanding the limits of the VCA access
technique and potential complications.
-While the study compares VCA access to other techniques within the rat model, it doesn't
include comparisons to larger animal models, which may have more clinical relevance. It would
be helpful to discuss how the findings might translate to larger models like rabbits or swine,
which are more commonly used for interventional studies in preclinical settings.
-The study mentions that the DEB-TACE group had a significantly higher tumor necrosis rate
compared to the NS group, but does not provide other key efficacy data, such as tumor size
reduction or survival rates. These additional metrics could help strengthen the conclusions about
the therapeutic efficacy of VCA access for TACE.