Initial experience of transcatheter arterial chemoembolization during portal vein occlusion for unresectable hepatocellular carcinoma with marked arterioportal shunts

Abstract

The purpose of this study was to assess the clinical effects of transcatheter arterial chemoembolization (TACE) during the corresponding portal vein occlusion (TACE-PVO) in patients with hepatocellular carcinoma (HCC) and marked arterioportal (AP) shunts. This was a prospective, nonrandomized study of TACE-PVO in patients with HCC who had marked AP shunts. The subjects were 21 patients with unresectable HCC and marked AP shunts who underwent shunt embolization with the use of coils and/or gelatin-sponge particles (group A: n = 7) or by TACE-PVO (group B: n = 14). Clinical parameters and data on embolization of AP shunts and on tumor response were assessed prospectively. No major procedure-related complication occurred in either group. Effectiveness of AP-shunt treatment was significantly better in group B than in group A in terms of both immediate results (P = 0.009) and subsequent results (P = 0.028). Tumor response in the therapeutic target area was significantly (P = 0.002) better in group B than in group A. Survival was significantly better in group B than in group A (P = 0.008). TACE-PVO may be a safe and useful therapy for selected patients with unresectable HCC and marked AP shunts.

Cholangiocytes of Cirrhotic Rats are More Tolerant to Ischemia than Normal Rats: A Role for Abnormal Hepatic Arteriovenous Communications?

“…This difference in response to ischemia prompts us to recognize whether the cholangiocytes of cirrhotic liver are more tolerant to ischemia of bile duct than normal liver. We cannot ignore that patients with hepatocellular carcinoma can develop arterioportal fistulas, as demonstrated by color Doppler ultrasonography, DSA, and CT [6,7], which play a protective role after hepatic artery embolization [8]. However, it is not clear whether the abnormal existence of communicating branches between the arterial and venous systems is the reason for this difference.…”

Fluctuating portal velocity tracing with rhythmicity: ultrasonic differential diagnosis and clinical significance

“…APF can be congenital, post-traumatic, iatrogenic (trans-hepatic intervention or biopsy), neo-plastic, or related to ruptured hepatic artery aneurysms 7,19–22. Trauma and neoplasm are the most common causes of APF 7.…”

“…The transvenous approach can be considered and used when there are multiple arteriovenous fistulas, or when embolisation via the trans-arterial approach is technically unsuccessful. Closure by embolisation with Gelfoam, steel coils, detachable balloons, n-butyl cyanoacrylate, or bucrylate has proven to be feasible 2,7,19,22,29. The choice of embolic agent should be based on the underlying mechanism of the shunts and their angio-architecture.…”

Pulmonary Lipiodol Embolism after Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

“…Embolization of AV shunting with polyvinyl alcohol, gelatine sponges, or coils may be an alternative strategy. 7,8 However, if AV shunting is refractory and severe after above-mentioned strategies, TACE is contraindicated.…”