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. 2022 Apr;45(4):450-458.
doi: 10.1007/s00270-021-03014-w. Epub 2021 Dec 14.

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

Ulrik Carling  1 , Bård Røsok  2 , Sigurd Berger  3 , Åsmund Avdem Fretland  2   4 , Eric Dorenberg  3
Affiliations

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

Ulrik Carling et al. Cardiovasc Intervent Radiol. 2022 Apr.

Abstract

Purpose: To 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 methods: This 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.

Results: A 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.

Conclusion: A CVP in addition to NBCA embolization was associated with increased growth of the FLR compared to NBCA alone.

Keywords: Colorectal liver metastases; Cone-beam CT; NBCA glue; Portal vein embolization; Vascular plug.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Portal vein embolization in a patient with colorectal liver metastases using a combination of glue and a central vascular plug guided by contrast-enhanced cone beam CT. A. Image of cone-beam CT 3D volume rendering which can be used as real-time overlay during fluoroscopy B. Digital subtraction angiography image after placement of a vascular plug (arrow) in the main right portal vein and into the main anterior sector stem after selective embolization of the posterior sector C. Maximum intensity projection image of contrast-enhanced CT 4 weeks after PVE showing the plug (black arrow) and glue cast (stapled black arrow) in the anterior sector
Fig. 2
Fig. 2
Flowchart of patient cohort. *Portal vein embolization, **Colo-rectal liver metastases
See this image and copyright information in PMC

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