Changes in Doppler parameters of portal pressure after interventional management of hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) has many options for management; some of them are complicated by development of portal hypertension (PHT). Doppler ultrasound is an effective method to diagnose and monitor PHT changes after HCC ablation procedures. The aim of this study is to investigate changes in portal pressure hemodynamics of HCC patients following treatment with different interventional strategies: radiofrequency ablation (RFA), microwave ablation (MWA), and transarterial chemoembolization (TACE). A total of 60 patients with HCC were divided into three main groups, and each group received a different type of therapy (RFA, MWA, and TACE). Full medical record and basic investigations were performed including Doppler ultrasound and upper GIT endoscopy for evaluation of PHT parameters, and then repeated after three months of ablation. RFA is associated with the increased splenic artery resistive index, while MWA has no significant impact on PHT indices. TACE has led to a marked increase in liver vascular index with significant decrease in hepatic artery resistive index and PHI after treatment. No significant changes in esophageal varices were observed by upper GIT endoscopy following all ablation methods. RFA is quite safe but associated with degree of PHT. On the contrary, TACE is associated with improved PHT parameters. MWA has no significant association to development of PHT following the technique. Doppler ultrasound could be used as a reliable and effective method of evaluation of PHT post ablation for HCC.

Fibroscan and Doppler Ultrasonography in the Assessment of Hepatocellular Carcinoma Interventional Therapy

“…The present results agree with those of El Sherbiny et al, 2016 who found no statistically significant changes concerning PHT parameters assessed by Doppler ultrasound in their HCC patients after MWA [16].…”

Heamodynamic Doppler changes in portal pressure after trans-arterial chemoembolization of hepatocellular carcinoma.

“…The vast majority of the HCC patients are diagnosed in the late stage thus aren't candidates for curative options that include liver transplantation and surgical resection [13].TACE is considered one of the treatment techniques that firstly recommended for intermediate-stage (Barcelona Clinic Liver Cancer (BCLC) B class) HCC yet has lower necrosis rates [14]. systematic review from 217 articles that had been published between 1980& 2013 revealed that post-embolization syndrome (that is manifested by fever, abdominal pain, in addition to ileus) was the common treatment-related side effect, appearing in 47.7% of patients treated with cTACE [15].There was a transient elevation in liver enzymes in 52% of patients, and the overall post-approach mortality rate was 0.6% [16]. Moreover, one of these risks is the development or the elevated degree of PHT after the ablative approach.…”

Correlation of baseline Portal pressure (hepatic venous pressure gradient) and Indocyanine Green Clearance Test With Post-transarterial Chemoembolization Acute Hepatic Failure

“…HCC has many options for interventional management; some of them are complicated by development of portal hypertension (PHT). 1 Percutaneous ablation remains the only curative option for this large group of patients with Child's A and B cirrhosis and single nodular-type HCC <5 cm or <3 HCC lesions, each smaller than 3 cm, not amenable to resection or transplantation, and RFA is one of the most popular local ablative therapies for inoperable HCC. Clinical implications of percutaneous radiofrequency ablation (RFA) in the treatment of early-stage HCC have expanded, and currently, RFA is recognized as a curative modality for early-stage HCC whose outcomes of which are comparable with those of surgery, as evidenced by many studies.…”

“…PHT may acutely increase the following procedures such as TACE for HCC, which adds to complications after these methods of intervention. 1,4 TACE can influence portal pressure by increasing portal blood flow compensatory to reduction of arterial blood flow after embolization. In fact, increased arterial inflow from the left gastric artery into esophageal varices has been reported.…”