The Safety and Efficacy of Hepatic Transarterial Embolization Using Microspheres and Microcoils in Patients with Symptomatic Polycystic Liver Disease

Abstract

Purpose: We investigated the long-term safety and efficacy of hepatic transarterial embolization (TAE) in patients with symptomatic polycystic liver disease (PLD). Materials and Methods: A total of 26 patients were included, mean age of 52.3 years (range: 33−78 years), undergoing 32 TAE procedures between January 2012 and December 2019 were included in this retrospective study. Distal embolization of the segmental hepatic artery was performed with 300−500 µm embolic microspheres associated with proximal embolization using microcoils. The primary endpoint was clinical efficacy, defined by an improvement in health-related quality of life using a modified Short Form-36 Health Survey and improvement in symptoms (digestive or respiratory symptoms and chronic abdominal pain), without invasive therapy during the follow-up period. Secondary endpoints were a decrease in total liver volume and treated liver volume and complications. Results: Hepatic embolization was performed successfully in 30 of 32 procedures with no major adverse events. Clinical efficacy was 73% (19/26). The mean reduction in hepatic volume was −12.6% at 3 months and −27.8% at the last follow-up 51 ± 15.2 months after TAE (range: 30−81 months; both ps < 0.01). The mean visual analog scale pain score was 5.4 ± 2.8 before TAE and decreased to 2.7 ± 1.9 after treatment. Three patients had minor adverse events, and one patient had an adverse event of moderate severity. Conclusion: Hepatic embolization using microspheres and microcoils is a safe and effective treatment for PLD that improves symptoms and reduces the volume of hepatic cysts.

Keywords: efficacy; embolization; polycystic liver disease; safety.

Figure 2

Computed Tomography (CT) from a patient with polycystic liver disease before and after transarterial embolization. (a,b) Pre-embolization CT showing a voluminous polycystic liver with a compression of the stomach by the cysts. (c,d) CT at 3 months showing coils and reduction of cysts volume. (e,f): CT at 4 years showing a significant liver volume reduction of 29% with a decompression of the stomach.

Figure 1

(a) arteriography of the coeliac artery showing well developed hepatic artery deviated by the cysts without parenchymography of the left liver. (b) Portography showing permeable splenic and portal vein, occlusion of the left portal and right anterior portal vein (arrow), and permeability of the right posterior portal vein (Star). (c,d): CT scan showing good correlation with the arteriography and portography. hepatic parenchyma is completely replaced by cysts in segment II, III and IV.

Figure 1

(a) arteriography of the coeliac artery showing well developed hepatic artery deviated by the cysts without parenchymography of the left liver. (b) Portography showing permeable splenic and portal vein, occlusion of the left portal and right anterior portal vein (arrow), and permeability of the right posterior portal vein (Star). (c,d): CT scan showing good correlation with the arteriography and portography. hepatic parenchyma is completely replaced by cysts in segment II, III and IV.