Cyst ablation using a mixture of N-butyl cyanoacrylate and iodized oil in patients with autosomal dominant polycystic kidney disease: the long-term results

Abstract

Objective: We wanted to assess the long-term results of cyst ablation with using N-butyl cyanoacrylate (NBCA) and iodized oil in patients with autosomal dominant polycystic kidney disease (ADPKD) and symptomatic cysts.

Materials and methods: Cyst ablation using a mixture of NBCA and iodized oil was performed in 99 cysts from 21 patients who had such symptoms as abdominal distension and pain. The collapse or reaccumulation of the ablated cysts after the procedure was assessed during the follow-up period of 36 to 90 months. The treatment effects, including symptom relief, and the clinical data such as the blood pressure and serum creatinine levels were also assessed, together with the complications.

Results: The procedure was technically successful in all 99 cysts from the 21 patients. Any procedure-related significant complications were not detected. Seventy-seven of 99 cysts (78%) were successfully collapsed on the follow-up CT. Twenty-two cysts showed reaccumulation during long-term follow-up period. The clinical symptoms were relieved in 17 of the 21 patients (76%). Four of 12 patients (33%) with hypertension and two of six patients (33%) with azotemia were improved. End stage renal disease (ESRD) occurred in six of the 21 patients (28%) during the follow-up period. The mean age of ESRD in our patients was 57 years. The mean time interval for the development of ESRD was 19 months.

Conclusion: Ablation using a mixture of NBCA and iodized oil may be an effective, safe method for obtaining symptom relief in patients with ADPKD.

Keywords: Autosomal dominant polycystic kidney disease; Cyst ablation; Kidney cyst.

Fig. 1

36-year-old woman with autosomal dominant polycystic kidney disease. A, B. Axial contrast enhanced CT scans show multiple cysts in both kidneys. Cyst ablation was performed for two cysts in right kidney and for two cysts in left kidney (asterisk). C, D. Antero-posterior radiographies after procedure show lobulated radiopacities that represent mixture of N-butyl cyanoacrylate and iodized oil in right (C) and left (D) kidneys. E. Follow-up CT scans 36 months after procedure show collapsed cysts with mixture of N-butyl cyanoacrylate and iodized oil. F. Follow-up CT scans at 60 months show no evidence of reaccumulation in ablated cysts.

Fig. 2

52-year-old man with autosomal dominant polycystic kidney disease and who underwent cyst ablation. A, B. Follow-up CT scans 24 month later show radiopacities within ablated cysts. C, D. Follow-up CT scans at 50 month show reaccumulation of cystic fluid.