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Wu Z, Zhang M, Tian R, Liu J, Chang X, Ning S, Yu Y, Zhang L. Clinical efficacy of TACE using coil or gelatin sponge combined with targeted therapy in the treatment of giant hepatocellular carcinoma with arterioportal fistulas. BMC Gastroenterol 2025; 25:387. [PMID: 40394522 PMCID: PMC12090417 DOI: 10.1186/s12876-025-03970-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Accepted: 05/05/2025] [Indexed: 05/22/2025] Open
Abstract
BACKGROUND The present study aimed to evaluate the effectiveness of spring coils or gelatin sponges for the embolization of giant hepatocellular carcinoma (HCC) with a hepatic arterioportal shunt (APS) in targeted therapy. METHODS A total of 81 patients with a large HCC complicated with APS were divided into two groups on the basis of the use of block-APS embolic agents: the coil group and the gelatin sponge group. Both groups received lipiodol transarterial chemoembolization (TACE) after APS was correspondingly blocked with a coil or gelatin sponge. Sorafenib or lenvatinib was administered 3-5 days before TACE. RESULTS Both groups showed improvement in the incidence of fistula one month after the first TACE session and the last TACE session compared with before treatment. In addition, the improvement in the incidence of fistulas in the coil group was greater than that in the gelatin sponge group [p = 0.003], whereas the compensation of extrahepatic blood vessels was more severe in the coil group. There was no significant difference in median overall survival (OS) (11.13 months, 95% CI 7.67-14.59 months vs. 15.13 months, 95% CI 10.18-20.09 months, p = 0.303) or progression-free survival (PFS) (5.37 months, 95% CI 5.04-5.70 months vs. 5.7 months, 95% CI 0.66-10.74 months, p = 0.376) between the two groups. However, both groups showed early progression of intrahepatic lesions. CONCLUSIONS Spring coil or gelatin sponge embolization combined with APS was used for giant HCC patients, which significantly improved the incidence of fistulas.
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Affiliation(s)
- Zhijuan Wu
- Department of Gerontology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Min Zhang
- Department of Breast and Thyroid Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Ruirui Tian
- Department of Oncology, Dongying District People's Hospital, Dong Ying City, Shandong Province, China
| | - Jibing Liu
- Department of Interventional Therapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xu Chang
- Department of Interventional Therapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Shangkun Ning
- Department of Interventional Therapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yingli Yu
- Department of Interventional Therapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Lin Zhang
- Department of Interventional Therapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
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Gallo C, Invernizzi P. Hepatic arterioportal fistula after biopsy conditioning portal hypertension: first case in primary biliary cholangitis and a systematic literature review. Ann Hepatol 2025:101924. [PMID: 40383369 DOI: 10.1016/j.aohep.2025.101924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Revised: 04/22/2025] [Accepted: 05/01/2025] [Indexed: 05/20/2025]
Abstract
Hepatic arterioportal fistulas (HAPFs) are aberrant shunts between the portal venous and the hepatic arterial systems leading to portal hypertension (PH). Acquired post-biopsy HAPFs are rare and most of them resolve spontaneously with no clinical manifestations. If symptomatic, they should be treated, and endovascular embolization represents the standard of care. We present the first case of an acquired high-flow post-biopsy HAPF causing clinically significant PH and PH-related bleeding in a 26-year-old female patient affected by early-stage primary biliary cholangitis (PBC). The HAPF was safely and successfully treated with selective arterial embolization through spring steel coils and liquid embolizing agents. In fact, no peri-procedural complications were reported, and final result showed the complete closure of the shunt at control abdominal Doppler ultrasound, with almost complete regression of PH-related endoscopic signs. Despite the possibility of developing PH even in early histologic stages of PBC, we attributed the most significant proportion of PH to the high-flow HAPF and we proved that its embolization was needed to be prioritized in the therapeutic management of the case.
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Affiliation(s)
- Camilla Gallo
- Digestive and Interventional Endoscopy Unit, ASST GOM Niguarda, Milan, Italy; University of Milano-Bicocca School of Medicine, Monza, Italy.
| | - Pietro Invernizzi
- University of Milano-Bicocca School of Medicine, Monza, Italy; Division of Gastroenterology, Fondazione IRCCS San Gerardo dei Tintori, Italy
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Terauchi M, Yamashiro T, Sawamura S, Koyama S, Nakaigawa N, Kondo K, Hasumi H, Makiyama K, Utsunomiya D. Combining Transarterial Embolization and Percutaneous Cryoablation for Early-Stage Renal Cell Carcinoma: Embolization Materials and Impacts of Tumor Size. Tomography 2024; 10:1767-1779. [PMID: 39590939 PMCID: PMC11598556 DOI: 10.3390/tomography10110130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 10/30/2024] [Accepted: 11/03/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND/OBJECTIVES Our aim was to compare the complication rates of different embolization materials (absolute ethanol and gelatin sponges) used for combined transarterial embolization (TAE) and to investigate the impact of tumor size on operative time and cryoneedle use during percutaneous cryoablation (PCA). METHODS We treated 27 patients (9 women and 18 men; mean age, 74 years) with 28 early-stage (T1a) renal cell carcinoma (RCC) lesions using combined TAE and PCA between September 2018 and January 2021. During TAE, 15 lesions in 14 patients were embolized using mixed absolute ethanol and iodized oil. The remaining 13 lesions (in 13 patients) were embolized using a gelatin sponge followed by iodized oil. The PCA was performed within 3 to 21 days of the TAE. We compared complications between the TAE subgroups (i.e., absolute ethanol and gelatin sponge) and assessed potential correlations between tumor size and the operative time of the PCA. RESULTS All patients were successfully treated by combined TAE-PCA. Local control was achieved for all patients (monitoring period, 1-48 months; median, 28 months). Although the effect of TAE did not differ between subgroups, a significantly higher number of patients in the absolute ethanol group experienced intraprocedural pain than in the gelatin sponge group (p < 0.05). The operative time of the PCA was significantly correlated with the size of the RCC lesion (p < 0.01). The number of cryoneedles used for the PCA was also correlated with the size of the RCC lesion (p < 0.0001). CONCLUSIONS For TAE prior to PCA for early-stage RCC, gelatin sponges can replace absolute ethanol to reduce intraprocedural pain. Tumor size correlates with operative time and the number of cryoneedles needed for PCA, which suggests the total medical cost for PCA therefore varies based on the tumor's size.
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Affiliation(s)
- Miki Terauchi
- Department of Interventional Radiology, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, 3211 Kozukuechou, Kohoku-ku, Yokohama 222-0036, Japan
| | - Tsuneo Yamashiro
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (T.Y.); (S.S.); (S.K.); (D.U.)
| | - Shungo Sawamura
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (T.Y.); (S.S.); (S.K.); (D.U.)
| | - Shingo Koyama
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (T.Y.); (S.S.); (S.K.); (D.U.)
| | - Noboru Nakaigawa
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (N.N.); (K.K.); (H.H.); (K.M.)
- Department of Urology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama 241-8515, Japan
| | - Keiichi Kondo
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (N.N.); (K.K.); (H.H.); (K.M.)
- Kanazawa-Hakkei Kondo Urology Clinic, 19-14 Seto, Kanazawa-ku, Yokohama 236-0027, Japan
| | - Hisashi Hasumi
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (N.N.); (K.K.); (H.H.); (K.M.)
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (N.N.); (K.K.); (H.H.); (K.M.)
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (T.Y.); (S.S.); (S.K.); (D.U.)
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Xia WL, Zhao XH, Guo Y, Hu HT, Li HL. TACE Combined with Portal Vein Tumor Thrombus 125I Seed Implantation in the Treatment of HCC with Hepatic Arterioportal Shunts. J Hepatocell Carcinoma 2024; 11:1689-1697. [PMID: 39247518 PMCID: PMC11378794 DOI: 10.2147/jhc.s480082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 08/27/2024] [Indexed: 09/10/2024] Open
Abstract
Background and Objectives Transarterial chemoembolization (TACE) and 125I seed implantation are methods used to treat hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT), PVTT often associated with arterioportal shunts(APS), there are few reports on the combined use of TACE and 125I seed implantation for such patients. This study aimed to evaluate the efficacy and safety of TACE combined with PVTT 125I seed implantation in the treatment of HCC patients with APS. Methods Forty-two patients diagnosed with HCC combined with PVTT and APS between January 2020 and December 2021 were included. Appropriate materials were selected to transarterial embolization of the APS, and 125I seeds were implanted into the PVTT. The occlusion effect was observed and recorded after 3 months, the efficacy of intrahepatic lesions and PVTT was evaluated, and the patient survival, prognostic factors affecting APS recanalization were analyzed. Results All 42 patients completed the follow-up three months after treatment. The immediate APS improvement rate was 100%, and the APS improvement rate at the three-month follow-up was 64.29%. The disease control rates of PVTT and intrahepatic lesions were 81.00% and 78.60%, respectively. The patients' 6-month and 12-month survival rates were 78.6% and 46.8%. The median OS for all patients was 11.90 months, and the median OS was 13.30 months in the APS effective treatment group and 8.30 months in the ineffective group. The PVTT type is the only independent factor affecting APS recanalization. (P=0.02). Conclusion For HCC patients with PVTT and APS, TACE combine with 125I seed implantation in PVTT is a potentially effective and safe method that contributes to prolonging patient survival.
