[Treatment of intrahepatic arteriovenous fistula after biopsy. Results in 5 chemoembolization candidates with hepatocarcinoma].

We report our experience in the treatment of post-bioptic intrahepatic arterioportal fistulas (HAPF) in 5 patients with hepatocellular carcinoma (HCC) treated February, 1993, to May, 1995. In this retrospective study, we reviewed the imaging findings and clinical records of 3 men and 2 women (age range: 49-71 years) with HCC previously diagnosed with US, CT and biopsy. HAPF was detected by angiography (DSA) performed before chemoembolization (TACE). All HAPFs were referrable to biopsy (14-gauge Thru-Cut needle) and were treated with platinum coils positioned through coaxial catheters. TACE was performed immediately after or within a week of HAPF embolization. Therapeutic response after TACE was assessed on the basis of clinical and CT findings, while HAPF embolization success was assessed on the basis of DSA and color Doppler US findings. Reembolization was required in two patients--7 maneuvers in all in 5 patients. Complete HAPF occlusion was demonstrated in 4 patients during color Doppler follow-up and immediately after and at 13 and 24 months (in 2 patients) at DSA. Two of 5 patients died, one because of liver failure after 15 months' follow-up and the other because of complications related to liver transplantation at 11 months' follow-up. Of the extant 3 patients, one underwent liver transplantation and was followed-up for 25 months, while the other two are alive after 24 and 13 months, respectively. Our experience demonstrates that HAPF embolization in HCC patients is really useful for hemodynamic redistribution before TACE and to avoid further HAPF progression.