Abstract No. 264: Transarterial embolization with cyanoacrylate for severe arterioportal shunts causing hepatofugal portal flow complicated by hepatocellular carcinoma

Abstract

To evaluate the clinical efficacy and safety of N-butyl cyanoacrylate (NBCA) embolization in the treatment of severe arterioportal shunts (APS) presenting with hepatofugal portal venous flow in patients with hepatocellular carcinoma (HCC). Between January 2006 and January 2010, 12 patients with unresectable HCC accompanied by severe APS with hepatofugal portal venous flow who underwent transarterial APS embolization with NBCA were defined as the TAE group; and 11 patients in the similar situations who did not receive APS embolization but adjunctive intra-arterial chemotherapy due to the technique limitation between July 2000 and December 2005 were set as a control group. The change of APS, survival rates and procedure related complications of each group were analyzed. The occlusion rate of APS after initial treatment in the TAE group was 83.3% (10/12). The long term APS improvement with hepatopetal portal flow was achieved in 80% (8/10) patients who underwent follow-up angiography in the TAE group. The survival rates in the TAE group were 67% at 6 months, 40% at 1 year, 15% at 2 years, whereas those in the control group were 0 at 6 months(P<0.05). The median survival time in the TAE group was 275 days, which was significantly longer than that of 107 days in the control group after using multivariate Cox regression analysis (P=0.001, hazard ratio= 9.04, 95% confidence interval 2.38, 34.33). There were no major complications related to the interventional treatments in both groups. The preliminary experience in our series suggests NBCA embolization may be an effective and safe therapy in the clinical management of severe APS accompanied with HCC, and may also improve patient's survival.