Objective To investigate the safety and efficiency of drug-eluting beads (DEB) in the treatment of hepatocellular carcinoma (HCC) with hepatic arterio-portal shunt (HAPS).Methods 26 HCC patients with HAPS who underwent DEB-TACE (transcatheter arterial chemoembolization) were included in this retrospective study.Liver function level included preoperative serum albumin level,ascites,Child-Pugh classification,imaging manifestations of HAPS,follow-up and record survival time and response to cancer treatment.According to the degree of HAPS,all the patients were divided into 4 groups.After performing Kaplan-Meier,survival rate was calculated.Tumor response was measured by mRECIST criteria.Results The median survivals were 310 days,261 days,333 days,and 250 days in the entire study population,group 1,group 2,and group 3,respectively.There was no statistical significance in the survival curve among three groups (P =0.456).In the entire study population,the survival rates were 76.9％,37.3％,and 12.4％ at 6 months,12 months,and 24 months,respectively.After performing proportional hazards model,the preoperative serum albumin level,presence or absence of ascites,and preoperative Child-Pugh classification were independent predict factors for prognosis.Conclusions DEB-TACE is a safe and effective treatment for HCC with HAPS.The preoperative liver function is essential for patients'prognosis.