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Affiliation(s)
- Wei-Li Xia
- Department of Interventional Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, People's Republic of China
| | - Xiao-Hui Zhao
- Department of Interventional Radiology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, People's Republic of China
| | - Yuan Guo
- Department of Interventional Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, People's Republic of China
| | - Hong-Tao Hu
- Department of Interventional Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, People's Republic of China
| | - Hai-Liang Li
- Department of Interventional Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, People's Republic of China
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Yuan GS, Zhang LL, Chen ZT, Zhang CJ, Tian SH, Gong MX, Wang P, Guo L, Shao N, Liu B. Comparison of ethanol-soaked gelatin sponge and microspheres for hepatic arterioportal fistulas embolization in hepatic cellular carcinoma. World J Gastrointest Oncol 2023; 15:1595-1604. [PMID: 37746643 PMCID: PMC10514721 DOI: 10.4251/wjgo.v15.i9.1595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/24/2023] [Accepted: 08/18/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Hepatic arterioportal fistulas (APFs) are common in hepatocellular carcinoma (HCC). Moreover, correlated with poor prognosis, APFs often complicate anti-tumor treatments, including transarterial chemoembolization (TACE). AIM To compare the efficacy of ethanol-soaked gelatin sponges (ESG) and microspheres in the management of APFs and their impact on the prognosis of HCC. METHODS Data from patients diagnosed with HCC or hepatic APFs between June 2016 and December 2019 were retrospectively analyzed. Furthermore, APFs were embolized with ESG (group E) or microspheres (group M) during TACE. The primary outcomes were disease control rate (DCR) and objective response rate (ORR). The secondary outcomes included immediate and first follow-up APF improvement, overall survival (OS), and progression-free survival (PFS). RESULTS Altogether, 91 participants were enrolled in the study, comprising 46 in group E and 45 in group M. The DCR was 93.5% and 91.1% in groups E and M, respectively (P = 0.714). The ORRs were 91.3% and 66.7% in groups E and M, respectively (P = 0.004). The APFs improved immediately after the procedure in 43 (93.5%) patients in group E and 40 (88.9%) patients in group M (P = 0.485). After 2 mo, APF improvement was achieved in 37 (80.4%) and 33 (73.3%) participants in groups E and M, respectively (P = 0.421). The OS was 26.2 ± 1.4 and 20.6 ± 1.1 mo in groups E and M, respectively (P = 0.004), whereas the PFS was 16.6 ± 1.0 and 13.8 ± 0.7 mo in groups E and M, respectively (P = 0.012). CONCLUSION Compared with microspheres, ESG embolization demonstrated a higher ORR and longer OS and PFS in patients of HCC with hepatic APFs.
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Affiliation(s)
- Guang-Sheng Yuan
- Institute of Interventional Oncology, Shandong University, Jinan 250033, Shandong Province, China; Department of Radiology, Dongying Traditional Chinese Medicine Hospital, Dongying 257055, Shandong Province, China
| | - Li-Li Zhang
- Department of Gastroenterology, People's Hospital of Qihe County, Dezhou 251100, Shandong Province, China
| | - Zi-Tong Chen
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China; Institute of Interventional Oncology, Shandong University, Jinan 250033, Shandong Province, China
| | - Cun-Jing Zhang
- Dean’s Office, Jinan Vocational College of Nursing, Jinan 250100, Shandong Province, China
| | - Shu-Hui Tian
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China; Institute of Interventional Oncology, Shandong University, Jinan 250033, Shandong Province, China
| | - Ming-Xia Gong
- Institute of Interventional Oncology, Shandong University, Jinan 250033, Shandong Province, China; Department of Radiology, Dongying Traditional Chinese Medicine Hospital, Dongying 257055, Shandong Province, China
| | - Peng Wang
- Department of Interventional Medicine, People’s Hospital of Zouping City, Binzhou 256299, Shandong Province, China
| | - Lei Guo
- Department of Vascular Anomalies and Interventional Radiology, Qilu Children’s Hospital of Shandong University, Jinan 250022, Shandong Province, China
| | - Nan Shao
- Institute of Interventional Oncology, Shandong University, Jinan 250033, Shandong Province, China; Department of Radiology, Dongying Traditional Chinese Medicine Hospital, Dongying 257055, Shandong Province, China
| | - Bin Liu
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China; Institute of Interventional Oncology, Shandong University, Jinan 250033, Shandong Province, China
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Chen J, Lai L, Luo J, Wang H, Li M, Huang M. DEM-TACE as the initial treatment could improve the clinical efficacy of the hepatocellular carcinoma with portal vein tumor thrombus: a retrospective controlled study. BMC Cancer 2022; 22:1242. [PMID: 36451104 PMCID: PMC9714197 DOI: 10.1186/s12885-022-10361-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Conventional-transarterial chemoembolization (C-TACE) was proven to improve overall survival (OS) in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT), drug-eluting microsphere-TACE (DEM-TACE) was supposed to provide more benefit than C-TACE in this respect. PURPOSE To compare the safety and efficacy between DEM-TACE and C-TACE as the initial treatment in HCC patients with PVTT and to identify prognostic factors of OS. METHODS The medical records of advanced HCC patients with PVTT who underwent DEM-TACE or C-TACE as the initial thearpy from September 2015 with mean follow-up time 14.9 ± 1.2 (95% CI 12.6-17.2) months were retrospectively evaluated. A total of 97 patients were included, 49 patients in the DEM-TACE group and 48 in the C-TACE group. Adverse events (AEs) related to TACE were compared. Tumor and PVTT radiologic response, time to tumor progression (TTP) and OS were calculated and compared in both groups. RESULTS Patients in DEM-TACE group had a better radiologic response (Tumr response: 89.8% vs. 75.0%; PVTT response: 85.7% vs. 70.8%; overall response: 79.6% vs. 58.3%, P = 0.024) and longer TTP (7.0 months vs. 4.0 months, P = 0.040) than patients in C-TACE group. A lower incidence of abdominal pain was found in the DEM-TACE group than in C-TACE group (21 vs. 31, P = 0.032), but there were no significant differences between DEM-TACE and C-TACE patients in any other AEs reported. When compared to C-TACE, DEM-TACE also showed significant OS benefits (12.0 months vs. 9.0 months, P = 0.027). DEM-TACE treatment, the absence of arterioportal shunt (APS), lower AFP value and better PVTT radiologic response were the independent prognostic factors for OS in univariate/multivariate analyses, which provided us with a guide for better patient selection. CONCLUSIONS Based on our retrospective study, DEM-TACE can be performed safely and might be superior to C-TACE as the initial treatment for HCC patients with PVTT. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Junwei Chen
- Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road 600#, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Lisha Lai
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510030, China
| | - Junyang Luo
- Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road 600#, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Haofan Wang
- Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road 600#, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Mingan Li
- Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road 600#, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Mingsheng Huang
- Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road 600#, Tianhe District, Guangzhou, 510630, Guangdong, China.
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Cao B, Tian K, Zhou H, Li C, Liu D, Tan Y. Hepatic Arterioportal Fistulas: A Retrospective Analysis of 97 Cases. J Clin Transl Hepatol 2022; 10:620-626. [PMID: 36062281 PMCID: PMC9396316 DOI: 10.14218/jcth.2021.00100] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/03/2021] [Accepted: 11/16/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND AIMS Hepatic arterioportal fistulas (HAPFs) are abnormal shunts or aberrant functional connections between the portal venous and the hepatic arterial systems. Detection of HAPFs has increased with the advances in diagnostic techniques. Presence of HAPFs over a prolonged period can aggravate liver cirrhosis and further deteriorate liver function. However, the underlying causes of HAPFs and the treatment outcomes are now well characterized. This study aimed to summarize the clinical characteristics of patients with HAPFs, and to compare the outcomes of different treatment modalities. METHODS Data of 97 patients with HAPFs who were admitted to the Second Xiangya Hospital between January 2010 and January 2020 were retrospectively reviewed. Demographic information, clinical manifestations, underlying causes, treatment options, and short-term outcomes were analyzed. RESULTS The main cause of HAPF in our cohort was hepatocellular carcinoma (78/97, 80.41%), followed by cirrhosis (10/97, 10.31%). The main clinical manifestations were abdominal distention and abdominal pain. Treatment methods included transcatheter arterial embolization (n=63, 64.9%), surgery (n=13, 13.4%), and liver transplantation (n=2, 2.1%); nineteen (19.6%) patients received conservative treatment. Among patients who underwent transcatheter arterial embolization, polyvinyl alcohol, lipiodol combined with gelatin sponge, and spring steel ring showed comparable efficacy. CONCLUSIONS Hepatocellular carcinoma and cirrhosis are common causes of HAPFs. Transcatheter arterial embolization is a safe and effective method for the treatment of HAPFs, and polyvinyl alcohol, lipiodol combined with gelatin sponge, and spring steel ring showed comparable efficacy in our cohort.
