[Evaluation of interventional therapy for hepatocellular carcinoma with arteriovenous fistulas: an analysis of 38 cases].

OBJECTIVE: To evaluate the therapeutical effects and techniques of superselective arterial embolization in hepatocellular carcinoma (HCC) patients with arteriovenous fistulas (AVFs). METHODS: Data from 425 cases of HCC patients treated with transcatheter arterial chemoembolization (TACE) in our hospital during the last 2 years were analyzed. Ethanol and/or ethanol and gelfoam (into AVFs), ethanol and/or lipiodol (1:1) or lipiodol and 2 to 3 other kinds of chemodrugs (into tumors) were used to do the transcatheter superselective arterial embolization. RESULTS: AVFs were found in 38 of our 425 HCC cases (8.9%). Among those 38 cases, 21 (55%) had high flux APFs and 17(45%) had low flux APFs. Eight patients (21% of the 38) had both AVFs and hepatic artery-hepatic venous fistulas. AVFs and tumors of the 38 cases were successfully superselectively embolized, but 35 of the 38 cases had 2-3 procedures. After treatment, hepatic functions improved in 23 cases (61%), ascites disappeared in 13 cases (32%) and ascites decreased in 20 cases (53%). The survival rates at 6 months and 1 year were 84% (32/38) and 61% (23/38). CONCLUSION: Superselective embolization procedure is beneficial in relieving portal high pressure and its serious consequences in HCC patients with APFs; it is also a foundation for TACE. The procedure can improve the quality of life and the survival rate of the patients.