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Polyvinyl alcohol embolization adjuvant to oily chemoembolization in advanced hepatocellular carcinoma with arterioportal shunts.

Kim YJ, Lee HG, Park JM, Lim YS, Chung MH, Sung MS, Yoo WJ, Lim HW - Korean J Radiol (2007 Jul-Aug)

Bottom Line: In group A, APS grade was improved in eight patients and five of six patients with hepatofugal flow showed restored hepatopetal flow postoperatively.The mean and median survival time all study subjects was 280 days and 162 days.P-TACE is feasible and safe in advanced HCC patients with APS.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Holy Family Hospital, College of Medicine, The Catholic University of Korea, Kyungki-Do 420-717, Korea.

ABSTRACT

Objective: To assess the feasibility and safety of polyvinyl alcohol (PVA) embolization adjuvant to transarterial oily chemoembolization (P-TACE) in advanced hepatocellular carcinoma (HCC) with arterioportal shunts (APS).

Materials and methods: Nineteen patients who underwent PVA embolization for APS before a routine chemoembolization (TACE) procedure were retrospectively reviewed. 10 of these 19 patients underwent follow-up TACE or P-TACE after P-TACE (Group A), but nine patients underwent only initial P-TACE because of progression of HCC and/or underlying liver cirrhosis (Group B). Hepatic function tests, APS grades, and portal flow directions were evaluated before and after P-TACE sessions. Complications after procedures and survival days were also evaluated.

Results: In group A, APS grade was improved in eight patients and five of six patients with hepatofugal flow showed restored hepatopetal flow postoperatively. No immediate complication was developed in either group. Transient hepatic insufficiency developed in eight (42.1%) of 19 patients after P-TACE, and seven (87.5%) of these eight recovered within two weeks under conservative care. The mean and median survival time all study subjects was 280 days and 162 days.

Conclusion: P-TACE is feasible and safe in advanced HCC patients with APS.

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Related in: MedlinePlus

A 51-year-old woman with grade 3 arterioportal shunt and hepatocellular carcinomas (patient 9). On initial hepatic arteriogram (A) showing multiple tumors in both hepatic lobes (black arrows). The main portal vein (white arrow) was opacified indirectly through arterioportal shunt of hepatocellular carcinomas. Polyvinyl alcohol embolization was performed using half a bottle of 355-500 µm sized particles via the right hepatic artery and conventional TACE was performed in both hepatic lobes. Follow-up hepatic arteriogram (B), two months after P-TACE, demonstrating arterioportal shunt improvement. Transarterial chemoembolization was performed without polyvinyl alcohol embolization. After four months, arterioportal shunt recurred in both hepatic lobes with hepatofugal flow in the main portal vein (arrow) on gastroduodenal (C) and right inferior phrenic (D) arteriograms. P-TACE was performed using one bottle of 355-500 µm sized particles into both arteries.
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Figure 2: A 51-year-old woman with grade 3 arterioportal shunt and hepatocellular carcinomas (patient 9). On initial hepatic arteriogram (A) showing multiple tumors in both hepatic lobes (black arrows). The main portal vein (white arrow) was opacified indirectly through arterioportal shunt of hepatocellular carcinomas. Polyvinyl alcohol embolization was performed using half a bottle of 355-500 µm sized particles via the right hepatic artery and conventional TACE was performed in both hepatic lobes. Follow-up hepatic arteriogram (B), two months after P-TACE, demonstrating arterioportal shunt improvement. Transarterial chemoembolization was performed without polyvinyl alcohol embolization. After four months, arterioportal shunt recurred in both hepatic lobes with hepatofugal flow in the main portal vein (arrow) on gastroduodenal (C) and right inferior phrenic (D) arteriograms. P-TACE was performed using one bottle of 355-500 µm sized particles into both arteries.

Mentions: Arterioportal shunt grades were improved in eight (80%) patients in group A by last follow-up preprocedural arteriography (Fig. 1, Table 1). One patient (patient 10) with grade 3 APS failed to respond twice to P-TACE. Another patient (patient 9) showed a transient APS improvement from grade 3 to 0 on the preprocedural arteriogram at the second procedure, but APS was aggravated to grade 3 at third follow-up preprocedural arteriography (Fig. 2).