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Affiliation(s)
- Bendaxin Cao
- Department of Respiratory and Critical Care Medicine, Affiliated Nanhua Hospital, University of South China, Hengyang, Hunan, China
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Research Center of Digestive Disease, Central South University, Changsha, Hunan, China
| | - Ke Tian
- Department of Respiratory and Critical Care Medicine, Affiliated Nanhua Hospital, University of South China, Hengyang, Hunan, China
| | - Hejun Zhou
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Research Center of Digestive Disease, Central South University, Changsha, Hunan, China
| | - Chenjie Li
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Research Center of Digestive Disease, Central South University, Changsha, Hunan, China
| | - Deliang Liu
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Research Center of Digestive Disease, Central South University, Changsha, Hunan, China
| | - Yuyong Tan
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Research Center of Digestive Disease, Central South University, Changsha, Hunan, China
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Comparison of Transcatheter Arterial Chemoembolization-Radiofrequency Ablation and Transcatheter Arterial Chemoembolization Alone for Advanced Hepatocellular Carcinoma with Macrovascular Invasion Using Propensity Score Analysis: A Retrospective Cohort Study. JOURNAL OF ONCOLOGY 2020; 2020:1341863. [PMID: 32884569 PMCID: PMC7455819 DOI: 10.1155/2020/1341863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 02/08/2023]
Abstract
Background To compare the efficacies of transcatheter arterial chemoembolization (TACE) with radiofrequency ablation (RFA) (TACE + RFA) and TACE alone in patients with hepatocellular carcinoma (HCC) and macrovascular invasion (MVI). Methods In total, 664 patients having HCC with MVI were included. Of these patients, 141 were treated with TACE + RFA, 254 with TACE alone, and 269 with supportive therapy (control group). The overall survival (OS) was compared among these groups. Propensity score matching (PSM) was performed for balancing the characteristics of the three groups. Results After one-to-one PSM, the 12-month OS rates were higher in the TACE and TACE + RFA groups than in the control group (p=0.0009 and p=0.0017, respectively). Furthermore, higher 12-month OS rates were observed in the TACE + RFA group than in the TACE group (p=0.0192). The 12-month OS rates of patients were remarkably higher in α-fetoprotein (AFP) < 400 ng/ml, tumor < 3, tumor diameter < 5 cm, or portal vein tumor thrombosis (PVTT) group who were treated with TACE + RFA than in those who were treated with TACE (p=0.0122, p=0.0090, p=0112, and p=0.0071, respectively). Conclusions TACE + RFA provides a superior survival outcome than TACE alone in HCC patients, especially in AFP <400 ng/ml, tumor <3, tumor diameter <5 cm, or PVTT group.
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A case of complete remission of advanced hepatocellular carcinoma with type III portal vein tumor thrombosis treated using transarterial chemoembolization with microspheres and radiation therapy. Clin J Gastroenterol 2020; 13:847-854. [PMID: 32350739 DOI: 10.1007/s12328-020-01124-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Abstract
Portal vein tumor thrombosis (PVTT) is an extremely locally advanced form of hepatocellular carcinoma. The natural median survival time of patients with hepatocellular carcinoma with PVTT is 2.7 to 4.0 months. A 63-year-old woman visited our clinic complaining of abdominal distention and appetite loss, which she had had for 3 weeks prior to admission. A contrast-enhanced computed tomography scan showed double hepatocellular carcinomas with Type III PVTT and massive ascites caused by arterio-portal shunts within the PVTT. The ascites could not be treated by concentrated ascites reinfusion therapy or diuretics. Transarterial embolization using microspheres followed by radiation therapy against PVTT and five courses of transarterial chemoembolization using microspheres and cisplatin led to the maintaining of complete remission of both ascites and tumors for over 12 months after treatment. Fluoroglucose accumulation of PVTT showed 11.2 as a maximum standard uptake value on positron emission tomography before treatment. No fluoroglucose accumulation within PVTT was observed for over 12 months following treatment. Transarterial chemoembolization using microspheres followed by radiation therapy against Type III PVTT may result in drastic anti-cancer effects and improvement of both serum albumin and intractable ascites after treatment of arterio-portal shunts within the PVTT causing portal hypertension.
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Xiao YD, Ma C, Zhang ZS, Liu J. Safety and efficacy assessment of transarterial chemoembolization using drug-eluting beads in patients with hepatocellular carcinoma and arterioportal shunt: a single-center experience. Cancer Manag Res 2019; 11:1551-1557. [PMID: 30863165 PMCID: PMC6388950 DOI: 10.2147/cmar.s193948] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective To evaluate the feasibility and safety of transarterial chemoembolization with drug-eluting beads (DEB-TACE) in patients with hepatocellular carcinoma (HCC) and arterioportal shunts (APSs). Materials and methods Fifty-eight patients with unresectable HCC and APSs who were treated with DEB-TACE (n=26) or polyvinyl alcohol (PVA) plus TACE (PVA-TACE, n=32) were included in this retrospective study. The tumor response was evaluated by the modified Response Evaluation Criteria in Solid Tumors. Toxicity was graded by the Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v5.0) and compared between the two groups. Survival curves were calculated by the Kaplan-Meier method and compared by the log-rank test between the two groups. The influence of potential prognostic factors on survival in the DEB-TACE group was analyzed via a multivariate Cox regression model. Results The disease control rate was better in the DEB-TACE group than in the PVA-TACE group. The median survival times were 346 and 274 days in the DEB-TACE group and PVA-TACE group, respectively. There was no significant difference in survival rates between the two groups (P=0.081). Patients treated with DEB-TACE were significantly less likely to have fever (P=0.048) or a low-grade (grade 1-2) increase in transaminases (P=0.046) than the patients treated with PVA-TACE. The potential predictive prognostic factors in the DEB-TACE group were tumor response, APS grading, and serum bilirubin. Conclusion DEB-TACE may be feasible and safe in HCC patients with APS. Survival in the DEB-TACE group was associated with tumor response, APS grading, and serum bilirubin levels.
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Affiliation(s)
- Yu-Dong Xiao
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China, ;
| | - Cong Ma
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China, ;
| | - Zi-Shu Zhang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China, ;
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China, ;
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11
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Abstract
An 81-year-old man with a large hepatocellular carcinoma was referred in our institution for Y radioembolization (RE). The preliminary arteriography using Tc-macroaggregate albumin demonstrated an important hepatopulmonary shunt. It was an exclusion criterion for RE due to high risks of lung radiations. Then, the patient was treated with sorafenib during 4 months, stopped because of grade 3 toxicity. A second liver arteriography was performed, and Tc-macroaggregate albumin imaging showed an important reduction of the lung shunt. Transient therapy with sorafenib permitted to close the lung shunt and was a bridge for RE.
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12
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Wu H, Zhao W, Zhang J, Han J, Liu S. Clinical characteristics of hepatic Arterioportal shunts associated with hepatocellular carcinoma. BMC Gastroenterol 2018; 18:174. [PMID: 30419830 PMCID: PMC6233279 DOI: 10.1186/s12876-018-0899-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 10/25/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Hepatic arterioportal shunt (A-P shunt) is defined as the direct blood flow established between hepatic artery and portal venous system; it is frequently observed in patients with hepatocellular carcinoma (HCC). Clinically, it is important to diagnose HCC associated A-P shunts, as it may impact the treatment strategy of the patients. In the present study, we described the imaging findings of the HCC associated A-P shunts and discussed the treatments strategy of such patients. From the findings, we also discussed the potential cause of A-P shunts. METHODS Clinical data of HCC patients (n = 560), admitted to the hospital between April 2012 to April 2014, were reviewed. Hepatic angiography was used to examine the presence of A-P shunts. Of the 137 patients with A-P shunts, grading of the A-P shunts was performed, and statistical analysis of the different grades of A-P shunts and clinical characteristics was performed. RESULTS The hepatic angiography confirmed that 99 patients had typical A-P shunts (Grade 1-3), and 38 patients had atypical A-P shunts. Embolization was the main strategy used to treat A-P shunts, in which liquid embolic agents appeared to provide a better treatment outcome. The correlation analysis showed that the grading of portal vein tumor thrombus was significantly associated with the grading of A-P shunt (p = < 0.001, Spearman correlation coefficient was 0.816 ± 0.043). CONCLUSIONS We characterized A-P shunts and proposed treatment strategy for treating HCC patients with various levels of A-P shunts. The findings supported the hypothesis that the formation of HCC associated A-P shunts was caused by tumor thrombus.
