Abstract: Objective:To investigate the onset of hepatic artery- portal vein shunts (HAPVS) in primary liver cancer (PLC) pa -tients through digital subtraction angiography (DSA) and to devise a suitable strategy for treating both lesions and shunt tracts. In the process, the therapeutic effect on such patients can be enhanced.Methods:A total of 769 PLC patients who accepted transarterial che -moembolization (TACE) were analyzed retrospectively. We examined the image characteristics of 112 cases with HAPVS based on shunt type. For patients with middle or severe fistula, we initially attempted to overpass the fistula. Then, we either embolized the tumor lesions or merely provided chemotherapy to the patients. For patients with mild peripheral fistula, we embolized the tumor and fistula si -multaneously. Then, the accompanying arterial-vein shunt and portal vein tumor thrombus (PVTT) were handled at the same time.Re-sults: DSA findings showed that portal veins were observed in the early stage of angiography. A total of 52of the 112 cases with HAPVS involved mild shunts, 34exhibited moderate shunts, and 26reported severe shunts. Among these cases, 31involved central-and central peripheral-type artery-portal vein fistula, whereas 81involved peripheral-type artery-portal vein fistula. Seven cases were examined in combination with hepatic artery-liver vein shunts, and50cases were investigated in conjunction with PVTT. Tumor embo -lization was successful in 101 cases ( 90.1%). Moreover, catheters successfully overpassed shunt tracts and embolized the tumors in48 cases ( 42.9%). Shunt tracts were successfully closed in 74cases ( 66.1%), and no serious complication was observed.Conclusion:Pe-ripheral-type artery-portal vein fistula and mild-to-moderate shunts were easier to close than central-type artery-portal vein fistula and severe shunts were. Tumor embolization and shunt closure were successful in most patients. Therefore, TACE is a safe and reliable method for treating HAPVS in PLC.