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Review
. 2023 Jun 16;40(2):197-211.
doi: 10.1055/s-0043-1768610. eCollection 2023 Apr.

Liver Venous Deprivation Using Amplatzer Vascular Plug-Assisted N-Butyl Cyanoacrylate Embolization of the Portal and Hepatic Veins: How Do I Do it?

Emily A Knott  1 , Sasan Partovi  2 , Aaron McBride  2 , Abraham Levitin  2 , Sameer Gadani  2
Affiliations
Review

Liver Venous Deprivation Using Amplatzer Vascular Plug-Assisted N-Butyl Cyanoacrylate Embolization of the Portal and Hepatic Veins: How Do I Do it?

Emily A Knott et al. Semin Intervent Radiol. .
No abstract available

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest None declared.

Figures

Fig. 1
Fig. 1
( a, b ) Segmental portal venograms demonstrating portoportal collaterals (arrows) between nonembolized segmental portal venous branches and peripheral portal venous branches of adjacent segment distal to the NBCA cast.
Fig. 2
Fig. 2
Right portal venograms obtained before ( a ) and after ( b ) Amplatzer vascular plug (AVP)-assisted NBCA embolization of the right hepatic vein. ( a ) A 0.018-inch guidewire (solid arrows) was placed in the right hepatic vein. The anterior sectoral branch of the right portal vein was embolized with NBCA with AVP assistance. The posterior sectoral branch had a portal hepatic venous fistula (dashed arrow) that persisted even after coil embolization through collaterals from adjacent portal venous branches. Right hepatic vein embolization was performed before posterior sectoral portal venous embolization to prevent nontarget embolization of NBCA in the pulmonary artery. ( b ) Marked interval reduction in the antegrade flow can be seen in the posterior sectoral portal venous branch after right hepatic vein embolization (stars). Both images were obtained using the same injection parameters in the same venogram phase for comparison.
Fig. 3
Fig. 3
Schematic demonstrating percutaneous access of hepatic vein(s) with the placement of placeholder 0.018-inch guidewires (Reprinted with permission, Cleveland Clinic Foundation ©2023. All Rights Reserved.).
Fig. 4
Fig. 4
Example of bleeding at trans-splenic access site. ( a ) At 30 minutes after percutaneous splenic access for portal vein embolization (PVE), the patient developed severe hypotension requiring massive fluid resuscitation. Pullback splenic venography through the sheath revealed contrast extravasation (star) at the splenic access site. This splenic laceration was suspected to have occurred during the advancement of 6-Fr sheath over a 0.035-inch guidewire. ( b ) An 8 mm × 40 mm angiographic balloon (arrow) was placed across the area of contrast extravasation. The balloon was kept gently inflated for 10 minutes, with marked interval improvement in the patient's hemodynamic status. ( c ) Complete cessation of extravasation can be seen on the venogram obtained after balloon tamponade of the splenic laceration site. PVE was completed after this episode, and the access site was embolized with Amplatzer vascular plug II (8 mm).
Fig. 5
Fig. 5
Trans-splenic venous access. ( a ) Doppler ultrasound is used to detect venous flow and to plan needle trajectory. ( b ) Real-time ultrasound image demonstrating Chiba needle (arrow) accessing the venous system.
Fig. 6
Fig. 6
Portal venogram obtained using digital subtraction angiography demonstrates optimal separation of the right and left portal venous branches.
Fig. 7
Fig. 7
Main portal venogram demonstrating portal and hepatic venous fistula (arrow).
Fig. 8
Fig. 8
Schematic ( a ) and fluoroscopic image ( b ) of a 6 French sheath (white arrow in b ) placed in a sectoral portal branch over a guidewire (black arrow in b ) (Reprinted with permission, Cleveland Clinic Foundation ©2023. All Rights Reserved.).
Fig. 9
Fig. 9
Schematic ( a ) and fluoroscopic image ( b ) of Amplatzer vascular plug I (arrows in b ) in the sectoral portal branch with the guidewire located distally (Reprinted with permission, Cleveland Clinic Foundation ©2023. All Rights Reserved.).