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Affiliation(s)
- Huiyong Wu
- Department of Intervention, Shandong Tumor Hospital Affiliated to Shandong University, Jinan, 250117, China
| | - Wei Zhao
- Department of Radiotherapy, Shandong Tumor Hospital Affiliated to Shandong University, Jinan, 250117, China
| | - Jianbo Zhang
- Department of pathology, Shandong Tumor Hospital Affiliated to Shandong University, Jinan, 250117, China
| | - Jianjun Han
- Department of Intervention, Shandong Tumor Hospital Affiliated to Shandong University, Jinan, 250117, China
| | - Shuguang Liu
- Department of Thoracic Oncology Surgery, Shandong Tumor Hospital Affiliated to Shandong University, No. 440, Jiyan Road, Jinan, 250117, China.
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13
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Xiao L, Liu Q, Zhao W, Pang H, Zeng Q, Chen Y, Zhao J, Mei Q, He X. Chemoembolisation with polyvinyl alcohol for advanced hepatocellular carcinoma with portal vein tumour thrombosis and arterioportal shunts: efficacy and prognostic factors. Clin Radiol 2018; 73:1056.e17-1056.e22. [PMID: 30224186 DOI: 10.1016/j.crad.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 08/03/2018] [Indexed: 01/14/2023]
Abstract
AIM To evaluate the efficacy and to identify prognostic factors of polyvinyl alcohol (PVA) chemoembolisation for treating advanced hepatocellular carcinoma (HCC) with portal vein (PV) tumour thrombosis (PVTT) and arterioportal shunts. MATERIALS AND METHODS The clinical data of 145 advanced HCC patients with PVTT and arterioportal shunts were collected. The patients were divided into two groups: group A, with main PV invasion, (n=56) and group B, with PV branch invasion, (n=89). Based on arterioportal shunt types, different particle sizes of PVA were used for chemoembolisation. The overall survival (OS), time to progression (TTP), and postoperative complications were analysed retrospectively. RESULTS The median OS of all patients was 10.1 months. The median OS of group A and group B was 8.2 and 12.5 months, respectively (χ2=6.03, p=0.01). The overall 6-, 12-, and 18-month survival rates of groups A and B were 63.8%, 24.9%, and 6.3%, and 78.1%, 55.2%, and 23.7%, respectively. After embolisation, there were two cases of acute liver failure and three cases of upper gastrointestinal bleeding. Cox multivariate survival analysis revealed that main PVTT (HR [hazard ratio]=1.75, p=0.01), Child-Pugh B class (HR=1.99, p=0.003) and tumour burden ≥50% (HR=3.25, p<0.001) were independent risk factors. A dose of oxaliplatin >100 mg (HR=0.48, p<0.001) was an independent protection factor. CONCLUSION Treatment of advanced HCC with PVTT and arterioportal shunts by PVA chemoembolisation is safe and effective. The patients achieved a better prognosis with the dose of oxaliplatin >100 mg, while main PVTT, Child-Pugh B class, and tumour burden ≥50% were poor prognostic indicators.
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Affiliation(s)
- L Xiao
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Q Liu
- Department of Tumor and Vascular Interventional Radiology, Affiliated Zhongshan Hospital of Xiamen University, Xiamen, Fujian Province 361004, China
| | - W Zhao
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - H Pang
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Q Zeng
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Y Chen
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - J Zhao
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Q Mei
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - X He
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
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14
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Yasui D, Murata S, Ueda T, Sugihara F, Onozawa S, Kawamoto C, Kumita S. Novel treatment strategy for advanced hepatocellular carcinoma: combination of conventional transcatheter arterial chemoembolization and modified method with portal vein occlusion for cases with arterioportal shunt: a preliminary study. Acta Radiol 2018. [PMID: 28651444 DOI: 10.1177/0284185117717762] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background A novel strategy to combine conventional transcatheter arterial chemoembolization (TACE) and TACE during portal vein occlusion (TACE-PVO) in the presence of high-flow arterioportal shunt (APS) has been developed to treat hepatocellular carcinoma (HCC) with portal invasion. Purpose To evaluate the efficacy of this strategy. Material and Methods Twenty-five cases of HCC with portal invasion, treated between April 2006 and December 2015, were evaluated. Balloon occlusion of the portal venous outlet was performed in eight cases of high-flow APS when performing TACE. Conventional TACE was performed in the other 17 cases. The primary endpoint was overall survival. Adverse events and deterioration of liver function were also evaluated. Results The median survival time (MST) was 12 months. One-, two-, and three-year survival rates were 48.0%, 39.3%, and 26.2%, respectively. Subgroup analysis and multivariate analysis revealed the CLIP score as prognostic factor. MST was 2.5 months in the subgroup with CLIP score ≥4 and 26.0 months in the subgroup with CLIP score ≤3 (hazard ratio = 7.7, 95% confidence interval = 2.3-25.8). Transient elevations of the levels of transaminase and bilirubin were observed; however, deterioration of liver function was infrequent; upgrading of Child-Pugh class in 9.1% of cases. Conclusion A novel strategy, combining conventional TACE and TACE-PVO, is effective for HCC with portal invasion. The CLIP score may be useful for considering treatment indication.
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15
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Imai Y, Hirooka M, Koizumi Y, Nakamura Y, Watanabe T, Yoshida O, Tokumoto Y, Takeshita E, Abe M, Tanaka H, Kurata M, Kitazawa S, Hiasa Y. Histological assessment of the efficacy of drug-eluting beads in portal tumor thrombosis of hepatocellular carcinoma. Radiol Case Rep 2016; 12:179-184. [PMID: 28228906 PMCID: PMC5310373 DOI: 10.1016/j.radcr.2016.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/25/2016] [Accepted: 11/22/2016] [Indexed: 12/17/2022] Open
Abstract
A 58-year-old man was diagnosed with advanced hepatocellular carcinoma with portal vein tumor thrombosis (PVTT). The tumors were multiple and existed in both lobes. Drug-eluting beads transcatheter arterial chemoembolization (DEB-TACE) was performed for the tumors in the left lobe. Embosphere and Hepasphere were selected for embolization of the arterioportal shunt, followed by loaded epirubicin infusion into the left hepatic artery. Computed tomography showed reduction of PVTT. However, liver failure progressed, and the patient died 67 days after DEB-TACE. Autopsy showed that the beads reached the tumor thrombosis in the portal vein. The prognosis of hepatocellular carcinoma with PVTT is poor. Although there are no established treatments for unresectable PVTT, DEB-TACE might be a useful option for such cases.
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Affiliation(s)
- Yusuke Imai
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Masashi Hirooka
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Yohei Koizumi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Yoshiko Nakamura
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Takao Watanabe
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Osamu Yoshida
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Yoshio Tokumoto
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Eiji Takeshita
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Masanori Abe
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Hiroaki Tanaka
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Mie Kurata
- Department of Pathogenomics, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Sohei Kitazawa
- Department of Molecular Pathology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
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16
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Liu QS, Mei QL, Li YH. Polyvinyl alcohol terminal chemoembolization for hepatocellular carcinoma with hepatic arteriovenous shunts: Safety, efficacy, and prognostic factors. Eur J Radiol 2016; 89:277-283. [PMID: 27908612 DOI: 10.1016/j.ejrad.2016.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/04/2016] [Accepted: 04/29/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of polyvinyl alcohol (PVA) terminal chemoembolization and to identify the prognostic factors associated with survival in hepatocellular carcinoma (HCC) patients with hepatic arteriovenous shunts (HAVS). MATERIALS AND METHODS Of 133 patients' managements were retrospectively analyzed. HAVS was classified into three types: slow-flow, intermediate-flow and high-flow. The size of the PVA used was determined following the scheme: slow-flow HAVS: 300-500μm PVA; intermediate-flow HAVS: 500-710μm PVA; high-flow HAVS: 710-1000μm PVA. The HCCs with slow-flow and intermediate-flow HAVS were embolized by PVA plus chemotherapeutic agents lipiodol emulsion, while the high-flow HAVS were treated by PVA with chemotherapeutic agents. Survival curves were calculated by Kaplan-Meier method and compared by log-rank test. The influence of possible prognostic factors on survival were analyzed by multivariate Cox proportional-hazards method. RESULTS The median overall survival (OS) of 133 patients was 9.1 months. The median OS of the slow-flow type, intermediate-flow type and high-flow type patients were 10.8, 9.1 and 7.3 months, respectively. There was no statistically significant difference among different HAVS types (P=0.239). The 30-day mortality was 3.8%. Cox multivariate survival analysis revealed that initial preoperative AFP value≥400ng/ml (HR=2.105, P=0.006) was an independent risk factor. While multiple embolization (HR=0.482, P=0.011), tumor remission (HR=0.431, P=0.041) and multimodality therapy (HR=0.416, P=0.004) were independent protection factors. CONCLUSION It is safe and effective for HCCs with HAVS treated by terminal chemoembolization therapy with PVA plus chemotherapeutic agents lipiodol emulsion (or PVA plus chemotherapeutic agents). The HCCs with HAVS achieves good prognosis with multiple embolization, tumor remission and multimodality therapy, while achieves poor prognosis with inital preoperative high AFP value (≥400ng/ml).
