Polyvinyl alcohol embolization adjuvant to oily chemoembolization in advanced hepatocellular carcinoma with arterioportal shunts.
OBJECTIVE
To assess the feasibility and safety of polyvinyl alcohol (PVA) embolization adjuvant to transarterial oily chemoembolization (P-TACE) in advanced hepatocellular carcinoma (HCC) with arterioportal shunts (APS).


METHODS
Nineteen patients who underwent PVA embolization for APS before a routine chemoembolization (TACE) procedure were retrospectively reviewed. 10 of these 19 patients underwent follow-up TACE or P-TACE after P-TACE (Group A), but nine patients underwent only initial P-TACE because of progression of HCC and/or underlying liver cirrhosis (Group B). Hepatic function tests, APS grades, and portal flow directions were evaluated before and after P-TACE sessions. Complications after procedures and survival days were also evaluated.


RESULTS
In group A, APS grade was improved in eight patients and five of six patients with hepatofugal flow showed restored hepatopetal flow postoperatively. No immediate complication was developed in either group. Transient hepatic insufficiency developed in eight (42.1%) of 19 patients after P-TACE, and seven (87.5%) of these eight recovered within two weeks under conservative care. The mean and median survival time all study subjects was 280 days and 162 days.


CONCLUSIONS
P-TACE is feasible and safe in advanced HCC patients with APS.
Kim
Yeo Ju
YJ
Department of Radiology, Holy Family Hospital, College of Medicine, The Catholic University of Korea, Kyungki-Do 420-717, Korea.
Lee
Hae Giu
HG
Park
Jeong Mi
JM
Lim
Yeon Soo
YS
Chung
Myung Hee
MH
Sung
Mi Sook
MS
Yoo
Won Jong
WJ
Lim
Hyun Wook
HW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D001164:Arteriovenous Fistula / Q000628:therapy; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003287:Contrast Media / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage; D008102:Liver Circulation; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D011142:Polyvinyl Alcohol / Q000008:administration & dosage*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D003287:Contrast Media; D016685:Mitomycin; D007459:Iodized Oil; D011142:Polyvinyl Alcohol