Fig. 10
Fig. 10
Schematic ( a ) and fluoroscopic image ( b ) of Amplatzer vascular plug I (star in b ) with glide catheter advanced into the peripheral branch (arrow) (Reprinted with permission, Cleveland Clinic Foundation ©2023. All Rights Reserved.).
Fig. 11
Fig. 11
Schematic (a, b) and fluoroscopic image (c) of injection of NBCA in the sectoral portal vein branch (arrow in b ) peripheral to the Amplatzer vascular plug I (star in b ) (Reprinted with permission, Cleveland Clinic Foundation ©2023. All Rights Reserved.).
Fig. 12
Fig. 12
Schematic ( a ) and fluoroscopic image ( b ) demonstrate complete Amplatzer vascular plug–assisted NBCA embolization of the right anterior and posterior portal veins (Reprinted with permission, Cleveland Clinic Foundation ©2023. All Rights Reserved.).
Fig. 13
Fig. 13
Schematic of portal vein embolization from ipsilateral access. Access is obtained ( a ) and embolization is performed for the alternate sectoral branch ( b, c ). ( d ) An Amplatzer vascular plug (AVP) I is then deployed 1 cm from the main portal vein in the accessed branch and another AVP I is used more peripherally, trapping the catheter. ( e ) NBCA is used between the 2 plugs and ( f ) then peripherally (Reprinted with permission, Cleveland Clinic Foundation ©2023. All Rights Reserved.).
Fig. 14
Fig. 14
Schematic ( a ) and fluoroscopic image ( b ) of closure with Amplatzer vascular plug II plugs/coils (arrows) at the percutaneous access site (Reprinted with permission, Cleveland Clinic Foundation ©2023. All Rights Reserved.).
Fig. 15
Fig. 15
Hepatic veno-venous collaterals (arrow) between the accessory and right hepatic veins after placement of Amplatzer vascular plug II in the accessory hepatic vein.
Fig. 16
Fig. 16
Schematic ( a ) and fluoroscopic image with outlined plug ( b ) to demonstrate the placement of the Amplatzer vascular plug II in the right hepatic vein (Reprinted with permission, Cleveland Clinic Foundation ©2023. All Rights Reserved.).
Fig. 17
Fig. 17
Schematics ( a, b ) and fluoroscopic image ( c ) demonstrating Amplatzer vascular plug II–assisted NBCA injection in the right hepatic vein (Reprinted with permission, Cleveland Clinic Foundation ©2023. All Rights Reserved.).
Fig. 18
Fig. 18
Schematic of extended liver venous deprivation (LVD), with Amplatzer vascular plug II–assisted NBCA embolization of the middle hepatic vein after LVD (Reprinted with permission, Cleveland Clinic Foundation ©2023. All Rights Reserved.).
Fig. 19
Fig. 19
( a ) Tc-99m mebrofenin scan demonstrating differential function between the embolized and nonembolized lobes of the liver. Using a 40% threshold uptake, the function of the left lobe of the liver was 65%. ( b ) Gd-EOB-DTPA MRI demonstrating clear distinction between the embolized and nonembolized lobes of the liver.
Fig. 20
Fig. 20
Gross image of the liver during surgical resection demonstrates visual distinction between the embolized (star) and nonembolized lobes.
See this image and copyright information in PMC

References

    1. Benson A B, D'Angelica M I, Abbott D E. Hepatobiliary cancers, version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021;19(05):541–565. - PubMed
    1. May B J, Madoff D C. Portal vein embolization: rationale, technique, and current application. Semin Intervent Radiol. 2012;29(02):81–89. - PMC - PubMed
    1. Rahbari N N, Garden O J, Padbury R. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS) Surgery. 2011;149(05):713–724. - PubMed
    1. Kauffmann R, Fong Y. Post-hepatectomy liver failure. Hepatobiliary Surg Nutr. 2014;3(05):238–246. - PMC - PubMed
    1. Li D, Madoff D C. Portal vein embolization for induction of selective hepatic hypertrophy prior to major hepatectomy: rationale, techniques, outcomes and future directions. Cancer Biol Med. 2016;13(04):426–442. - PMC - PubMed