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Affiliation(s)
- Qiu-Song Liu
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, No.1838, North of Guangzhou Avenue, Guangzhou 510515, China
| | - Que-Lin Mei
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, No.1838, North of Guangzhou Avenue, Guangzhou 510515, China
| | - Yan-Hao Li
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, No.1838, North of Guangzhou Avenue, Guangzhou 510515, China.
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17
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Takagi K, Yagi T, Yoshida R, Shinoura S, Umeda Y, Nobuoka D, Watanabe N, Kuise T, Sui K, Hirose A, Tsuboi M, Ogasawara M, Iwasaki S, Saibara T, Fujiwara T. A successful case of deceased donor liver transplantation for a patient with intrahepatic arterioportal fistula. Hepatol Res 2016; 46:1409-1415. [PMID: 26990240 DOI: 10.1111/hepr.12701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/17/2016] [Accepted: 03/01/2016] [Indexed: 12/31/2022]
Abstract
Intrahepatic arterioportal fistula (IAPF) is a rare cause of portal hypertension that is often difficult to treat with interventional radiology or surgery. Liver transplantation for IAPF is extremely rare. We report a case of bilateral diffuse IAPF with severe portal hypertension requiring deceased donor liver transplantation (DDLT). A 51-year-old woman with no past medical history was admitted to another hospital complaining of abdominal distension and marasmus. A computed tomography scan and digital subtraction angiography indicated a massive pleural effusion, ascites, and a very large IAPF. Several attempts of interventional embolization of the feeding artery failed to ameliorate arterioportal shunt flow. As ruptures of the esophageal varices became more frequent, hepatic encephalopathy worsened. After repeated, uncontrollable attacks of hepatic coma, the patient was referred to our facility for further treatment. Surgical approaches to IAPF other than liver transplantation were challenging because of diffuse collateralization; therefore, we placed the patient on the national waiting list for DDLT. Although her Model for End-Stage Liver Disease score was relatively low, she received a DDLT 2 months after the waiting period. The postoperative course was uneventful, and the patient was discharged 44 days after her transplant. Liver transplantation may be a valid treatment option for uncontrollable IAPF with severe portal hypertension.
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Affiliation(s)
- Kosei Takagi
- Hepato-Biliary and Pancreatic Surgery, Okayama University Hospital, Okayama, Japan
| | - Takahito Yagi
- Hepato-Biliary and Pancreatic Surgery, Okayama University Hospital, Okayama, Japan
| | - Ryuichi Yoshida
- Hepato-Biliary and Pancreatic Surgery, Okayama University Hospital, Okayama, Japan
| | - Susumu Shinoura
- Hepato-Biliary and Pancreatic Surgery, Okayama University Hospital, Okayama, Japan
| | - Yuzo Umeda
- Hepato-Biliary and Pancreatic Surgery, Okayama University Hospital, Okayama, Japan
| | - Daisuke Nobuoka
- Hepato-Biliary and Pancreatic Surgery, Okayama University Hospital, Okayama, Japan
| | - Nobuyuki Watanabe
- Hepato-Biliary and Pancreatic Surgery, Okayama University Hospital, Okayama, Japan
| | - Takashi Kuise
- Hepato-Biliary and Pancreatic Surgery, Okayama University Hospital, Okayama, Japan
| | - Kenta Sui
- Hepato-Biliary and Pancreatic Surgery, Okayama University Hospital, Okayama, Japan
| | - Akira Hirose
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
| | - Makiko Tsuboi
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
| | - Mitsunari Ogasawara
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
| | - Shinji Iwasaki
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
| | - Toshiji Saibara
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Transplant Surgery and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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18
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Huang M, Lin Q, Wang H, Chen J, Bai M, Wang L, Zhu K, Jiang Z, Guan S, Li Z, Qian J, Li M, Pang P, Shan H. Survival benefit of chemoembolization plus Iodine125 seed implantation in unresectable hepatitis B-related hepatocellular carcinoma with PVTT: a retrospective matched cohort study. Eur Radiol 2016; 26:3428-36. [PMID: 26792430 PMCID: PMC5021746 DOI: 10.1007/s00330-015-4198-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 12/22/2015] [Accepted: 12/30/2015] [Indexed: 01/10/2023]
Abstract
Objectives To investigate the survival benefit of transarterial chemoembolization (TACE) plus Iodine125 seed implantation (TACE-Iodine125) in hepatitis B-related HCC patients with portal vein tumour thrombus (PVTT) and the underlying prognostic factors. Methods A retrospective matched cohort study was performed on consecutive HCC patients with PVTT from January 2011 to June 2014. Seventy patients (TACE-Iodine125 group) who underwent TACE-Iodine125 were compared with a historical case-matched control group of 140 patients (TACE group) who received TACE alone. The survival of patients and the underlying prognostic factors were analysed. Results The median survival times of the TACE-Iodine125 and TACE groups were 11.0 and 7.5 months, respectively (p < 0.001). The survival probability at 12, 24, and 36 months was 50 %, 14.5 %, and 14.5 % vs. 25 %, 9 %, and 5 % in the TACE-Iodine125 and TACE groups, respectively (p < 0.001). The PVTT responders had better survival than the PVTT non-responders (p < 0.001). For the PVTT non-responders, there were no differences in the survival curves between the groups (p = 0.353). Multivariate analysis showed that type III PVTT (p < 0.001) and APS (p < 0.001) were independent predictors of poor prognosis. In contrast, the treatment modality of TACE-Iodine125 (p < 0.001) and PVTT response (p = 0.001) were favourable prognostic features. Conclusions TACE combined with Iodine125 seed implantation may be a good choice for selected HB-HCC patients with PVTT. Key Points • TACE-Iodine125 was more effective than TACE for patients with HCC-PVTT. • The TACE-Iodine125 procedure was safe. • TACE-Iodine125 was conditional for patients with HCC-PVTT. • TACE-Iodine125 resulted in a better PVTT response compared to TACE alone. • A good PVTT response is a favourable prognostic factor.
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Affiliation(s)
- Mingsheng Huang
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China. .,Department of Interventional Radiology, Ling-nan Hospital, Sun Yat-Sen University, Guangzhou, China. .,Interventional Radiology Institute, Sun Yat-sen University, Guangzhou, China.
| | - Qu Lin
- Department of Oncology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haofan Wang
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China.,Department of Interventional Radiology, Ling-nan Hospital, Sun Yat-Sen University, Guangzhou, China.,Interventional Radiology Institute, Sun Yat-sen University, Guangzhou, China
| | - Junwei Chen
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China.,Department of Interventional Radiology, Ling-nan Hospital, Sun Yat-Sen University, Guangzhou, China.,Interventional Radiology Institute, Sun Yat-sen University, Guangzhou, China
| | - Mingjun Bai
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China.,Department of Interventional Radiology, Ling-nan Hospital, Sun Yat-Sen University, Guangzhou, China.,Interventional Radiology Institute, Sun Yat-sen University, Guangzhou, China
| | - Long Wang
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China.,Department of Interventional Radiology, Ling-nan Hospital, Sun Yat-Sen University, Guangzhou, China.,Interventional Radiology Institute, Sun Yat-sen University, Guangzhou, China
| | - Kangshun Zhu
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China.,Department of Interventional Radiology, Ling-nan Hospital, Sun Yat-Sen University, Guangzhou, China.,Interventional Radiology Institute, Sun Yat-sen University, Guangzhou, China
| | - Zaibo Jiang
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China.,Department of Interventional Radiology, Ling-nan Hospital, Sun Yat-Sen University, Guangzhou, China.,Interventional Radiology Institute, Sun Yat-sen University, Guangzhou, China
| | - Shouhai Guan
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China.,Department of Interventional Radiology, Ling-nan Hospital, Sun Yat-Sen University, Guangzhou, China.,Interventional Radiology Institute, Sun Yat-sen University, Guangzhou, China
| | - Zhengran Li
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China.,Department of Interventional Radiology, Ling-nan Hospital, Sun Yat-Sen University, Guangzhou, China.,Interventional Radiology Institute, Sun Yat-sen University, Guangzhou, China
| | - Jiesheng Qian
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China.,Department of Interventional Radiology, Ling-nan Hospital, Sun Yat-Sen University, Guangzhou, China.,Interventional Radiology Institute, Sun Yat-sen University, Guangzhou, China
| | - Mingan Li
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China.,Department of Interventional Radiology, Ling-nan Hospital, Sun Yat-Sen University, Guangzhou, China.,Interventional Radiology Institute, Sun Yat-sen University, Guangzhou, China
| | - Pengfei Pang
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China.,Department of Interventional Radiology, Ling-nan Hospital, Sun Yat-Sen University, Guangzhou, China.,Interventional Radiology Institute, Sun Yat-sen University, Guangzhou, China
| | - Hong Shan
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China. .,Department of Interventional Radiology, Ling-nan Hospital, Sun Yat-Sen University, Guangzhou, China. .,Interventional Radiology Institute, Sun Yat-sen University, Guangzhou, China.
