Purpose: To evaluate the efficacy and safety of transarterial embolization with gelatin sponge soaked in ethanol (GSE) for the treatment of arteioportal shunt (APS) in patients with hepatocellular carcinoma (HCC),and to determine the prognostic factors for patients’ survival.Method: This study was approved by the ethics committee of our institution.Informed consent was waived in this study.From June 2008 to November 2011,79 unresectable HCC patients with moderate or severe APS received transarterial therapy.Of them,61 patients were included in our study.The patients received transarterial embolization of the shunt with GSE,followed by routine transarterial chemoembolization (TACE) if it is possible.The immediate and follow-up changes of APS,initial tumor response,post embolization events,patients’ survival and prognostic factors were analyzed.Results: The median follow-up time was 13 months (range,3-34 months).At the end of follow up,10 patients were alive,51 patients were dead.The immediate APS improvement rate was 96.7% (59/61) and the initial follow-up APS improvement rate was 54.1% (33/61).Using mRECIST criteria to evaluate tumor response on CT two months after the initial embolization,26 patients were initial treatment responders,and the other 35 patients were initial non-responders.The cumulative survival rates were 78.7% at 6 months,50.3% at 1 year,and 12.1% at 2 years,with a median survival time of 382 days.Univariate analysis showed the significantly associated factors with prognosis: (1) maximal tumor size,(2) inital APS improvement,(3) initial tumor response,(4) bilirubin level.In the multivariate analysis,the maximal tumor size and inital APS improvement were found to be independent prognostic factors.There were no procedure related major complications.Conclusions: It is safe and effective to treat APS in unresectable HCC patients with GSE.Small tumor size (<5cm) and follow-up improved APS favor patients’ overall survival.