title: Transarterial embolization with cyanoacrylate for severe arterioportal shunt complicated by hepatocellular carcinoma.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of cyanoacrylate glue embolization in the treatment of severe arterioportal shunt (APS) presenting with hepatofugal portal venous flow in hepatocellular carcinoma (HCC) patients.
  
  
  METHODS
  Between July 2000 and January 2010, 27 HCC patients with severe APS presenting with hepatofugal portal venous flow underwent transarterial angiography and treatment. Among them, four patients were excluded from the study. Twelve patients underwent transarterial chemoperfusion and embolization of APS with cyanoacrylate glue between January 2006 and January 2010 (Emb group), and the other 11 patients undergoing only transarterial chemoperfusion without embolization of APS between July 2000 and December 2005 served as a control group (non-Emb group). The change of APS, survival rates, and procedure related complications were analyzed.
  
  
  RESULTS
  In the Emb group, APS was improved in all of the 12 patients after initial glue embolization; long-term APS improvement with hepatopetal portal flow was achieved in 80 % (8 of 10) patients who underwent follow-up angiography. Survival rates in the Emb group were 67 % at 6 months, 33 % at 1 year, and 8 % at 2 years, whereas those in the non-Emb group were 0 % at 6 months (P < 0.05). Median survival time in the Emb group was 275 days, which was longer than that of 107 days in the non-Emb group (P = 0.001). There were no major complications in both groups.
  
  
  CONCLUSIONS
  The preliminary experience suggests that glue embolization may be an effective and safe therapy in the management of severe APS accompanied by HCC and also improve patient survival.
authors.affiliation: Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China. shihb@vip.sina.com
authors.forename: Hai-Bin
authors.initials: HB
authors.lastname: Shi
authors.forename: Zheng-Qiang
authors.initials: ZQ
authors.lastname: Yang
authors.forename: Sheng
authors.initials: S
authors.lastname: Liu
authors.forename: Wei-Zhong
authors.initials: WZ
authors.lastname: Zhou
authors.forename: Chun-Gao
authors.initials: CG
authors.lastname: Zhou
authors.forename: Lin-Bo
authors.initials: LB
authors.lastname: Zhao
authors.forename: Jin-Guo
authors.initials: JG
authors.lastname: Xia
authors.forename: Lin-Sun
authors.initials: LS
authors.lastname: Li
mesh_terms: D000368:Aged; D000792:Angiography; D001164:Arteriovenous Fistula / Q000209:etiology* / Q000628:therapy*; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000150:complications*; D003487:Cyanoacrylates / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000098:blood supply / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D003487:Cyanoacrylates