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19
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Nakajima Y, Takahashi A, Kanno Y, Gunji N, Imaizumi H, Hayashi M, Okai K, Abe K, Watanabe H, Ohira H. Paralytic Ileus due to Superior Mesenteric Venous Thrombosis after Transarterial Injection for Hepatocellular Carcinoma. Intern Med 2016; 55:37-42. [PMID: 26726083 DOI: 10.2169/internalmedicine.55.5907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 69-year-old man was admitted to hospital with abdominal pain. In the four years prior to his presentation, he had undergone repeated transarterial chemoembolizations and injections for hepatocellular carcinoma. He underwent his 8th transcatheter arterial therapy one month prior to admission. Abdominal X-rays and contrast-enhanced computed tomography showed large amounts of small intestinal gas and venous thrombosis from the portal vein to the superior mesenteric vein, respectively. The thrombosis was reduced after anticoagulation therapy (heparin, antithrombin III, danaparoid sodium and warfarin). This is the first case report of paralytic ileus due to superior mesenteric venous thrombosis after transcatheter arterial therapy for hepatocellular carcinoma with an arterioportal shunt.
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Affiliation(s)
- Yuki Nakajima
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Japan
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Zhou WZ, Shi HB, Liu S, Yang ZQ, Zhou CG, Xia JG, Zhao LB, Li LS. Arterioportal shunts in patients with hepatocellular carcinoma treated using ethanol-soaked gelatin sponge: therapeutic effects and prognostic factors. J Vasc Interv Radiol 2015; 26:223-230. [PMID: 25645411 DOI: 10.1016/j.jvir.2014.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 10/30/2014] [Accepted: 11/01/2014] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of transarterial embolization with ethanol-soaked gelatin sponge (ESG) for the treatment of arterioportal shunts (APSs) in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS A total of 61 patients with unresectable HCC was included in this study, conducted from June 2008 to November 2011. These patients, who were treated with APSs, had received transarterial therapy. They underwent transarterial embolization of the shunt with ESG followed by transarterial chemoembolization if available. Changes in APSs, tumor response (per modified Response Evaluation Criteria in Solid Tumors), postembolization events, patient survival, and prognostic factors were analyzed. RESULTS The median follow-up period was 13 months (range, 3-34 mo). The immediate APS improvement rate was 97% (59 of 61), and the APS improvement rate at first-time follow-up was 54% (33 of 61). Tumor response at 2 months after first embolization was as follows: complete response in two patients (3.3%), partial response in 24 patients (39.3%), stable disease in 24 patients (39.3%), and progressive disease in 11 patients (18.1%). Survival rates were 79% at 6 months, 50% at 1 year, and 12% at 2 years; the median survival time was 382 days. Maximal tumor size and APS improvement at first-time follow-up were demonstrated to be independent prognostic factors (P < .05). CONCLUSIONS Transarterial embolization with ESG may be safe and effective for the treatment of APSs in patients with unresectable HCC. Small maximal tumor size (< 5 cm) and an improvement in APSs favored overall survival.
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Affiliation(s)
- Wei-Zhong Zhou
- Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Rd., Gulou District, Nanjing 210029, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Rd., Gulou District, Nanjing 210029, China.
| | - Sheng Liu
- Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Rd., Gulou District, Nanjing 210029, China
| | - Zheng-Qiang Yang
- Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Rd., Gulou District, Nanjing 210029, China
| | - Chun-Gao Zhou
- Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Rd., Gulou District, Nanjing 210029, China
| | - Jin-Guo Xia
- Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Rd., Gulou District, Nanjing 210029, China
| | - Lin-Bo Zhao
- Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Rd., Gulou District, Nanjing 210029, China
| | - Lin-Sun Li
- Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Rd., Gulou District, Nanjing 210029, China
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Oh D, Shin SW, Park HC, Cho SK, Lim DH, Paik SW. Changes in arterioportal shunts in hepatocellular carcinoma patients with portal vein thrombosis who were treated with chemoembolization followed by radiotherapy. Cancer Res Treat 2014; 47:251-8. [PMID: 25578056 PMCID: PMC4398114 DOI: 10.4143/crt.2014.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 03/18/2014] [Indexed: 01/14/2023] Open
Abstract
Purpose In this study, we retrospectively investigated the prevalence of arterioportal (AP) shunts in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) and evaluated the changes in AP shunts after chemoembolization followed by external beam radiation therapy (EBRT). Materials and Methods We analyzed 54 HCC patients with PVTT who were treated with chemoembolization followed by EBRT. EBRT was uniformly delivered at a total dose of 30 to 45 Gy (median, 35 Gy), with a daily dose of 2 to 4.5 Gy. Angiographic images of chemoembolization before and after radiation therapy (RT) were reviewed to investigate the AP shunt. Results During the initial session of chemoembolization, 33 of 54 patients (61%) had an AP shunt. After EBRT, 32 out of 33 patients had an additional session of chemoembolization and were evaluated for a change in the AP shunt. The AP shunt decreased in 20 of 32 patients (63%) after chemoembolization followed by EBRT. The 1-year calculated overall survival (OS) rate for all patients was 52.6% and the 2-year OS was 36.4%. The median OS in all patients was 13 months. Patients with AP shunt showed poorer median OS than those without AP shunt, but there was no statistically significant difference (median, 12 months vs. 17 months). Conclusion The AP shunt frequently occurs in HCC patients with PVTT. This study suggests that a poor prognosis is associated with an AP shunt. Chemoembolization followed by RT may produce a decrease in AP shunts.
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Affiliation(s)
- Dongryul Oh
- Departments of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Wook Shin
- Departments of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Chul Park
- Departments of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Ki Cho
- Departments of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Hoon Lim
- Departments of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woon Paik
- Departments of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Louguet S, Verret V, Bédouet L, Servais E, Pascale F, Wassef M, Labarre D, Laurent A, Moine L. Poly(ethylene glycol) methacrylate hydrolyzable microspheres for transient vascular embolization. Acta Biomater 2014; 10:1194-205. [PMID: 24321348 DOI: 10.1016/j.actbio.2013.11.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 11/06/2013] [Accepted: 11/27/2013] [Indexed: 11/19/2022]
Abstract
Poly(ethylene glycol) methacrylate (PEGMA) hydrolyzable microspheres intended for biomedical applications were readily prepared from poly(lactide-co-glycolide) (PLGA)-poly(ethylene glycol) (PEG)-PLGA crosslinker and PEGMA as a monomer using a suspension polymerization process. Additional co-monomers, methacrylic acid and 2-methylene-1,3-dioxepane (MDO), were incorporated into the initial formulation to improve the properties of the microspheres. All synthesized microspheres were spherical in shape, calibrated in the 300-500 μm range, swelled in phosphate-buffered saline (PBS) and easily injectable through a microcatheter. Hydrolytic degradation experiments performed in PBS at 37 °C showed that all of the formulations tested were totally degraded in less than 2 days. The resulting degradation products were a mixture of low-molecular-weight compounds (PEG, lactic and glycolic acids) and water-soluble polymethacrylate chains having molecular weights below the threshold for renal filtration of 50 kg mol(-1) for the microspheres containing MDO. Both the microspheres and the degradation products were determined to exhibit minimal cytotoxicity against L929 fibroblasts. Additionally, in vivo implantation in a subcutaneous rabbit model supported the in vitro results of a rapid degradation rate of microspheres and provided only a mild and transient inflammatory reaction comparable to that of the control group.
