Portal hypertension caused by arterio-portal fistula developing after radiofrequency ablation for hepatocellular carcinoma

Abstract

Percutaneous radiofrequency ablation (RFA) has been widely doing as a therapeutic procedure for hepatocellular carcinoma in Japan. Hepatic arterioportal fistula (APF), however, may occur after RFA procedures as a complication in a part of patients. When the shunt flow volume through APF increases, portal hypertensive events such as varices, ascites, encephalopathy and portal vein thrombosis might occur. In this study, clinical features of patients in whom APF developed after RFA procedures were investigated. Portal hypertensive events due to APF requiring therapies occurred in 9 patients (0.55%) among 1, 638 patients receiving RFA. When CT images were retrospectively evaluated, APF was observed before the onset of portal hypertensive events with a median duration of 3 days after RFA procedures. Thus, the appearance of APF should be evaluated following RFA procedures on CT images, and portal hypertensive events are required to be monitored in patients in whom APF developed. In these patients, transcatheter arterial embolization is recommended to be done for APF when portal hypertensive events occur.