Embolization of hepatic arterio-portal shunt in patients with HCC complicated by portal vein tumor ;thrombus treated with TACE combined with portal vein stenting：its clinical significance / 介入放射学杂志

ABSTRACT

Objective To evaluated the clinical significance of embolization of arterio-portal venous shunt (APVS) in hepatocellular carcinoma (HCC) patients with main portal vein tumor thrombus (MPVTT) treated by transcatheter arterial chemoembolization (TACE) and portal vein stenting. Methods Twenty-six HCC patients with MPVTT and marked APVS, who were treated with TACE and portal vein stenting, were enrolled in this study. Portal vein stenting was performed via percutaneous transhepatic approach, which was followed by the embolization of the feeding arteries of APVS by using suitable embolic agents. The portal vein pressure levels were separately measured before, after portal vein stenting and after APVS embolization. The results were statistically analyzed. Results Both the portal vein stenting and APVS embolization were successfully accomplished in all the 26 patients. Hepatic angiography and portal venography performed before portal vein stenting revealed bidirectional portal flow in 16 cases and hepatofugal portal flow in 10 cases. Among the 16 patients with bidirectional portal flow, remarkable improvement of portal vein to liver blood flow after portal vein stenting was seen in 14, and obvious recovery of main portal vein to liver blood flow after APVS embolization in 2. Obvious recovery of main portal vein to liver blood flow after APVS embolization was also demonstrated in 10 cases with hepatofugal portal flow. The portal vein pressure determined before, after portal vein stenting and after APVS embolization was (50.1±6.3) cmH2O,(43.5± 7.5) cmH2O and (36.9 ±8.2) cmH2O respectively. After portal vein stenting the portal vein pressure was significantly decreased when compared with the preoperative pressure, and the difference was statistically significant (P<0.05); after APVS embolization the portal vein pressure was further decreased (P<0.05). Conclusion For HCC patients with MPVTT and marked APVS, portal vein stenting can effectively restore the portal blood flow and reduce the portal vein pressure; and embolization of APVS can further reduce the pressure of portal vein, thus the bidirectional portal flow or hepatofugal portal flow will return to normal hepatopetal flow.