HEPATOCELLULAR-CARCINOMA WITH PORTAL-VEIN TUMOR THROMBUS - EMBOLIZATION OF ARTERIOPORTAL SHUNTS

PURPOSE: To evaluate transcatheter arterial embolization in patients w ith hepatocellular carcinoma, portal vein tumor thrombus, and arteriop ortal shunts. MATERIALS AND METHODS: Ten patients with hepatocellular carcinoma, portal vein tumor thrombus, and severe arterioportal shunti ng were identified; in these patients, portal blood now before emboliz ation was hepatofugal. Embolization of arterioportal shunts was perfor med with steel coils that were introduced through a catheter during ar teriography. After embolization, changes in portal hemodynamics and cl inical signs and performance status of patients were evaluated; surviv al rates of patients with and patients without severe arterioportal sh unting were compared. RESULTS: In all patients after embolization, ang iography showed resolution of arterioportal shunting, and portography showed hepatopetal blood now in the portal vein trunk. After embolizat ion, performance status of five patients with initial scores of 2 or 3 improved. Ascites resolved in four patients and improved in four pati ents. One patient died of hepatic failure caused by rupture of esophag eal varices 7 days after embolization. Median survival was 4.3 months, and the 6-month and 1-year survival rates were 45% and 12%, respectiv ely. There were no significant differences between survival rates in p atients with and patients without severe arterioportal shunting. CONCL USION: Transcatheter arterial embolization of arterioportal shunts is a useful treatment for improving quality of life in patients with hepa tocellular carcinoma.