[Digital subtraction angiography manifestation and interventional therapy of arteriovenous shunting in primary hepatocellular carcinoma of advanced stage].
OBJECTIVE
To explore the appearances of digital subtraction angiography (DSA) and therapeutic efficacy of interventional therapy of hepatic carcinoma accompanied with arteriovenous shunting (AVS).


METHODS
To retrospectively analyze clinical material of 97 patients with hepatocellular carcinoma with hepatic artery-portal vein shunting(HA-PVS), of whom, 16 had upper gastrointestinal hemorrhage, 51 had middle to large amounts of ascites, and 53 had varices of esophagus and fundus gastricus. All the patients were treated with transcatheter arterial chemoembolization (TACE) or transcatheter arterial infusion chemotherapy (TAI). Shunts were embolized by lipidol in 40 patients, by lipidol and sponjgia gelatinosa particle in 34 patients, and by coil in 6 patients. The remaining 17 were treated only with TAI.


RESULTS
Twelve (12.4%) cases had hepatic arteryjhepatic vein shunting (HA-HVS)ìwhile 32 (33%)cases had portal vein tumor thrombosis (PVTT). In 70(72.2%) patients, all shunts were completely closed successfully, in 15(15.5%) patients, the shunts were partly closed, and in 12(12.3%)patients, the shunts were not closed. In 12 patients, the shunts reopened in later therapy, their blood flow was smaller than before and they were closed after second embolization. In 17 patients, new shunts emerged. After TACE therapy ìthe tumors were smaller in 57(58.7%)ìbigger in 24 (24.7%)ìand 16(16.5%) were the same in size before and after TACE. Ascites disappeared in 29 patients, decreased in 18 patients and had no change in 4 patients. Five patients who had upper gastrointestinal hemorrhage prejoperation had new hemorrhage. Of the 47 patients who had diarrhea, 23 improved. In 67 alpha fetoprotein (AFP) positive patients, degree of AFP in 53 patients decreased. Eighty-one patients died and their middle survival period was 12.9 months. No serious damage to hepatic function due to the treatment was observed in most patients.


CONCLUSIONS
Primary hepatic carcinoma with AVS increases difficulty of interventional therapyìbut as long as we take active and proper treating measureìwe could acquire satisfactory curative effect without serious syndrome. DSA can demonstrate the type, the site and the degree of AVS completely and directly, thus having important value in treating primary hepatic carcinoma and improving prognosis.
Zhu
Lin zhong
Lz
Department of Interventional TherapyìBeijing Cancer Hospital, Peking University School of Oncology, Beijing Institute for Cancer Research, Beijing 100036, China.
Yang
Ren jie
Rj
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D001164:Arteriovenous Fistula / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000000981:diagnostic imaging; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D006499:Hepatic Artery / Q000002:abnormalities; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000002:abnormalities; D012189:Retrospective Studies