Wang Xiang-Dong, Ge Nai-Jian, Yang Ye-Fa
Department of Interventional Radiology, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai 200438, China.
World J Gastrointest Surg. 2023 Dec 27;15(12):2926-2931. doi: 10.4240/wjgs.v15.i12.2926.
Marked arterioportal shunt (APS) can be a contraindication for transarterial radioembolization (TARE) because of the risk of radiation-induced liver toxicity or pneumonitis. To date, the best method to close marked APS to reduce intrahepatic shunt (IHS) and hepatopulmonary shunt (HPS) before TARE has not been elucidated.
This case report describes a novel strategy of embolization of the portal venous outlet to reduce IHS and HPS caused by marked APS before TARE in a patient with advanced hepatocellular carcinoma (HCC). The patient had a significant intratumoral shunt from the tumor artery to the portal vein and had already been suspected based on pre-interventional magnetic resonance angiography, and digital subtraction angiography (DSA) confirmed the shunt. Selective right portal vein embolization (PVE) was performed to close the APS outlet and DSA confirmed complete closure. Technetium-99m macroaggregated albumin was administered and single photon emission computed tomography revealed a low HPS with 8.4%. Successful TARE was subsequently performed. No major procedure-related complication occurred.
Closure of APS with PVE during mapping angiography of advanced-stage HCC to enable reduction of HPS and subsequent TARE is feasible.
显著的动门脉分流（APS）可能是经动脉放射性栓塞（TARE）的禁忌证，因为存在辐射诱导的肝毒性或肺炎风险。迄今为止，在TARE之前封闭显著的APS以减少肝内分流（IHS）和肝肺分流（HPS）的最佳方法尚未阐明。
本病例报告描述了一种新的策略，即在一名晚期肝细胞癌（HCC）患者中，在TARE之前栓塞门静脉出口以减少由显著APS引起的IHS和HPS。该患者存在从肿瘤动脉到门静脉的显著瘤内分流，在介入前磁共振血管造影时就已怀疑，数字减影血管造影（DSA）证实了分流。进行了选择性右门静脉栓塞（PVE）以封闭APS出口，DSA证实完全封闭。给予锝-99m大颗粒白蛋白，单光子发射计算机断层扫描显示HPS较低，为8.4%。随后成功进行了TARE。未发生重大的与手术相关的并发症。
在晚期HCC的造影血管成像期间用PVE封闭APS以减少HPS并随后进行TARE是可行的。
