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. 2016 Dec;27(12):1897-1905.e1. doi: 10.1016/j.jvir.2016.05.023. Epub 2016 Jul 18.

Abstract

Purpose: To report outcomes after portal vein embolization (PVE) and right hepatectomy in patients receiving embolization with N-butyl cyanoacrylate (NBCA) glue + central AMPLATZER Vascular Plug (AVP; glue group) or polyvinyl alcohol (PVA) particles ± coils (PVA group).

Materials and methods: Between March 2008 and August 2013, all patients having PVE with NBCA + AVP or PVA ± coils before right hepatectomy were retrospectively reviewed; 85 patients underwent PVE with NBCA + AVP (n = 45) or PVA ± coils (n = 40). The groups were compared using Mann-Whitney U and χ2 tests.

Results: Technical success of embolization was 100%. Degree of hypertrophy (16.2% ± 7.8 vs 12.3% ± 7.62, P = .009) and kinetic growth rate (3.5%/wk ± 2.0 vs 2.6%/wk ± 1.9, P = .016) were greater in the glue group versus the PVA group. Contrast volume (66.1 mL ± 44.8 vs 189.87 mL ± 62.6, P < .001) and fluoroscopy time (11.2 min ± 7.8 vs 23.49 min ± 11.7, P < .001) were significantly less during the PVE procedure in the glue group. Surgical outcomes were comparable between groups, including the number of patients unable to go onto surgery (P = 1.0), surgical complications (P = .30), length of hospital stay (P = .68), and intensive care unit admissions (P = .71). There was 1 major complication (hepatic abscess) in each group after PVE.

Conclusions: PVE performed with NBCA + AVP compared with PVA ± coils resulted in greater degree of hypertrophy of the future liver remnant, less fluoroscopic time and contrast volume, and similar complication rates.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Cell Proliferation*
  • Chi-Square Distribution
  • Contrast Media / administration & dosage
  • Embolization, Therapeutic / adverse effects
  • Embolization, Therapeutic / methods*
  • Enbucrilate / administration & dosage*
  • Enbucrilate / adverse effects
  • Female
  • Fluoroscopy
  • Hepatectomy / adverse effects
  • Hepatectomy / methods*
  • Humans
  • Hypertrophy
  • Length of Stay
  • Liver Neoplasms / pathology
  • Liver Neoplasms / physiopathology
  • Liver Neoplasms / secondary
  • Liver Neoplasms / surgery*
  • Liver Regeneration*
  • Male
  • Middle Aged
  • Phlebography / methods
  • Polyvinyl Alcohol / administration & dosage*
  • Polyvinyl Alcohol / adverse effects
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome

Substances

  • Contrast Media
  • Polyvinyl Alcohol
  • Enbucrilate