Advertisement

European Radiology

, Volume 28, Issue 11, pp 4810–4817 | Cite as

Ethylene vinyl alcohol copolymer for occlusion of specific portal branches during preoperative portal vein embolisation with n-butyl-cyanoacrylate

  • Romain Breguet
  • Sana Boudabbous
  • Lawrence F. Pupulim
  • Christoph D. Becker
  • Laura Rubbia-Brandt
  • Christian Toso
  • Maxime Ronot
  • Sylvain Terraz
Interventional
  • 126 Downloads

Abstract

Objectives

To evaluate the safety and efficacy of ethylene vinyl alcohol copolymer (EVOH) injection for selective occlusion of portal branches considered at risk for non-target embolisation during preoperative portal vein embolisation (PVE).

Methods

Twenty-nine patients (mean age, 57 ± 17 years) submitted to PVE with n-butyl-cyanoacrylate (NBCA) and additional EVOH for selected portal branches were retrospectively analysed. Indications for the use of EVOH and the selected portal branches were evaluated. Degree of hypertrophy of the future liver remnant (FLR) and kinetic growth were assessed by CT volumetry performed before and 3–6 weeks after PVE. Clinical outcome and histopathological analysis of portal veins occluded with EVOH were reviewed.

Results

EVOH was indicated intraoperatively for embolisation of selected portal branches that the operator reported at risk to provoke non-target embolisation with NBCA. Indications for the use of EVOH were embolisation of segment IV (n = 21), embolisation of segmental portal branches with early bifurcation (n = 7) and PVE in a 1-year-old girl with cystic hamartomas. All targeted portal branches were successfully embolised. There were no cases with non-target embolisation by EVOH. The degree of hypertrophy of the FLR was 14.3 ± 8.1% and the kinetic growth rate was 2.7 ± 1.8% per week.

Conclusion

EVOH is safe and effective for embolisation of selected portal vein branches considered at risk for non-target embolisation.

Key Points

• EVOH is another effective liquid embolic agent for preoperative PVE.

• EVOH is relatively simple to handle with a minimal risk of non-target embolisation.

• During PVE, some portal branches considered complicated to occlude with NBCA may be efficiently embolised with EVOH.

Keywords

Portal vein Embolisation Therapeutic Ethylene vinyl alcohol copolymer Hepatectomy 

Abbreviations

ALT

Alanine transaminase

AST

Aspartate transaminase

CT

Computed tomography

DMSO

Dimethyl sulfoxide

EVOH

Ethylene vinyl alcohol

FLR

Future liver remnant

NBCA

n-butyl cyanoacrylate

PVE

Portal vein embolisation

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Professor Sylvain Terraz.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

