Korean J Radiol.  2014 Apr;15(2):250-253. 10.3348/kjr.2014.15.2.250.

N-Butyl Cyanoacrylate Embolization with Blood Flow Control of an Arterioportal Shunt That Developed after Radiofrequency Ablation of Hepatocellular Carcinoma

• Sonomura T
• Kawai N
• Kishi K
• Ikoma A
• Sanda H
• Nakata K
• Minamiguchi H
• Nakai M
• Hosokawa S
• Tamai H
• Sato M

• KMID: 1705580
• DOI: http://doi.org/10.3348/kjr.2014.15.2.250

Abstract

We present a case of a patient with rapid deterioration of esophageal varices caused by portal hypertension accompanied by a large arterioportal shunt that developed after radiofrequency ablation of hepatocellular carcinoma. We used n-butyl cyanoacrylate (NBCA) as an embolic material to achieve pinpoint embolization of the shunt, because the microcatheter tip was 2 cm away from the shunt site. Under hepatic arterial flow control using a balloon catheter, the arterioportal shunt was successfully embolized with NBCA, which caused an improvement in the esophageal varices.

Keyword

Arterioportal shunt; Balloon catheter; Blood flow control; Embolization; N-butyl cyanoacrylate

MeSH Terms

Aged
Arteriovenous Fistula/etiology/radiography/*therapy
Carcinoma, Hepatocellular/*surgery
Catheter Ablation/*adverse effects
Embolization, Therapeutic/*methods
Enbucrilate/*therapeutic use
Esophageal and Gastric Varices/etiology/*therapy
Hepatic Artery/*abnormalities/radiography
Humans
Liver Neoplasms/*surgery
Male
Portal Vein/*abnormalities/radiography
Enbucrilate

Figure

• 

  Fig. 1 N-butyl cyanoacrylate (NBCA) embolization of arterioportal shunt under blood flow control with balloon catheter. A. Endoscopy before embolization revealed large red-colored esophageal varices. B. Arterial phase contrast-enhanced computed tomography performed before embolization revealed early enhancement of left portal vein (arrow), suggesting presence of arterioportal shunt. C. Angiography performed before embolization revealed presence of large arterioportal shunt (arrow) in left lateral segment of liver. D. Volume-rendered images from computed tomography performed during hepatic arteriography. Superior view showed that shunt site (yellow) was 5 mm in diameter (arrow), and was located between hepatic artery (red) and portal vein (light blue) in segment 3 of liver. E. NBCA mixture was injected through 2-Fr microcatheter that was advanced as close as possible to arterioportal shunt under blood flow control using balloon catheter (arrow) that was inserted in proper hepatic artery. Balloon was used to incompletely occlude artery, allowing antegrade blood flow (inset at bottom right). F. Angiography performed after embolization showed complete disappearance of shunt and presence of NBCA mixture at shunt site (arrow). LHA = left hepatic artery. G. Contrast-enhanced computed tomography (CE-CT) after embolization showed complete disappearance of shunt. H. Endoscopy performed at 6 months after embolization confirmed that varices had shrunk and red color sign had disappeared. I, J. CE-CT performed at 6 months after embolization revealed presence of NBCA mixture at shunt site in segment 3 of liver, and in left portal vein (arrows). Necrotic lesions (asterisks) caused by radiofrequency ablation were found in segments 8 and 4 of liver.

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