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Case Reports
. 2023 Dec 27;15(12):2926-2931.
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  1 , Nai-Jian Ge  1 , Ye-Fa Yang  2
Affiliations
Case Reports

Portal vein embolization for closure of marked arterioportal shunt of hepatocellular carcinoma to enable radioembolization: A case report

Xiang-Dong Wang et al. World J Gastrointest Surg. .

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.

Keywords: Arterioportal shunt; Case report; Hepatopulmonary shunt; Intrahepatic shunt; Portal vein embolization; Transarterial radioembolization.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
A 58-year-old man with hepatocellular carcinoma and marked arterioportal shunt due to portal vein tumor thrombus. A: Axial magnetic resonance imaging T1 post contrast weighted image showing a large hypervascular mass in the right hepatic lobe (white arrows). Note enhancement of the portal vein (orange arrow) in the arterial phase denoting an underlying arterioportal shunt; B: Digital subtraction angiography showing opacified portal vein (white arrows) during the early arterial phase.
Figure 2
Figure 2
Direct portography and hepatic arteriography after portal vein embolization. A: Direct portography revealed carcinoma thrombus formed in the main portal vein (white arrow), and collateral circulation formed with spongy degeneration (orange arrows); B: Hepatic arteriography after portal vein embolization demonstrates non-visualized arterioportal shunt.
Figure 3
Figure 3
Planar scintigraphy following injection of 4.5 mCi of technetium-99m macroaggregated albumin into the right hepatic artery after using portal vein embolization to embolize the outlet of the arterioportal shunt. The calculated hepatopulmonary shunt was 8.4%.
See this image and copyright information in PMC

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