Safety and Efficacy of TACE Sequential Thermal Ablation in the Treatment of Hepatocellular Carcinoma After TIPS

Purpose: This study aims to investigate the efficacy and safety of combining transjugular intrahepatic portosystemic shunt (TIPS) and transarterial chemoembolization (TACE) followed by thermal ablation in patients with hepatocellular carcinoma (HCC) complicated by portal hypertension. Materials and Methods: The clinical data of 43 patients with HCC in Beijing YouAn Hospital, Capital Medical University, from 1 June 2015 to 31 May 2025 were retrospectively analysed. All patients underwent TIPS for esophagogastric variceal bleeding (EGVB) and refractory ascites (RA) prior to treatment of HCC, and followed by TACE sequential thermal ablation. The OS, progression-free survival (PFS) and patency rates of TIPS stents were counted, and the incidence of operation complications were observed. Results: All 43 patients successfully underwent the procedures, with no perioperative mortality. Among the 35 patients with VIATORR covered stents, the patency rates at 1 - year, 3 - year, and 5 - year were 100%, 96.2%, and 94.1% respectively. For the 8 patients with E-Luminexx bare metal stents in combination with Fluency covered stents, the 1 - year, 3 - year, and 5 - year patency rates were 87.5%, 57.1%, and 50% respectively. The median PFS of patients after TACE sequential thermal ablation was 21 months, and the PFS rates of 1 year, 3 years and 5 years were 67.6%, 26.7% and 3.6%, respectively. The 1-, 3-, and 5-year OS rates were 95.3%, 73.9%, and 38.5%, respectively. Serum albumin (ALB) level is an independent prognostic risk factor for patients with tips combined with TACE sequential thermal ablation. Conclusion: TACE followed by thermal ablation is safe and effective for patients with HCC after TIPS procedure. Keywords: transjugular intrahepatic portosystemic shunt, hepatocellular carcinoma, transarterial chemoembolization, ablation, combination therapy