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Affiliation(s)
- Stéphanie Louguet
- Occlugel S.A.S., 12 Rue Charles de Gaulle, 78350 Jouy en Josas, France
| | - Valentin Verret
- Occlugel S.A.S., 12 Rue Charles de Gaulle, 78350 Jouy en Josas, France; Archimmed S.A.R.L., 12 Rue Charles de Gaulle, 78350 Jouy en Josas, France
| | - Laurent Bédouet
- Occlugel S.A.S., 12 Rue Charles de Gaulle, 78350 Jouy en Josas, France
| | - Emeline Servais
- Occlugel S.A.S., 12 Rue Charles de Gaulle, 78350 Jouy en Josas, France
| | - Florentina Pascale
- Archimmed S.A.R.L., 12 Rue Charles de Gaulle, 78350 Jouy en Josas, France
| | - Michel Wassef
- AP-HP hôpital Lariboisière, Department of Pathology, University of Paris 7 - Denis Diderot, Faculty of Medicine, 2 rue Ambroise Paré, 75010 Paris, France
| | - Denis Labarre
- Université Paris-Sud, Institut Galien Paris-Sud, LabEx LERMIT, Faculté de Pharmacie, 5 rue J.B. Clément, 92296 Châtenay-Malabry, France; CNRS UMR 8612, Institut Galien Paris-Sud, LabEx LERMIT, 5 rue J.B. Clément, 92296 Châtenay-Malabry, France
| | - Alexandre Laurent
- AP-HP hôpital Lariboisière, Department of Pathology, University of Paris 7 - Denis Diderot, Faculty of Medicine, 2 rue Ambroise Paré, 75010 Paris, France; "Laboratoire Matières et Systèmes Complexes", CNRS 7057, University of Paris 7, Bâtiment Condorcet, 10 rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
| | - Laurence Moine
- Université Paris-Sud, Institut Galien Paris-Sud, LabEx LERMIT, Faculté de Pharmacie, 5 rue J.B. Clément, 92296 Châtenay-Malabry, France; CNRS UMR 8612, Institut Galien Paris-Sud, LabEx LERMIT, 5 rue J.B. Clément, 92296 Châtenay-Malabry, France.
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Shi HB, Yang ZQ, Liu S, Zhou WZ, Zhou CG, Zhao LB, Xia JG, Li LS. Transarterial embolization with cyanoacrylate for severe arterioportal shunt complicated by hepatocellular carcinoma. Cardiovasc Intervent Radiol 2013; 36:412-421. [PMID: 22580682 DOI: 10.1007/s00270-012-0410-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE 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. MATERIALS AND 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. CONCLUSION 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.
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Affiliation(s)
- Hai-Bin Shi
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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Ratti F, Cipriani F, Paganelli M, Ferla G, Aldrighetti LAM. Surgical approach to multifocal hepatocellular carcinoma with portal vein thrombosis and arterioportal shunt leading to portal hypertension and bleeding: a case report. World J Surg Oncol 2012; 10:34. [PMID: 22330617 PMCID: PMC3305563 DOI: 10.1186/1477-7819-10-34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 02/13/2012] [Indexed: 02/06/2023] Open
Abstract
It is reported the case of a 69 years man who presented to the Emergency Room because of pain and abdominal distension from ascites. After admission and paracentesis placement, he developed a digestive hemorrhage due to oesophageal varices from portal ipertension secondary to the formation of a portal shunt concomitant with a multifocal HepatoCellular Carcinoma (HCC) with portal vein thrombosis (PVT). The patient underwent endoscopic varices ligation, twice transarterial embolization (TAE) of arterial branches feeding the shunt and subsequent left hepatectomy. During the postoperative course he developed mild and transient signs of liver failure and was discharged in postoperative day 16. He is alive and disease free 8 months after surgery.
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Affiliation(s)
- Francesca Ratti
- Department of Surgery, Vita-Salute S Raffaele University, Milan, Italy.
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Vogl TJ, Nour-Eldin NE, Emad-Eldin S, Naguib NNN, Trojan J, Ackermann H, Abdelaziz O. Portal vein thrombosis and arterioportal shunts: effects on tumor response after chemoembolization of hepatocellular carcinoma. World J Gastroenterol 2011; 17:1267-75. [PMID: 21455325 PMCID: PMC3068261 DOI: 10.3748/wjg.v17.i10.1267] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 11/11/2010] [Accepted: 11/18/2010] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the effect of portal vein thrombosis and arterioportal shunts on local tumor response in advanced cases of unresectable hepatocellular carcinoma treated by transarterial chemoembolization. METHODS A retrospective study included 39 patients (mean age: 66.4 years, range: 45-79 years, SD: 7) with unresectable hepatocellular carcinoma (HCC) who were treated with repetitive transarterial chemoembolization (TACE) in the period between March 2006 and October 2009. The effect of portal vein thrombosis (PVT) (in 19 out of 39 patients), the presence of arterioportal shunt (APS) (in 7 out of 39), the underlying liver pathology, Child-Pugh score, initial tumor volume, number of tumors and tumor margin definition on imaging were correlated with the local tumor response after TACE. The initial and end therapy local tumor responses were evaluated according to the response evaluation criteria in solid tumors (RECIST) and magnetic resonance imaging volumetric measurements. RESULTS The treatment protocols were well tolerated by all patients with no major complications. Local tumor response for all patients according to RECIST criteria were partial response in one patient (2.6%), stable disease in 34 patients (87.1%), and progressive disease in 4 patients (10.2%). The MR volumetric measurements showed that the PVT, APS, underlying liver pathology and tumor margin definition were statistically significant prognostic factors for the local tumor response (P = 0.018, P = 0.008, P = 0.034 and P = 0.001, respectively). The overall 6-, 12- and 18-mo survival rates from the initial TACE were 79.5%, 37.5% and 21%, respectively. CONCLUSION TACE may be exploited safely for palliative tumor control in patients with advanced unresectable HCC; however, tumor response is significantly affected by the presence or absence of PVT and APS.
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Spontaneous resolution of an iatrogenic arterioportal fistula following portal-vein thrombosis. Radiol Case Rep 2011; 6:422. [PMID: 27307923 PMCID: PMC4899985 DOI: 10.2484/rcr.v6i4.422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Ishii H, Sonoyama T, Nakashima S, Nagata H, Shiozaki A, Kuriu Y, Ikoma H, Nakanishi M, Ichikawa D, Fujiwara H, Okamoto K, Ochiai T, Kokuba Y, Sakakura C, Otsuji E. Surgical treatment of hepatocellular carcinoma with severe intratumoral arterioportal shunt. World J Gastroenterol 2010; 16:3211-4. [PMID: 20593509 PMCID: PMC2896761 DOI: 10.3748/wjg.v16.i25.3211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We report a case of hepatocellular carcinoma (HCC) that caused a severe arterioportal shunt (APS). A 49-year-old man was admitted to hospital due to esophagogastric variceal hemorrhage and HCC, and underwent endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS). He was then referred to our hospital. Abdominal computed tomography revealed a low-density lesion in the posterior segment of the liver and an intratumoral APS, which caused portal hypertension. Although the patient underwent EVL, EIS, Hassab’s operation, and transcatheter arterial embolization for APS, he vomited blood due to rupture of esophagogastric varices. Right hepatectomy was performed for the treatment of HCC and APS, although the indocyanine green retention value at 15 min after intravenous injection was poor (30%). The patient’s postoperative course was uneventful. Eventually, APS disappeared and the esophagogastric varices improved.
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Absolute Ethanol Sclerotherapy for Venous Malformations in the Face and Neck. J Oral Maxillofac Surg 2010; 68:1622-7. [DOI: 10.1016/j.joms.2009.07.094] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Revised: 05/10/2009] [Accepted: 07/27/2009] [Indexed: 11/18/2022]
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Zheng LZ, Fan XD, Zheng JW, Su LX. Ethanol embolization of auricular arteriovenous malformations: preliminary results of 17 cases. AJNR Am J Neuroradiol 2009; 30:1679-84. [PMID: 19617451 DOI: 10.3174/ajnr.a1687] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Because of the relatively rare and extremely varied clinical presentations, arteriovenous malformations (AVMs) involving the auriculae are technically challenging clinical entities to diagnose and, ultimately, manage. The purpose of our study was to present our initial experience of ethanol embolization in a series of 17 patients with auricular AVMs and assess the interim therapeutic outcomes of this method. MATERIALS AND METHODS Our study group consisted of 17 patients. Transcatheter arterial embolization and/or direct percutaneous puncture embolization were performed. Pure or diluted ethanol was manually injected. Follow-up evaluation was obtained on the basis of physical examination and angiography at 3- to 4-month intervals and telephone questionnaire at 1-month intervals in all patients. RESULTS During the 29 ethanol embolization procedures, the amount of ethanol used ranged from 4 to 65 mL. The obliteration of ulceration, hemorrhage, pain, infection, pulsation, and bruit in most of the patients was obtained. The reduction of redness, swelling, and warmth was achieved in all of the patients, and 15 of the patients achieved downstaging of the Schobinger status. According to the angiographic findings, AVMs were devascularized 100% in 3 patients, 76% to 99% in 5 patients, 50% to 75% in 6 patients, and less than 50% in 3 patients. The most common complications were reversible necrosis and blister. CONCLUSIONS Ethanol embolization has proved efficacious and safe in the treatment of auricular AVMs and has the potential to be accepted as the primary mode of therapy in the management of these lesions.
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Affiliation(s)
- L Z Zheng
- Department of Radiology, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, P.R. China
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Kim YJ, Lee HG, Park JM, Lim YS, Chung MH, Sung MS, Yoo WJ, Lim HW. Polyvinyl alcohol embolization adjuvant to oily chemoembolization in advanced hepatocellular carcinoma with arterioportal shunts. Korean J Radiol 2007; 8:311-9. [PMID: 17673842 PMCID: PMC2627160 DOI: 10.3348/kjr.2007.8.4.311] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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). MATERIALS AND 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. CONCLUSION P-TACE is feasible and safe in advanced HCC patients with APS.
