Portal vein embolization for arterio-portal shunt closure in hepatocellular carcinoma to facilitate selective internal radiation therapy

BACKGROUND: Selective internal radiation therapy (SIRT) has been widely used in the treatment of hepatocellular carcinoma (HCC). However, marked intrahepatic shunt (IHS) secondary to arterio-portal shunt (APS) often precludes safe SIRT administration. AIM: To evaluate the efficacy and safety of portal vein embolization (PVE) in reducing IHS and enabling SIRT therapy in HCC patients with APS. METHODS: This retrospective study enrolled seven HCC patients with APS confirmed by hepatic angiography during mapping. PVE was performed to close the APS outlet and single photon emission computed tomography/computed tomography was performed to determine the distribution of (99m) technetium-labeled macroaggregated albumin. These patients meeting the criteria for SIRT subsequently underwent Yttrium-90 (Y-90) resin microspheres administration. Changes in liver function and complications were monitored during the 6-month follow-up period. RESULTS: = 6, 6/7). The hepatopulmonary shunt rate was below 20% (4.65%-16.95%) in five of six patients with APS occluded, and Y-90-SIRT was subsequently administered in these patients. No severe procedural complications occurred. CONCLUSION: PVE is a safe and effective strategy to reduce IHS in HCC patients with APS, thereby improving eligibility for SIRT.