Clinical characteristics of hepatic Arterioportal shunts associated with hepatocellular carcinoma

Huiyong Wu,Shuguang Liu,Shuguang Liu,Shuguang Liu,Jianbo Zhang,Jianbo Zhang,Jianbo Zhang,Jianjun Han,Jianjun Han,Jianjun Han,Wei Zhao,Wei Zhao,Wei Zhao

doi:10.1186/s12876-018-0899-3

Huiyong Wu, Shuguang Liu + Show 11 more

Open Access

https://doi.org/10.1186/s12876-018-0899-3

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Abstract

BackgroundHepatic 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.MethodsClinical 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.ResultsThe 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).ConclusionsWe 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.

Highlights

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)
The eligibility criteria include: 1) confirmed diagnosis of HCC by biopsy or imaging according to accepted guideline [10]; 2) observation of hepatic A-P shunt in hepatic arteriography; 3) if A-P shunt was not found on hepatic arteriography, observation of iodized oil flowing from hepatic artery to the portal vein must be observed during Transcatheter arterial embolization (TAE) under X-ray examination; 4) patients with no history of hepatic resection
Imaging and clinical characteristics of typical and atypical A-P shunt A-P shunts were classified into two types according to the hepatic arteriogram images

Summary

Introduction

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). It is important to diagnose HCC associated A-P shunts, as it may impact the treatment strategy of the patients. We described the imaging findings of the HCC associated A-P shunts and discussed the treatments strategy of such patients. Transcatheter arterial chemoembolization (TACE) is one of the important treatment strategies for patients with hepatocellular carcinoma (HCC). It is used as a standard treatment for middle-stage tumor and as a necessary treatment for early stage patients after surgery [1, 2]. For HCC patients, it was suggested that A-P shunts were caused by the invasion of HCC into the

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