Postbiopsy arterioportal fistula in patients with hepatocellular carcinoma: clinical significance in transarterial chemoembolization.
To evaluate the altered findings of hepatic arteriography after radiofrequency (RF) ablation of hepatocellular carcinoma which can potentially influence subsequent transcatheter arterial chemoembolization. Hepatic arteriograms of 26 index hepatocellular carcinomas in 24 patients treated only by RF ablation (M:F = 22:2, mean age 55 years), in which hepatic arteriography was performed before and after RF ablation, were retrospectively compared for the altered findings. The altered findings of hepatic arteriography after RF ablation of the hepatocellular carcinoma were arterio-portal shunt (n = 3), periablational enhancement (n = 5), varied caliber of the feeding artery to the index tumor (n = 12) among which eight decreased, and occlusion of an adjacent arterial branch (n = 8). Residual unablated or locally progressed tumor was not detected in post-RF ablation arteriography (n = 5) due to the arterio-portal shunt (n = 2) or the periablational enhancement (n = 3). The possibility of not detecting the residual unablated or locally progressed tumor was higher within 24 weeks after RF ablation (Mann–Whitney test, P = 0.041). The findings of hepatic arteriography are altered after RF ablation, and the altered findings may increase the difficulty in performing super-selective transcatheter arterial chemoembolization due to undetected tumor staining, decreased caliber, or occlusion of the feeding artery.