Combined transjugular intrahepatic portosystemic shunt and segmentai lipiodol hepatic artery embolization for the treatment of esophagogastric varices and hepatocellular carcinoma in patients with cirrhosis: Preliminary report
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To evaluate the feasibility of combining placement of a transjugular intrahepatic portosystemic shunt (TIPS) and transcatheter hepatic segmental artery chemoembolization with Lipiodol (Seg-Lp-TAE) in patients with cirrhosis, esophagogastric varices, and hepatocellular carcinoma (HCC).
Five patients with bleeding or large, highflow esophagogastric varices and HCC were treated by TIPS and Seg-Lp-TAE.
The mean portosystemic pressure gradient decreased from 20.8 cm H2O to 7.8 cm H2O after TIPS. The direct portogram and endoscopic examination revealed reduction of varices. At 6 months, one shunt had functionally occluded and could not be reopened; the other TIPS remained functional Follow-up CT and the changes of alpha fetoprotein indicated effective therapy of Seg-Lp-TAE for HCC. Four patients are in stabile clinical condition at 9, 6, 1, and 1 months after the combined therapy; one died after 14 months due to decompensated liver cirrhosis.
The combined therapy of TIPS and SegLp-TAE will become a new interventional approach for patients with HCC and esophagogastric varices.
Key wordsEsophagogastric varices Hepatocellular carcinoma Transjugular intrahepatic portosystemic shun Segmental embolotherapy Lipoidol
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