Transcatheter Arterial Chemoembolization Based on Hepatic Hemodynamics for Hepatocellular Carcinoma
Figure 4
Multiple HCCs with significant arterioportal shunts in a 58-year-old man. Proper hepatic arteriography ((a): early arterial phase, (b): late arterial phase) reveals multiple HCCs with significant arterioportal vein shunts ((b), arrows). (c) indicates proper hepatic arteriography under balloon occlusion of the anterior segmental portal vein. CT during right hepatic arteriography before TACE shows a well-enhanced HCC in the S5. Arrow of (d) indicates a balloon. Precontrast CT one month after TACE-PVO demonstrated a dense lipiodol deposit HCC (e). Lipiodol retains in both HCC and surrounding liver parenchyma ((e), arrow). Common hepatic arteriography 12 months after TACE-PVO reveals that arterioportal shunts and hypervascular tumors are no longer evident (f). The patient first received 2 sessions of conventional TACE for residual HCCs. Reservoir placement was performed 9 months after TACE-PVO. The patient is alive for 4 years after TACE-PVO.
