Effect of N-butyl cyanoacrylate particles in the Portal vein embolization treatment

Abstract

Portal vein embolization was developed to extend the indications for hepatic resection and has become the standard care for selected patients with primary liver cancer. Due to insufficient volume of future liver remnant, portal vein embolization is one of the main methods to stimulate growth of the future remnant liver to improving the possibility of extension liver resection. There are a lot of studies including uses of gelfoam, coils, polyvinyl alcohol particles, N-butyl cyanoacrylate, absolute ethanol, metal coils and combination of these materials for PVE. The aim of our study was to evaluate the effectiveness of N-butyl cyanoacrylate particles for percutaneous transhepatic portal vein embolization in Mongolia. Our study was conducted retrospectively at National cancer center of Mongolia between Jan of 2018 to Jun of 2019. A total number of patients was 59 who underwent percutaneous transhepatic portal vein embolization with N-butyl cyanoacrylate particles before liver resection. All data including general information, laboratory and imaging findings were reviewed in our study. Peripheral portal vein branch was punctured with 22 gauge Chiba needle under ultrasound and fluoroscopic guidance. A metal introducer set is accessed into the portal vein branch over a 0.018” guidewire, followed by placement of 5-Fr vascular sheath. A N-butyl cyanoacrylate mixed with ethiodized Lipiodol® medium was used to embolize the portal vein branches until occlusion. A p value < 0.05 was considered statistically significant. Statistical analysis was performed with SPSS 20. A total number of 59 patients, who aged between 44-71 years old (mean age of …±10.1) with and hepatocellular cancer (Table 1). There were 48 patients with a single lesion while 11 patients were with multiple lesions in the right lobe of the liver. The mean FRL diameter of total patients were measured as 406±35cm3 before PVE. The mean FLR diameter of total patients were measured as 530±70cm3 after PVE. The mean technical success rate of the PVE was 95.7%. The mean hospital stay after PVE was 2±1 day. Size difference before and after PVE were not statistically significant. 2 number of patients, the hypertrophy response was insufficient to perform the resection due to complication including liver ruptured tumor and abscess. Minor complications including nausea and vomiting (10.6%), fever (38.3%) and pain (63.5%) occurred after PVE. There was not a big difference in laboratory changes before and after PVE. PVE is used for extending the indications for hepatic resection in Mongolia since 2009. This study demonstrates that PVE using Histoacryl glue®, introduced in our country since 2018, were highly effective with low complications rate and no significant tumor growth after.