Combined Therapy of Transjugular Intrahepatic Portosystemic Shunt(TIPS) and Transcatheter Hepatic ArteryChemoembolization (TACE) in Patients with Hepatocellular Carcinoma and Gastroesophageal Variceal Bleeding

ABSTRACT

PURPOSE: To evaluate the efficacy of combined TIPS and superselective TACE therapy in patients withhepatocellular carcinoma and variceal bleeding. MATERIALS AND METHODS: Of a total of 132 patients who underwentTIPS, 14 had hepatocellular carcinoma ; of these six with a patent main portal vein who had undergone TACE wereincluded this study. One underwent TIPS 13 months after TACE, and five underwent TACE at various points during theTIPS follow-up period. TIPS followed the standard procedure, while TACE involved superselective segmental orsubsegmental embolization in four patients, lobar artery embolization in one, and non-selective chemoembolizationin one with on advanced tumor. RESULTS: Except for mild hepatic encephalopathy in two patients, no clinicallysignificant immediate complication was seen after TIPS or TACE. Three patients died due to hepatic failure ; theysurvived for one to three months after combined therapy, a mean of 2.3 months. After combined therapy, otherpatients survived for between five and 49 (mean, 22) months. CONCLUSION: Combined TIPS and TACE therapy iseffective for the threatment of patients with hepatocellular carcinoma and esophagogastric variceal bleeding.