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Affiliation(s)
- Yeo Ju Kim
- Department of Radiology, Holy Family Hospital, College of Medicine, The Catholic University of Korea, Kyungki-Do 420-717, Korea
| | - Hae Giu Lee
- Department of Radiology, Holy Family Hospital, College of Medicine, The Catholic University of Korea, Kyungki-Do 420-717, Korea
| | - Jeong Mi Park
- Department of Radiology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 150-713, Korea
| | - Yeon Soo Lim
- Department of Radiology, Holy Family Hospital, College of Medicine, The Catholic University of Korea, Kyungki-Do 420-717, Korea
| | - Myung Hee Chung
- Department of Radiology, Holy Family Hospital, College of Medicine, The Catholic University of Korea, Kyungki-Do 420-717, Korea
| | - Mi Sook Sung
- Department of Radiology, Holy Family Hospital, College of Medicine, The Catholic University of Korea, Kyungki-Do 420-717, Korea
| | - Won Jong Yoo
- Department of Radiology, Holy Family Hospital, College of Medicine, The Catholic University of Korea, Kyungki-Do 420-717, Korea
| | - Hyun Wook Lim
- Department of Radiology, Holy Family Hospital, College of Medicine, The Catholic University of Korea, Kyungki-Do 420-717, Korea
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Mamada Y, Yoshida H, Taniai N, Bandou K, Mizuguchi Y, Kakinuma D, Ishikawa Y, Akimaru K, Tajiri T, Naito Z. Major arterioportal shunt caused by hepatocellular carcinoma. J NIPPON MED SCH 2007; 74:314-8. [PMID: 17878703 DOI: 10.1272/jnms.74.314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A case of hepatocellular carcinoma (HCC) causing a major arterioportal (A-P) shunt is reported. The patient exhibited massive ascites and tested positive for hepatitis B surface antigen. An abdominal computed tomography (CT) examination showed a low-density lesion in the left lobe of the liver and an A-P shunt, but no tumor stain was visible. Upper gastrointestinal endoscopy revealed severe esophageal varices. Because the tumor marker level was abnormally high, an HCC causing an A-P shunt in a cirrhotic liver background with severe esophageal varices as a result of portal hypertension was diagnosed. We performed endoscopic variceal ligation to treat the severe esophageal varices and interventional radiology treatment for the A-P shunt and HCC, but the patients condition was unchanged. Because the patients liver function gradually improved, surgical treatment was selected. The patient underwent left hepatectomy. Pathological examination revealed a poorly differentiated HCC in a cirrhotic liver background. The postoperative course was uneventful, and the patient was discharged 2 weeks after the operation. The patient subsequently underwent transcatheter arterial embolization therapy for recurrent HCC in the right lobe of the liver, but the esophageal varices disappeared.
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Affiliation(s)
- Yasuhiro Mamada
- Surgery for Organ Function and Biological Regulation, Graduate School of Medinine, Nippon Medical School, Tokyo, Japan.
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Stampfl S, Stampfl U, Rehnitz C, Schnabel P, Satzl S, Christoph P, Henn C, Thomas F, Richter GM. Experimental evaluation of early and long-term effects of microparticle embolization in two different mini-pig models. Part II: liver. Cardiovasc Intervent Radiol 2007; 30:462-8. [PMID: 17342551 DOI: 10.1007/s00270-005-0350-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate trisacryl-gelatin microspheres (40-120 microm) for acute and chronic tissue embolization in mini-pig livers. METHODS Thirteen animals were divided into four groups: group 1 (n = 3), total arterial bed occlusion with acute procedure; groups 2 to 4, chronic superselective embolization with follow-up of 1 week (group 2, n = 1), 4 weeks (group 3, n = 4) or 14 weeks (group 4, n = 5). Key endpoints were homogeneity and particle distribution in acute embolizations (group 1) and necrosis and inflammation in chronic embolizations (groups 2-4) as assessed microscopically and angiographically. RESULTS After liver embolization, parenchymal necrosis did not occur; only signs of vessel wall disintegration were evident. The bile ducts remained intact. A distinct foreign body reaction with sparse leukocytic infiltration and giant cells was found at 14 weeks, but no signs of major inflammation were found. Particles were seen at the presinusoidal level, but no particle transportation into the sinusoids was observed. CONCLUSIONS Embolization in mini-pig livers, using small trisacryl-gelatin microspheres, results in vessel fibrosis without parenchymal or bile duct necrosis. The most likely explanation for preservation of the parenchyma is portal inflow. Small trisacryl-gelatin microspheres may be ideal as an adjunct for chemoembolization.
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Affiliation(s)
- S Stampfl
- Department of Diagnostic Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
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Liver embolizations in oncology: A review. Med Oncol 2007; 25:1-11. [DOI: 10.1007/s12032-007-0039-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Accepted: 05/20/2007] [Indexed: 02/08/2023]
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Hsu HC, Chen TY, Chiu KW, Huang EY, Leung SW, Huang YJ, Wang CY. Three-dimensional conformal radiotherapy for the treatment of arteriovenous shunting in patients with hepatocellular carcinoma. Br J Radiol 2007; 80:38-42. [PMID: 16971419 DOI: 10.1259/bjr/55395102] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The objective of this study is to evaluate the efficacy of radiotherapy for the treatment of arteriovenous shunting (AVS) in patients with hepatocellular carcinoma (HCC). Between November 1997 and April 2005, 20 HCC patients with AVS were referred to our department for radiotherapy. The radiation was delivered with 10-15 MV X-ray given 5 days per week at 2 approximately 2.5 Gy per fraction. Total doses ranged from 45 to 64 Gy (median dose 60 Gy). The patients were followed up with color Doppler sonography. When non-invasive imaging suggested obliteration, X-ray angiography was performed to verify the results. Four of the 20 AVS proved to be completely obliterated at X-ray angiography in 1.9, 2.8, 1.8 and 2.9 months after radiotherapy. One of the remaining 16 showed obvious regression on Doppler sonography 0.5 months after radiotherapy, but X-ray angiography was not performed to verify the result. Radiation-related hepatic failure did not occur during the follow-up period. In conclusion, radiotherapy is a treatment alternative for AVS in HCC patients and gives patients with poor prognosis the chance to receive further transcatheter arterial embolization.
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Affiliation(s)
- H C Hsu
- Department of Radiation Oncology, Chang Gung Memorial Hospital-Kaohsung Medical Center, 123, Ta-Pei Road, Niao Sung Hsian, Kaohsiung 807, Taiwan.
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Su YW, Huang YW, Chen SH, Tzen CY. Quantitative analysis of plasma HBV DNA for early evaluation of the response to transcatheter arterial embolization for HBV-related hepatocellular carcinoma. World J Gastroenterol 2005; 11:6193-6. [PMID: 16273649 PMCID: PMC4436639 DOI: 10.3748/wjg.v11.i39.6193] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assesse changes in plasma HBV DNA after TAE in HBV-related HCC and correlate the levels with the pattern of lipiodol accumulation on CT.
METHODS: Between April and June 2001, 14 patients with HBV-associated HCC who underwent TAE for inoperable or recurrent tumor were studied. Levels of plasma HBV DNA were measured by real-time quantitative PCR daily for five consecutive days after TAE. More than twofold elevation of circulating HBV DNA was considered as a definite elevation. Abdominal CT was performed 1-2 mo after TAE for the measurement of lipiodol retention.
RESULTS: Circulating HBV DNA in 10 out of 13 patients was elevated after TAE, except for one patient whose plasma HBV DNA was undetectable before and after TAE. In group I patients (n = 6), the HBV DNA elevation persisted for more than 2 d, while in group II (n = 7), the HBV DNA elevation only appeared for 1 d or did not reach a definite elevation. There were no significant differences in age or tumor size between the two groups. Patients in group I had significantly better lipiodol retention (79.31±28.79%) on subsequent abdominal CT than group II (18.43±10.61%) (P = 0.02).
CONCLUSION: Patients with durable HBV DNA elevation for more than 2 d correlated with good lipiodol retention measured 1 mo later, while others associated with poor lipiodol retention. Thus, circulating HBV DNA may be an early indicator of the success or failure of TAE.
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Affiliation(s)
- Ying-Wen Su
- Department of Pathology, Mackay Memorial Hospital, 45 Minsheng Road, Tamshui, Taipei, Taiwan, China
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Catalano O, Siani A. Peripheral arterioportal fistula: demonstration with contrast-enhanced sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:1027-30. [PMID: 15972720 DOI: 10.7863/jum.2005.24.7.1027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Orlando Catalano
- Department of Radiology, Instituto Pascale, Via Crispi 92, Naples I-80121, Italy.
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