Embolization of hepatic arterioportal shunt with ethanol-soaked gelatin sponge

Objective: The objective of this study is to investigate the effect of ethanol-soaked gelatin sponge (ESG) in the treatment of hepatic arterioportal shunt (APS). Methods: Hepatocellular carcinoma (HCC) patients with APS were divided into experimental group (Group E) and control group (Group C). Patients in Group E were treated with ESG for APS embolization, whereas patients in Group C were treated with polyvinyl alcohol particles for APS embolization, with other treatment unchanged. APS and the Eastern Cooperative Oncology Group (ECOG) physical status scores of patients before and after the first treatment and further consultation in the 6th week and the survival rate in follow-up visit were recorded. The changes of liver function during treatment were monitored. Results: Before the first treatment, there was no statistical significant difference in APS between two groups. After that, APS in Groups E (P = 2.49 × 10−7) and C (P = 2.10 × 10−4) was improved. In further consultation, APS in Groups E (P = 2.73 × 10−13) and C (P = 2.90 × 10−8) was further improved after examinations and corresponding treatment. After the first treatment and further consultation, APS score was lower in Group E than in Group C, and there were still five patients whose APS score was 2 in Group C. Quality of life in two groups was effectively controlled without getting worse and the ECOG score reduced. Liver function in the two groups did not worsen with the use of liver protective drugs. No deaths occurred in Group E, whereas two patients died in Group C during treatment and follow-up visit. Conclusion: The results show that ESG can effectively reduce APS score and improve the survival rate of HCC patients

Changes in Arterioportal Shunts in Hepatocellular Carcinoma Patients with Portal Vein Thrombosis Who Were Treated with Chemoembolization Followed by Radiotherapy / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: In this study, we retrospectively investigated the prevalence of arterioportal (AP) shunts in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) and evaluated the changes in AP shunts after chemoembolization followed by external beam radiation therapy (EBRT). MATERIALS AND METHODS: We analyzed 54 HCC patients with PVTT who were treated with chemoembolization followed by EBRT. EBRT was uniformly delivered at a total dose of 30 to 45 Gy (median, 35 Gy), with a daily dose of 2 to 4.5 Gy. Angiographic images of chemoembolization before and after radiation therapy (RT) were reviewed to investigate the AP shunt. RESULTS: During the initial session of chemoembolization, 33 of 54 patients (61%) had an AP shunt. After EBRT, 32 out of 33 patients had an additional session of chemoembolization and were evaluated for a change in the AP shunt. The AP shunt decreased in 20 of 32 patients (63%) after chemoembolization followed by EBRT. The 1-year calculated overall survival (OS) rate for all patients was 52.6% and the 2-year OS was 36.4%. The median OS in all patients was 13 months. Patients with AP shunt showed poorer median OS than those without AP shunt, but there was no statistically significant difference (median, 12 months vs. 17 months). CONCLUSION: The AP shunt frequently occurs in HCC patients with PVTT. This study suggests that a poor prognosis is associated with an AP shunt. Chemoembolization followed by RT may produce a decrease in AP shunts.

Sonography of hepatic hemangioma accompanied by arterioportal shunt

No abstract available.

N-Butyl Cyanoacrylate Embolization with Blood Flow Control of an Arterioportal Shunt That Developed after Radiofrequency Ablation of Hepatocellular Carcinoma

We present a case of a patient with rapid deterioration of esophageal varices caused by portal hypertension accompanied by a large arterioportal shunt that developed after radiofrequency ablation of hepatocellular carcinoma. We used n-butyl cyanoacrylate (NBCA) as an embolic material to achieve pinpoint embolization of the shunt, because the microcatheter tip was 2 cm away from the shunt site. Under hepatic arterial flow control using a balloon catheter, the arterioportal shunt was successfully embolized with NBCA, which caused an improvement in the esophageal varices.

