Styrene-
maleic acid neocarzinostatin (
SMANCS) sometimes causes hepatic vascular side effects, including arterial
stricture, obstruction, and arterio-portal shunt. A total of 128 intra-arterial
SMANCS injection treatments, performed for 89 patients with
hepatocellular carcinoma, were analyzed to determine the relationship between angiographic findings and subsequent hepatic
vascular injuries. After
SMANCS therapy, hepatic arterial
stricture or obstruction occurred in 5 patients (5/128; 3.9%), arterio-portal shunting in 12 (12/128; 9.4%), liver shrinkage in 4 (4/128; 3.1%), and
cholangitis or biloma in 2 (2/128; 1.6%). Among 23 patients whose plain abdominal
X-ray films just after
SMANCS injection showed
Lipiodol retention in the hepatic artery, 5 patients developed arterial obstruction, 10 developed arterio-portal shunt, and 2,
cholangitis or biloma. Among 26 patients with
Lipiodol retention in the portal vein, 4 developed hepatic lobe
atrophy with aggravation of liver function. Among 3 patients with
Lipiodol retention in both the hepatic artery and the portal vein, 1 developed arterio-portal shunt. In 76 treatments without excessive
Lipiodol retention, only 1 of the patients developed arterio-portal shunt. Excessive retention of
Lipiodol in hepatic vascular beds just after
SMANCS therapy was significantly associated with future vascular side effects (22/52 vs 1/76; P < 0.0001).
Lipiodol retention in arteries just after
SMANCS injection was closely associated with subsequent arterial obstruction or arterio-portal shunt, and
Lipiodol retention in the portal vein was related to subsequent hepatic lobe
atrophy.