Combined transjugular intrahepatic portosystemic shunt and segmental Lipiodol hepatic artery embolization for the treatment of esophagogastric varices and hepatocellular carcinoma in patients with cirrhosis: preliminary report.
OBJECTIVE
To evaluate the feasibility of combining placement of a transjugular intrahepatic portosystemic shunt (TIPS) and transcatheter hepatic segmental artery chemoembolization with Lipiodol (Seg-Lp-TAE) in patients with cirrhosis, esophagogastric varices, and hepatocellular carcinoma (HCC).


METHODS
Five patients with bleeding or large, high-flow esophagogastric varices and HCC were treated by TIPS and Seg-Lp-TAE.


RESULTS
The mean portosystemic pressure gradient decreased from 20.8 cm H2O to 7.8 cm H2O after TIPS. The direct portogram and endoscopic examination revealed reduction of varices. At 6 months, one shunt had functionally occluded and could not be reopened; the other TIPS remained functional. Follow-up CT and the changes of alpha fetoprotein indicated effective therapy of Seg-Lp-TAE for HCC. Four patients are in stabile clinical condition at 9, 6, 1, and 1 months after the combined therapy; one died after 14 months due to decompensated liver cirrhosis.


CONCLUSIONS
The combined therapy of TIPS and Seg-Lp-TAE will become a new interventional approach for patients with HCC and esophagogastric varices.
Sakaguchi
H
H
Department of Radiology, Nara Medical University, Japan.
Uchida
H
H
Maeda
M
M
Matsuo
N
N
Kichikawa
K
K
Ohishi
H
H
Nishida
H
H
Ueno
K
K
Nishimine
K
K
Rösch
J
J
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D004932:Esophageal and Gastric Varices / Q000601:surgery* / Q000628:therapy*; D004945:Esophagoscopy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000601:surgery / Q000628:therapy; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage*; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000379:methods; D011172:Portography; D014057:Tomography, X-Ray Computed; D000509:alpha-Fetoproteins / Q000032:analysis
D000509:alpha-Fetoproteins; D007459:Iodized Oil