References

  1. 1.
    Pulitano C, Crawford M, Joseph D et al (2014) Preoperative assessment of postoperative liver function: the importance of residual liver volume. J Surg Oncol 110:445–450CrossRefGoogle Scholar
  2. 2.
    Yokoyama Y, Nagino M, Nimura Y (2007) Mechanisms of hepatic regeneration following portal vein embolization and partial hepatectomy: a review. World J Surg 31:367–374CrossRefGoogle Scholar
  3. 3.
    Van Lienden KP, van den Esschert JW, de Graaf W et al (2013) Portal vein embolization before liver resection: a systematic review. Cardiovasc Intervent Radiol 36:25–34CrossRefGoogle Scholar
  4. 4.
    De Baere T, Denys A, Paradis V (2009) Comparison of four embolic materials for portal vein embolization: experimental study in pigs. Eur Radiol 19:1435–1442CrossRefGoogle Scholar
  5. 5.
    Guiu B, Bize P, Gunthern D et al (2013) Portal vein embolization before right hepatectomy: improved results using n-butyl-cyanoacrylate compared to microparticles plus coils. Cardiovasc Intervent Radiol 36:1306–1312CrossRefGoogle Scholar
  6. 6.
    Jaberi A, Toor SS, Rajan DK et al (2016) Comparison of clinical outcomes following glue versus polyvinyl alcohol portal vein embolization for hypertrophy of the future liver remnant prior to right hepatectomy. J Vasc Interv Radiol 27:1897–1905CrossRefGoogle Scholar
  7. 7.
    Crowley RW, Ducruet AF, McDougall CG, Albuquerque FC (2014) Endovascular advances for brain arteriovenous malformations. Neurosurgery 74:S74–S82CrossRefGoogle Scholar
  8. 8.
    Kolber MK, Shukla PA, Kumar A, Silberzweig JE (2015) Ethylene vinyl alcohol copolymer (Onyx) embolization for acute hemorrhage: a systematic review of peripheral applications. J Vasc Interv Radiol 26:809–815CrossRefGoogle Scholar
  9. 9.
    Jamieson RW, Bachoo P, Tambyraja AL (2016) Evidence for ethylene-vinyl-alcohol-copolymer liquid embolic agent as a monotherapy in treatment of endoleaks. Eur J Vasc Endovasc Surg 51:810–814CrossRefGoogle Scholar
  10. 10.
    Denys A, Bize P, Demartines N et al (2010) Quality improvement for portal vein embolization. Cardiovasc Intervent Radiol 33:452–456CrossRefGoogle Scholar
  11. 11.
    Sacks D, McClenny TE, Cardella JF, Lewis CA (2003) Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 14:S199CrossRefGoogle Scholar
  12. 12.
    Vauthey J-N, Abdalla EK, Doherty DA et al (2002) Body surface area and body weight predict total liver volume in Western adults. Liver Transpl 8:233–240CrossRefGoogle Scholar
  13. 13.
    Shindoh J, Truty MJ, Aloia TA et al (2013) Kinetic growth rate after portal vein embolization predicts posthepatectomy outcomes: toward zero liver-related mortality in patients with colorectal liver metastases and small future liver remnant. J Am Coll Surg 216:201–209CrossRefGoogle Scholar
  14. 14.
    Guiu B, Bize P, Demartines N et al (2013) Simultaneous biliary drainage and portal vein embolization before extended hepatectomy for hilar cholangiocarcinoma: preliminary experience. Cardiovasc Intervent Radiol 37:698–704CrossRefGoogle Scholar
  15. 15.
    Terraz S, Ronot M, Breguet R et al (2015) Portal vein embolization before extended hepatectomy in a toddler with mesenchymal hamartoma. Pediatrics 136:1055–1059CrossRefGoogle Scholar
  16. 16.
    Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications. Ann Surg 240:205–213CrossRefGoogle Scholar
  17. 17.
    Rahbari NN, Garden OJ, Padbury R et al (2011) Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 149:713–724CrossRefGoogle Scholar
  18. 18.
    Aloia TA (2015) Associating liver partition and portal vein ligation for staged hepatectomy: portal vein embolization should remain the gold standard. JAMA Surg 150:927–928CrossRefGoogle Scholar
  19. 19.
    Guiu B, Chevallier P, Denys A et al (2016) Simultaneous trans-hepatic portal and hepatic vein embolization before major hepatectomy: the liver venous deprivation technique. Eur Radiol 26:4259–4267CrossRefGoogle Scholar
  20. 20.
    Dobrocky T, Kettenbach J, Lopez-Benitez R, Kara L (2015) Disastrous portal vein embolization turned into a successful Intervention. Cardiovasc Intervent Radiol 38:1365–1368CrossRefGoogle Scholar
