Robotic assistance for liver tumor ablation reduces patient dose and allows for fast positioning of the microwave applicator with high accuracy. The complication rate and ablation success of percutaneous microwave thermoablation of malignant liver tumors using either CT fluoroscopy or robotic guidance for needle positioning showed no significant differences in the 6-week follow-up.
Purpose: To report on first results of the embolization of transhepatic and transsplenic puncture tracts using an Amplatzer Vascular Plug (AVP) after percutaneous portal vein intervention.
Materials and Methods: Embolization of transhepatic and transsplenic puncture tracts with AVP was attempted in 5 patients (3 females; age range: 3???71 years). Portal vein access was gained by a transhepatic (n?=?4) or transsplenic (n?=?1) approach, and stenosis (n?=?2) or thrombosis (n?=?3) of the portal vein was successfully treated by percutaneous stenting or thrombus aspiration and thrombolysis using 6 to 10 French sheaths. Due to the relatively large bore and/or short transparenchymal puncture tracts, it was considered favorable to use AVPs as an embolic agent. The medical records, the radiological reports and images of these 5 patients were retrospectively evaluated.
Result: In three cases one AVP II (diameter, 4?mm), in one case one AVP IV (diameter, 4?mm) and in one case two AVPs II (diameter, 8 and 6?mm) were used for embolization of the puncture tract. In all five cases embolization was technically successful. There was no bleeding from the puncture tract. During a median follow-up of 14 months (range, 21 days to 21 months), one patient developed a focal liver abscess adjacent to the AVP which was successfully treated by antimicrobial and drainage therapy. There were no further embolization-related complications.
Conclusion: AVPs are suited to embolize large bore and/or short transhepatic and transsplenic puncture tracts effectively, safely, and precisely. Caution is required in patients with an increased risk for infectious complications.
Key Points:
??Embolization of transhepatic and transsplenic puncture tracts with AVPs is feasible
??Large and/or short puncture tracts can be effectively embolized with AVPs
??The risk of infectious complications has to be considered
Citation Format:
??Dollinger M, Goessmann H, Mueller-Wille R et?al. Percutaneous Transhepatic and Transsplenic Portal Vein Access: Embolization of the Puncture Tract Using Amplatzer Vascular Plugs. Fortschr R?ntgenstr 2014; 186: 142???150
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