ARTERIOVENOUS SHUNTING IN HEPATOCELLULAR-CARCINOMA - ITS PREVALENCE AND CLINICAL-SIGNIFICANCE

Arteriovenous shunting has been reported in hepatocellular carcinoma ( HCC) and is a recognized contraindication to treatment by transcathete r arterial chemoembolization. This study aims to determine the prevale nce of arteriovenous shunting in patients presenting with HCC and the development of shunts in those with inoperable HCC being treated with repeated chemoembolization. In a group of 292 Chinese patients (251 me n, 41 women; mean age 54.7 years) presenting with HCC, hepatic angiogr ams demonstrated arteriovenous shunting in 91 cases (31.2%); shunting into the portal vein was observed in 84 (28.8%) and shunting into the hepatic vein in seven (2.4%). The hepatic angiograms of a separate gro up of 171 Chinese patients (144 men, 27 women: mean age 55.4 years) un dergoing chemoembolization for inoperable HCC were analysed. Arteriove nous shunting developed during treatment in 20 patients (11.7%). Of th ese 20 patients, one had shunting into the hepatic vein while 19 (11.1 %) had arterioportal shunting. Arteriovenous shunting occurred through the tumour or portal vein tumour thrombus in 13 patients, and occurre d at sites remote from the tumour in the other seven patients. Shuntin g disappeared on repeat angiograms in three patients. Various postulat ed mechanisms responsible for arteriovenous shunting in HCC are review ed, The recognition of development of arteriovenous shunting during ch emoembolization of HCC is important as it has a direct bearing on pati ent management and prognosis.