Combination treatment with intrahepatic arterial infusion and intratumoral injection chemotherapy in patients with far-advanced hepatocellular carcinoma and arterioportal or arteriovenous shunts: preliminary results / 대한간학회지

BACKGROUND/AIMS: Combination treatment consisting of hepatic arterial infusion chemotherapy with epirubicin and cisplatin (HAIC-EC) and systemic infusion of low-dose 5-fluorouracil (5-FU) are sometimes effective against advanced hepatocellular carcinoma (HCC). However, there is no effective treatment for advanced HCCs with arterioportal shunts (APS) or arteriovenous shunts (AVS). METHODS: We investigated a response and adverse events of a new combination protocol of repeated HAIC-EC and percutaneous intratumoral injection chemotherapy with a mixture of recombinant interferon-gamma (IFN-gamma) and 5-FU (PIC-IF) in patients with far-advanced HCCs with large APSs or AVSs. RESULTS: There was a complete response (CR) for the large vascular shunts in all three patients and for all tumor burdens in two patients. Significant side effects were flu-like symptoms (grade 2) and bone marrow suppression (grade 2 or 3) after each cycle, but these were well-tolerated. CONCLUSIONS: These results suggest that the combination of HAIC-EC and PIC-IF is a new and promising approach for advanced HCC accompanied by a large APS or AVS.

Focal Sparing of the Fatty Liver Caused by a Nontumorous Arterioportal Shunt

We present two cases of focal fatty sparing caused by a nontumorous arterioportal shunt. Two patients underwent ultrasonography (US) as a part of routine medical screening, which revealed a hypoechoic lesion in the diffuse fatty liver. Each lesion appeared to be an arterioportal shunt on triphasic mutidetector computed tomography (CT) and was seen as being slightly hyperdense on noncontrast CT. No tumors were delineated around or within the arterioportal shunt. Both lesions remained unchanged on six-month follow-up US.

Small Hepatic Hemangiomas with Arterioportal Shunts:Diagnosis with 16-slice Spiral CT Multi-Phase Dynamic Contrast-Enhanced Scanning / 实用放射学杂志

Objective To investigate the multi-phase dynamic spiral CT findings of small hepatic hemangioma with arterioportal shunts,and to discuss its mechanism and influencing factors.Methods Multi-phase dynamic contrast-enhancement CT findings of 52 small hepatic hemangiomas in 33 cases were analyzed retrospectively.The criteria for diagnosing arterioportal shunts were as follow:①Transient wedge-shape or irregularly shape homogenous enhancement in the liver parenchyma adjacent to the tumor on hepatic arterial phase and slight hyper-or iso-attenuation in the area on portal venous phase and delayed phase;②Some branches of portal vein showed early appearance within the wedge-shaped homogenously hyper-attenuating area on the arterial phase.The correlation between the enhancement patterns of homangiomas and the prevalence of arterioportal shunts in small hepatic homangiomas were analyzed.Results Arterioportal shunts were found in 13(25%)of 52 small hepatic hemangiomas,all of them showed transient wedge-shaped enhancement peripheral to the tumor and in 7 of 13 hemangiomas showed early enhancement of branches of the portal veins on the arterial phase.Eleven(52.4%)of the 21 small hepatic hemangiomas with rapid enhancement had arterioportal shunt shunts,whereas only 2(6.5%)of the 31 hemangiomas with slow enhancement had arterioportal shunt shunts(P

Clinical Significance of Hepatic Arterioportal Shunts in Patients with Hepatocellular Carcinoma / 대한내과학회지

Arterioportal (AP) shunt is related to hepatocellular carcinoma (HCC) with variable frequency but its clinical significance is not well known. We retrospectively studied the prevalence and clinical significance including mortality of the AP shunt combined with HCC. METHODS: The clinical data and radiologic features of HCC patients who were performed hepatic angiography from 1992 to 1997 at St. Mary's Hospital in Korea were reviewed. The data of HCC patients with AP shunt were compared with that of randomized samples of HCC patients without AP shunt. RESULTS: The prevalence of AP shunt in HCC was 7.3%(45/616 HCC patients). There was no significant difference in clinical symptoms and signs such as ascites, encephalopathy, or variceal bleeding and laboratory findings between the HCC patients with AP shunt and those without. The AP shunt was more common in diffuse, poorly demarcated, large HCC. Especially, portal vein thrombosis (PVT) was one of the most common causes of AP shunt. Cumulative survival rate of the HCC patients with AP shunt was lower than that of those without. But only the size of HCC was significantly related with poor prognosis. CONCLUSION: AP shunt occurred in some HCC which was large in size or combined with PVT. AP shunt did not increase the severity of symptoms and signs, but decreased the survival because of its relation to tumor size.