  21. 21.
    Di Stefano DR, de Baere T, Denys A et al (2005) Preoperative percutaneous portal vein embolization: evaluation of adverse events in 188 patients. Radiology 234:625–630CrossRefGoogle Scholar
  22. 22.
    Bent CL, Low D, Matson MB et al (2009) Portal vein embolization using a nitinol plug (Amplatzer vascular plug) in combination with histoacryl glue and iodinized oil: adequate hypertrophy with a reduced risk of nontarget embolization. Cardiovasc Intervent Radiol 32:471–477CrossRefGoogle Scholar
  23. 23.
    Madoff DC (2014) Portal vein embolization: the continued search for the ideal embolic agent. J Vasc Interv Radiol 25:1053–1055CrossRefGoogle Scholar
  24. 24.
    Iqbal S (2017) Surgical implications of portal vein variations and liver segmentations: a recent update. J Clin Diagn Res 11:1–5CrossRefGoogle Scholar
  25. 25.
    Shaw CM, Madoff DC (2011) Acute thrombosis of left portal vein during right portal vein embolization extended to segment 4. Semin Intervent Radiol 28:156–161CrossRefGoogle Scholar
  26. 26.
    Capussotti L, Muratore A, Ferrero A et al (2005) Extension of right portal vein embolization to segment IV portal branches. Arch Surg 140:1100–1103CrossRefGoogle Scholar
  27. 27.
    Kishi Y, Madoff DC, Abdalla EK et al (2008) Is embolization of segment 4 portal veins before extended right hepatectomy justified? Surgery 144:744–751CrossRefGoogle Scholar
  28. 28.
    Shin SW, Chang IS, Choo SW et al (2015) Comparison of the effectiveness of preoperative portal vein embolization in patients with chronic liver disease: gelfoam versus gelfoam-coil combination. J Korean Soc Radiol 72:335–343CrossRefGoogle Scholar
  29. 29.
    Madoff DC, Abdalla EK, Gupta S et al (2005) Transhepatic ipsilateral right portal vein embolization extended to segment IV: improving hypertrophy and resection outcomes with spherical particles and coils. J Vasc Interv Radiol 16:215–225CrossRefGoogle Scholar
  30. 30.
    Nagino M, Kamiya J, Kanai M et al (2000) Right trisegment portal vein embolization for biliary tract carcinoma: technique and clinical utility. Surgery 127:155–160CrossRefGoogle Scholar
  31. 31.
    Fischman AM, Ward TJ, Horn JC et al (2014) Portal vein embolization before right hepatectomy or extended right hepatectomy using sodium tetradecyl sulfate foam: technique and initial results. J Vasc Interv Radiol 25:1045–1053CrossRefGoogle Scholar
  32. 32.
    Igami T, Ebata T, Yokoyama Y et al (2014) Portal vein embolization using absolute ethanol: evaluation of its safety and efficacy. J Hepatobiliary Pancreat Sci 21:676–681CrossRefGoogle Scholar
  33. 33.
    Saeed Kilani M, Izaaryene J, Cohen F et al (2015) Ethylene vinyl alcohol copolymer (Onyx®) in peripheral interventional radiology: indications, advantages and limitations. Diagn Interv Imaging 96:319–326.  https://doi.org/10.1016/j.diii.2014.11.030 CrossRefPubMedGoogle Scholar
  34. 34.
    de Baere T, Robinson JM, Deschamps F et al (2010) Preoperative portal vein embolization tailored to prepare the liver for complex resections: initial experience. Cardiovasc Intervent Radiol 33:976–982CrossRefGoogle Scholar
  35. 35.
    Smits MLJ, Vanlangenhove P, Sturm EJC et al (2012) Transsinusoidal portal vein embolization with ethylene vinyl alcohol copolymer (Onyx): a feasibility study in pigs. Cardiovasc Intervent Radiol 35:1172–1180CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Romain Breguet
    • 1
    • 2
  • Sana Boudabbous
    • 1
  • Lawrence F. Pupulim
    • 1
  • Christoph D. Becker
    • 1
    • 2
  • Laura Rubbia-Brandt
    • 2
    • 3
  • Christian Toso
    • 2
    • 4
  • Maxime Ronot
    • 1
    • 5
  • Sylvain Terraz
    • 1
    • 2
  1. 1.Department of RadiologyUniversity Hospitals of GenevaGeneva 14Switzerland
  2. 2.Hepato-Pancreato-Biliary CentreUniversity Hospitals of GenevaGenevaSwitzerland
  3. 3.Department of Clinical PathologyUniversity Hospitals of GenevaGenevaSwitzerland
  4. 4.Department of Visceral SurgeryUniversity Hospitals of GenevaGenevaSwitzerland
  5. 5.Department of RadiologyUniversity Hospitals of BeaujonParisFrance

Personalised recommendations