Portal Vein Embolization Using N-Butyl Cyanoacrylate-Glue: What Impact Does a Central Vascular Plug Have?

Ulrik Carling,Bård Røsok,Åsmund Avdem Fretland,Sigurd Berger,Eric Dorenberg

doi:10.1007/s00270-021-03014-w

Ulrik Carling, Bård Røsok + Show 3 more

Open Access

https://doi.org/10.1007/s00270-021-03014-w

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Abstract

PurposeTo examine if the addition of a central vascular plug (CVP) to portal vein embolization (PVE) with N-butyl cyanoacrylate-glue (NBCA) increases future liver remnant (FLR) growth.Material and MethodsThis is a single-center retrospective study of 115 consecutive patients with colorectal liver metastases undergoing PVE in 2013–2019. All patients were embolized with NBCA as the main embolic agent. In 2017–2019 NBCA was combined with a CVP in the central part of the right portal vein. Growth of the FLR and standardized FLR (sFLR) including degree of hypertrophy (DH) and kinetic growth rate (KGR) were analyzed, as well as procedure data such as use of cone-beam CT (CBCT), dose area product (DAP), fluoroscopy time and contrast dose.ResultsA total of 40 patients (35%) underwent PVE with a combination of CVP and NBCA. The DH was higher in these patients after 4 weeks, mean 13.6% (SD 7.8) vs. 10.5% (SD 6.4; p = 0.022), verified in multivariate analysis (coefficient 4.1, p = 0.015). A CVP did not significantly increase the resection rate (90% vs 82%, p = 0.4). Cone beam CT was used in 65 patients (57%). Use of CBCT did not affect FLR growth, and fluoroscopy time and contrast doses were not different in patients having a CBCT or not. Slightly lower DAP (median 3375 vs. 4499 cGy*cm2; p = 0.09) was seen in procedures where CBCT was used.ConclusionA CVP in addition to NBCA embolization was associated with increased growth of the FLR compared to NBCA alone.

Highlights

Portal vein embolization (PVE) is an established method for improving patient outcomes following large liver resections for malignant liver tumors, such as metastases from colorectal carcinoma (CRLM) [1]
A technique has been described where vascular plugs are combined with N-butyl cyanoacrylate-glue (NBCA) embolization to avoid non-target embolization of the future liver remnant (FLR) and reduce the re-canalization rate [7, 10], but there is no study demonstrating the actual benefit of this technique compared to embolization with NBCA alone
We found that portal vein embolization (PVE) with a central vascular plug in combination with NBCA glue was associated with an increased growth of the future liver remnant compared to PVE with NBCA alone

Summary

Introduction

Portal vein embolization (PVE) is an established method for improving patient outcomes following large liver resections for malignant liver tumors, such as metastases from colorectal carcinoma (CRLM) [1]. The goal of PVE is to stimulate growth of the intended future liver remnant (FLR) to reduce the risk for post hepatectomy liver failure (PHLF). Safe resection depends both on the size of the FLR relative to the size of the patient Several methods have been described for PVE and different embolization materials have been used; often either glue (e.g. N-butyl cyanoacrylate; NBCA) or particles, sometimes combined with plugs or coils [1, 4]. A technique has been described where vascular plugs are combined with NBCA embolization to avoid non-target embolization of the FLR and reduce the re-canalization rate [7, 10], but there is no study demonstrating the actual benefit of this technique compared to embolization with NBCA alone

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