Treatment of symptomatic polycystic liver disease: transcatheter super-selective hepatic arterial embolization using a mixture of NBCA and iodized oil

Abstract

Surgical therapy for symptomatic polycystic liver disease (PLD) is effective but has substantial mortality and morbidity. Minimally invasive options such as laparoscopic fenestration, percutaneous cyst aspiration with or without injection of a sclerosing solution have had disappointing results. Because the hepatic cysts in autosomal dominant polycystic kidney disease (ADPKD) patients are mostly supplied from hepatic arteries but not from portal veins, therefore, transcatheter arterial embolization (TAE) of the hepatic artery branches that supply major hepatic cysts can lead to shrinkage of the cyst and liver size. The purpose of this study was to evaluate the safety and effectiveness of TAE using a mixture of N-butyl-2-cyanoacrylate (NBCA) and iodized oil for massive PLD in ADPKD patients. From February 2007 to March 2011, a total of 21 patients with symptomatic PLD underwent super-selective hepatic TAE with the mixture of NBCA and iodized oil. The patients consisted of 17 women and 4 men (age range 36-64years, average age 48.8years). All patients underwent contrast-enhanced computed tomography (CT) of the liver before TAE, and at every 3months for the first year after TAE and at 6-monthly intervals thereafter. Laboratory data, including routine blood tests and liver enzymes, were collected before and 1, 3, 7, and 14days, 1, 3, 6, and 12months after TAE. Technical success was achieved in all cases. No serious complications were experienced. The mean follow-up period was 34±20months (range 12-60months). At follow-up of 6-12months, symptoms notably improved in 18 (85.7%) of 21 patients, and these patients experienced further relief of the symptoms during the follow-up period. TAE failed to benefit in 3 patients (14.3%). No patient complained of worsening of the symptoms after the procedure. At follow-up CT, the total liver volume and total intra-hepatic cyst volume decreased significantly (p<0.001) compared with pre-TAE in 18 (85.7%) of 21 patients at 12months after TAE. The total liver volume decreased from 8270±3016 to 6120±2680cm(3) and the total intra-hepatic cyst volume decreased from 7120±3070 to 4530±2600cm(3). Mild elevation of the liver enzymes was shown in patients at 1-14days after TAE but returned to the normal range within 1month. The mixture of NBCA and iodized oil is an acceptable embolic agent for embolization of the hepatic artery branches that supply the hepatic cysts in ADPKD patients. This technique is an option for patient with highly symptomatic PLD who are not candidates for surgical treatment.