Wang XD, Ge NJ, Yang YF. Portal vein embolization for closure of marked arterioportal shunt of hepatocellular carcinoma to enable radioembolization: A case report. World J Gastrointest Surg 2023; 15(12): 2926-2931 [PMID: 38222008 DOI: 10.4240/wjgs.v15.i12.2926]
Corresponding Author of This Article
Ye-Fa Yang, MD, Chief Doctor, Professor, Department of Interventional Radiology, Shanghai Eastern Hepatobiliary Surgery Hospital, No. 700 Moyu North Road, Shanghai 200438, China. decentofni@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Dec 27, 2023; 15(12): 2926-2931 Published online Dec 27, 2023. doi: 10.4240/wjgs.v15.i12.2926
Portal vein embolization for closure of marked arterioportal shunt of hepatocellular carcinoma to enable radioembolization: A case report
Xiang-Dong Wang, Nai-Jian Ge, Ye-Fa Yang
Xiang-Dong Wang, Nai-Jian Ge, Ye-Fa Yang, Department of Interventional Radiology, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai 200438, China
Author contributions: Wang XD composed and drafted the paper; Ge NJ revised and edited the draft; Yang YF conceptualized, designed, revised, and edited the draft.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrolment. Approval for publishing the study data was obtained from the patient.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ye-Fa Yang, MD, Chief Doctor, Professor, Department of Interventional Radiology, Shanghai Eastern Hepatobiliary Surgery Hospital, No. 700 Moyu North Road, Shanghai 200438, China. decentofni@163.com
Received: August 17, 2023 Peer-review started: August 17, 2023 First decision: October 17, 2023 Revised: October 24, 2023 Accepted: December 4, 2023 Article in press: December 4, 2023 Published online: December 27, 2023
Abstract
BACKGROUND
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.
CASE SUMMARY
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.
CONCLUSION
Closure of APS with PVE during mapping angiography of advanced-stage HCC to enable reduction of HPS and subsequent TARE is feasible.
Core Tip: Marked arterioportal shunt (APS) can be a contraindication for transarterial radioembolization (TARE) because of the risk of radiation-induced liver toxicity or pneumonitis. In this case report, portal vein embolization was performed, for the first time, to close the APS outlet in a patient with advanced hepatocellular carcinoma. Single photon emission computed tomography revealed a low intrahepatic shunt and hepatopulmonary shunt, and TARE was performed successfully.
