COMBINED TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT AND SEGMENTAL LIPIODOL HEPATIC-ARTERY EMBOLIZATION FOR THE TREATMENT OF ESOPHAGOGASTRIC VARICES AND HEPATOCELLULAR-CARCINOMA IN PATIENTS WITH CIRRHOSIS - PRELIMINARY-REPORT

Purpose: 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). Methods: Five patients with bleeding or large, high-flow esophagogastric varices and HCC were treated by TIPS and Seg-Lp-TAE. Results: 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. Conclusion: The combined therapy of TIPS and Seg-Lp-TAE will become a new interventional approach for patients with HCC and esophagogastric varices.