Portal vein embolization with Histoacryl using ipsilateral approach safe

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In experienced hands, non-target embolization is rare, a study presented at the European Congress of Radiology (ECR, 4–8 March, Vienna, Austria) concluded.

Portal vein embolization is a well-established technique to introduce hypertrophy of the future liver remnant in patients, scheduled to undergo extended hemihepatectomy. The most common embolization material used for portal vein embolization is usually Histoacryl/Lipiodol in either a ratio of 1:3 or 1:4 and coils.

Christina Loberg, Aachen, Germany, who presented the study said: “Histoacryl is an inexpensive and reliable embolizing agent, but it is difficult to control. So, when it is used, a contralateral approach is usually chosen to avoid non-target embolization. However, a puncture route through the contralateral lobe in the future liver remnant, has its own downsides. We therefore evaluated the safety of Histoacryl-based portal vein embolization from the ipsilateral approach.”

The investigators evaluated data from a total 107 portal vein embolization cases (68 were male and 39 female, age 22–84 years) of the right portal system, performed via percutaneous transhepatic right-sided approach. The embolization procedures were carried out between January 2010 and July 2014.

The researchers embolized the right portal branches with a Histoacryl/Lipiodol mixture and recorded the success rates and rates of complications following ipsilateral Histoacryl-based portal vein embolization.

Results

Our technical success was 99.1% with successful portal vein embolization achieved. In 0.9% embolization was impossible because of extensive right tumour load and we could not establish appropriate access to the right portal system. Clinical success, defined as sufficient hypertrophy, was achieved in 88.7% of cases. Nearly 73% of patients finally underwent successful extended hemihepatectomy,” Loberg continued.

In less than 2% of patients, Histoacryl/Lipiodol dislocated into the main portal trunk and caused non-target embolization requiring anticoagulation with prolonged hospitalisation for 72 hours. In 98% of the cohort, right sided Histoacryl-based procedures were completed successfully without non-target embolization. “Nearly 3% of patients developed severe sepsis after the procedure” she said.

Loberg told Interventional News: “We compared the complications for portal vein embolization with Histoacryl to major cohorts in the published literature. Kodama et al showed data for 47 patients, with 11 procedures performed contralaterally and 36 ipsilaterally. The overall complication rate was 15%. Di Stefano et al carried out 188 procedures and all used the contralateral approach. In this group, the overall complication rate was 12.8%. In our case, all procedures were ipsilateral and the overall complication rate was 5.5%. With regard to transient liver failure, this was not reported by Kodama, it was 3.2 % in the di Stefano group and 2.8% in our cohort. With regard to non-target embolization, in the Kodama et al cohort, it was 4.3%; in the di Stefano cohort, 5.3 % and in our cohort, 1.9%. Subcapsular hepatic haematoma occurred in 4.3% of cases in the Kodama cohort, 1.1% of the di Stefano cohort and 0% in our group. So, in comparison to these two other cohorts, our results show less complications in using the ipsilateral transhepatic right-sided approach,” she said.