Polyvinyl alcohol embolization adjuvant to oily chemoembolization in advanced hepatocellular carcinoma with arterioportal shunts.

Kim YJ, Lee HG, Park JM, Lim YS, Chung MH, Sung MS, Yoo WJ, Lim HW - Korean J Radiol (2007 Jul-Aug)

A 51-year-old woman with grade 3 arterioportal shunt and hepatocellular carcinomas (patient 9). On initial hepatic arteriogram (A) showing multiple tumors in both hepatic lobes (black arrows). The main portal vein (white arrow) was opacified indirectly through arterioportal shunt of hepatocellular carcinomas. Polyvinyl alcohol embolization was performed using half a bottle of 355-500 µm sized particles via the right hepatic artery and conventional TACE was performed in both hepatic lobes. Follow-up hepatic arteriogram (B), two months after P-TACE, demonstrating arterioportal shunt improvement. Transarterial chemoembolization was performed without polyvinyl alcohol embolization. After four months, arterioportal shunt recurred in both hepatic lobes with hepatofugal flow in the main portal vein (arrow) on gastroduodenal (C) and right inferior phrenic (D) arteriograms. P-TACE was performed using one bottle of 355-500 µm sized particles into both arteries.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627160&req=5

Figure 2: A 51-year-old woman with grade 3 arterioportal shunt and hepatocellular carcinomas (patient 9). On initial hepatic arteriogram (A) showing multiple tumors in both hepatic lobes (black arrows). The main portal vein (white arrow) was opacified indirectly through arterioportal shunt of hepatocellular carcinomas. Polyvinyl alcohol embolization was performed using half a bottle of 355-500 µm sized particles via the right hepatic artery and conventional TACE was performed in both hepatic lobes. Follow-up hepatic arteriogram (B), two months after P-TACE, demonstrating arterioportal shunt improvement. Transarterial chemoembolization was performed without polyvinyl alcohol embolization. After four months, arterioportal shunt recurred in both hepatic lobes with hepatofugal flow in the main portal vein (arrow) on gastroduodenal (C) and right inferior phrenic (D) arteriograms. P-TACE was performed using one bottle of 355-500 µm sized particles into both arteries.
Mentions: Arterioportal shunt grades were improved in eight (80%) patients in group A by last follow-up preprocedural arteriography (Fig. 1, Table 1). One patient (patient 10) with grade 3 APS failed to respond twice to P-TACE. Another patient (patient 9) showed a transient APS improvement from grade 3 to 0 on the preprocedural arteriogram at the second procedure, but APS was aggravated to grade 3 at third follow-up preprocedural arteriography (Fig. 2).

Bottom Line: In group A, APS grade was improved in eight patients and five of six patients with hepatofugal flow showed restored hepatopetal flow postoperatively.The mean and median survival time all study subjects was 280 days and 162 days.P-TACE is feasible and safe in advanced HCC patients with APS.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Holy Family Hospital, College of Medicine, The Catholic University of Korea, Kyungki-Do 420-717, Korea.

ABSTRACT

Objective: To assess the feasibility and safety of polyvinyl alcohol (PVA) embolization adjuvant to transarterial oily chemoembolization (P-TACE) in advanced hepatocellular carcinoma (HCC) with arterioportal shunts (APS).

Materials and methods: Nineteen patients who underwent PVA embolization for APS before a routine chemoembolization (TACE) procedure were retrospectively reviewed. 10 of these 19 patients underwent follow-up TACE or P-TACE after P-TACE (Group A), but nine patients underwent only initial P-TACE because of progression of HCC and/or underlying liver cirrhosis (Group B). Hepatic function tests, APS grades, and portal flow directions were evaluated before and after P-TACE sessions. Complications after procedures and survival days were also evaluated.

Results: In group A, APS grade was improved in eight patients and five of six patients with hepatofugal flow showed restored hepatopetal flow postoperatively. No immediate complication was developed in either group. Transient hepatic insufficiency developed in eight (42.1%) of 19 patients after P-TACE, and seven (87.5%) of these eight recovered within two weeks under conservative care. The mean and median survival time all study subjects was 280 days and 162 days.

Conclusion: P-TACE is feasible and safe in advanced HCC patients with APS.

Show MeSH
Related in: MedlinePlus