Comparison of long-term effects between intra-arterially delivered ethanol and Gelfoam for the treatment of severe arterioportal shunt in patients with hepatocellular carcinoma.
OBJECTIVE
To evaluate long-term effect of ethanol embolization for the treatment of hepatocellular carcinoma (HCC) with severe hepatic arterioportal shunt (APS), compared with Gelfoam embolization.


METHODS
Sixty-four patients (ethanol group) and 33 patients (Gelfoam group) with HCC and APS were respectively treated with ethanol and Gelfoam for APS before the routine interventional treatment for the tumor. Frequency of recanalization of shunt, complete occlusion of the shunt, side effects, complications, and survival rates were analyzed between the two groups.


RESULTS
The occlusion rate of APS after initial treatment in ethanol group was 70.3%(45/64), and recanalization rate of 1 month after embolization was 17.8%(8/45), and complete occlusion rate was 82.8%(53/64). Those in Gelfoam group were 63.6%(21/33), 85.7%(18/21), and 18.2%(6/33). There were significant differences in recanalization rate and complete occlusion rate between the two groups (P<0.05). The survival rates in ethanol group were 78% at 6 months, 49% at 12 months, 25% at 24 months, whereas those in Gelfoam group were 58% at 6 months, 23% at 12 months, 15% at 24 months. The ethanol group showed significantly better survival than Gelfoam group (P<0.05). In the ethanol group, there was a significant prolongation of survival in patients with monofocal HCC (P<0.05) and Child class A (P<0.05). There were no significant differences in survival rate in the Gelfoam group with regard to the number of tumor and Child class (P>0.05). The incidence rate of abdominal pain during procedure in ethanol group was 82.8%. There was no significant difference in postembolization syndromes between two groups. Procedure-related hepatic failure did not occur in ethanol group.


CONCLUSIONS
Ethanol embolization for patients with HCC and severe APS is efficacious and safe, and may contribute to prolongation of the life span versus Gelfoam embolization.
Huang
Ming-Sheng
MS
Department of Radiology, The 3rd Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road Guangzhou, 510630 China.
Lin
Qu
Q
Jiang
Zai-Bo
ZB
Zhu
Kang-Shun
KS
Guan
Shou-Hai
SH
Li
Zheng-Ran
ZR
Shan
Hong
H
D001164:Arteriovenous Fistula / Q000209:etiology* / Q000628:therapy*; D006528:Carcinoma, Hepatocellular / Q000150:complications*; D000431:Ethanol / Q000008:administration & dosage*; D005781:Gelatin Sponge, Absorbable / Q000008:administration & dosage*; D006490:Hemostatics / Q000008:administration & dosage*; D006499:Hepatic Artery; D006801:Humans; D007269:Injections, Intra-Arterial; D008113:Liver Neoplasms / Q000150:complications*; D011169:Portal Vein
D006490:Hemostatics; D000431:Ethanol