The clinical value of treatment for hepatocellular carcinoma complicated with arterio-portal fistula using N-butyl 2-cyanoacrylate

Objective: To evaluate the clinical application of embolization therapy using N-butyl 2-cyanoacrylate (NBCA) for hepatocellular carcinoma (HCC) complicated with arterio-portal fistula (APF). Methods: Eighty patients with HCC and APF underwent embolotherapy with NBCA (NBCA group, 26 patients) or absolute alcohol (alcohol group, 54 patients). The APF was first treated with liquid embolic agent during the TACE procedure. We used NBCA-Lipiodol mixtures in concentration of 20%-50% according to the different circulation times of these APF in NBCA group. Absolute alcohol plus gelfoam or other materials were used for embolization of APF in alcohol group. The pain reaction during the procedure, influence for liver function (χ2 test), occlusive successful rate after single embolization (Fisher's exact test) and the survival rate of 1 year (log-rank analysis) between two groups were compared after the embolotherapy. Results: Four patients in NBCA group and 52 patients in alcohol group felt painful during the procedures. There was statistically significant difference between two groups (χ2=58.86, P<0.001). The APF disappeared after only single embolization in 24 (92.3%, 24/26) cases of NBCA group and in 37(68.5%, 37/54) patients of alcohol group. There was also significant difference between two groups (P=0.024). There were no statistical difference in the post-embolization liver function change and 1 year survival rate between two groups. Conclusions: The embolization therapy using NBCA for HCC complicated with APF is safe, effective and more accurate. It can be used as a new technique for these patients. (authors)