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. 2022 Sep 5;5(1):48.
doi: 10.1186/s42155-022-00321-2.

Embolisation of the parenchymal tract after percutaneous portal vein catheterization: a retrospective comparison of outcomes with different techniques in two centres

Paolo Marra  1   2 , Francesco Saverio Carbone  3   4 , Luigi Augello  5 , Ludovico Dulcetta  1   2 , Riccardo Muglia  1 , Pietro Andrea Bonaffini  1   2 , Angelo Della Corte  5 , Stephanie Steidler  5 , Simone Gusmini  5 , Giorgia Guazzarotti  5 , Diego Palumbo  5   6 , Massimo Venturini  7 , Francesco De Cobelli  5   6 , Sandro Sironi  1   2
Affiliations

Embolisation of the parenchymal tract after percutaneous portal vein catheterization: a retrospective comparison of outcomes with different techniques in two centres

Paolo Marra et al. CVIR Endovasc. .

Abstract

Background: Embolisation of the parenchymal tract is a key step after any other transhepatic or transplenic percutaneous portal vein catheterization since eventual venous bleeding is difficult to control and may require surgical management. Different techniques have been proposed to perform tract embolisation. The aim of this study is to compare the safety and efficacy of different techniques of haemostasis of the parenchymal tract.

Materials and methods: All the interventional procedures with percutaneous transhepatic or transplenic access to the portal vein (excluding ipsilateral portal vein embolisation) from January 2010 to July 2020, in two tertiary hospitals, were retrospectively analyzed. The following data were evaluated: access site, the technique of embolisation, technical success in terms of immediate thrombosis of the tract, safety and clinical efficacy in terms of the absence of hemorrhagic and thrombotic complications.

Results: One-hundred-sixty-one patients underwent 220 percutaneous transhepatic or transplenic portal vein catheterization procedures. The main indications were pancreatic islet transplantation, portal anastomotic stenosis after liver transplantation, and portal vein thrombosis recanalization. As embolic materials gelfoam was used in 105 cases, metallic micro-coils in 54 cases, and cyanoacrylic glue in 44 cases; in 17 cases the parenchymal tract was not embolized. Technical success was 98% without significant difference among groups (p-value = 0.22). Eighteen post-procedural abdominal bleedings occurred, all grade 3 and were managed conservatively; difference among groups was not significant (p-value = 0.25). We detected 12 intrahepatic portal branch thromboses not related to the embolisation technique; only one case of non-target embolisation was documented after liver tract embolisation with glue, without clinical consequences.

Conclusion: Embolisation of the parenchymal tract after percutaneous portal vein catheterization is technically safe and effective. No significant differences were found between coils, glue, and gelfoam in effectiveness and complications rate.

Level of evidence: Level 3, Cohort study.

Keywords: Coils; Gelfoam; Glue; Parenchymal tract embolisation; Percutaneous portal vein catheterization.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Embolisation of transhepatic tract with cyanoacrylic glue after PPVC. Fluoroscopy image shows the deployment of cyanoacrylic glue in the hepatic parenchyma tract, through a 4F introducer sheath during its retraction (a). MIP reconstruction of contrast-enhanced CT performed after the procedure displays the location of glue cast in the hepatic parenchyma and confirms the adjacent segmental portal branches patency (b)
Fig. 2
Fig. 2
Embolisation of transhepatic tract with micro-coil after PPVC. Fluoroscopy image shows the deployment of a metallic micro-coil in the hepatic parenchyma tract, through a 4F catheter during its retraction (a). MIP reconstruction of contrast-enhanced CT performed after the procedure displays the location of micro-coil in the hepatic parenchyma and confirms the segmental portal branches patency (b)
Fig. 3
Fig. 3
Flow diagram summarizes the population selection
See this image and copyright information in PMC

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