Imaging Diagnosis and Interventional Treatment for Hepatocellular Carcinoma Combined with Arteriovenous Fistula

Abstract

In order to explore the imaging diagnosis methods and interventional treatment effects of hepatocellular carcinoma combined with hepatic arteriovenous fistula (HAVF), a total of 120 patients, who were diagnosed as hepatic carcinoma with arteriovenous shunting and underwent medical imaging diagnosis and interventional surgery therapy at a designated hospital by this study from December 2014 to December 2018, were chosen as study subjects. Digital subtraction angiography was performed to analyze the imaging features of hepatocellular carcinoma combined with HAVF in each patient; then, according to these imaging diagnosis results, gelatin sponge or coil was used to block the fistula; mitomycin, carboplatin powder, and lipiodol mixed emulsion was combined or separately utilized for hepatic tumor embolization, in which iodized oil embolization chemotherapy was used for patients with mild paralysis; gelatin sponge granule embolization chemotherapy was used for moderate paralysis patients at their first intervention, and, after about 1 month, if the sputum disappeared, iodized oil embolization was used again; and hepatic arterial infusion chemotherapy was used only for patients with severe paralysis. The results show that the central type of HAVF is characterized by early angiography of portal vein and large branches and tumor staining after portal vein’s angiography; the peripheral type of HAVF is characterized by portal vein branching in hepatic tumor and double rail sign accompanied by the arterial branch; 112 cases of patients completed embolization chemotherapy; 8 cases of patients only received chemotherapy perfusion; in 109 cases of patients sputum disappeared or shunt decreased at first treatment; and in 113 cases of patients iodine oil was well deposited or the tumor was stably reduced; most of the symptoms of refractory ascites, diarrhea, and upper gastrointestinal bleeding were controlled or improved, and there were no complications such as pulmonary embolism and hepatic failure. Therefore, HAVF increases the difficulty of interventional therapy, but, as long as the positive and appropriate treatment measures are taken, it can still achieve better curative effect without serious complications, which can effectively alleviate the clinical symptoms of patients and improve the quality of life of patients. The results of this study provide a reference for the further researches on imaging diagnosis and interventional treatment for hepatocellular carcinoma combined with arteriovenous fistula.

Imaging biomarkers on Angio-CT for predicting the efficacy of transarterial chemoembolization in hepatocellular carcinoma

“…These hepatic arteriovenous fistulas are usually small in diameter or do not open naturally. However, it will open when injecting the high-pressure syringe into the contrast medium (28).…”

Congenital hepatoblastoma presenting with hepatic arteriovenous fistulas: a case report

“…Meanwhile, enhanced CT and digital subtraction angiography (DSA) were performed to confirm the diagnosis. The current main treatment options for HAVF include interventional embolization, hepatic artery ligation, and hepatic lobectomy ( 7 ). Interventional embolization has the advantages of short hospitalization time and rapid recovery.…”

“…The relationship between the two diseases must be considered, and on the basis of monism, we hypothesized that hepatoblastoma led to the development of HAVF. First, HAVF is common in primary hepatocellular carcinoma with an advanced stage, frequently involving the hepatic venous and/or portal venous system ( 7 ). Hepatoblastoma is also a highly aggressive tumor that can cause vascular invasion ( 16 ).…”

Retrograde venous coil embolization prior to transarterial chemoembolization in hepatocellular carcinoma with arterio-hepatic venous shunts

“…The formation of AHVS appears to occur due to liver damage, 16 cirrhosis, 17 and tumor invasion of blood vessels; 18 tumor invasion of blood vessels is the most common cause of intrahepatic arteriovenous shunts. The formation of these shunts is related primarily to the tumor size, biological characteristics of the hepatic malignancy, and associated vascular invasion.…”