Hepatic failure, either transient or irreversible, related to regional chemotherapy treatment with floxuridine (FUDR) is rare in the modern era. Liver damage related to biliary toxicity or hepatocellular injury are both possible side effects of FUDR; however, permanent damage related to the latter is uncommon as long as appropriate dosing protocols are followed. When it does occur, hepatocellular injury related to FUDR is most often asymptomatic and therefore detected by elevations in serum transaminase levels. Catheter-related hepatic arterial thrombosis is another potential cause of acute liver injury, and this incidence is historically reported around 6%, though such an event rarely results in acute hepatic failure.