Feasibility of Mynxgrip®-Assisted Percutaneous Transhepatic Portal Venous Access Closure

Tan, Gary Xia Vern; Yong, Eric; Sathyanarayana, Raghuram; Brooks, Mark; Jhamb, Ashu

doi:10.1007/s00270-020-02647-7

Cited by 5 publications

(4 citation statements)

References 7 publications

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“…Embolic materials need to be visible under X-ray fluoroscopy to allow confirmation of tract embolization. Particularly in transportal procedures, radiopaque materials and devices have been used to ensure tract closure [19,20]. However, gelatin sponge itself was relatively hard to visualized, appearing almost radiolucent during the embolization procedure under X-ray fluoroscopy [21,22].…”

Section: Discussionmentioning

confidence: 99%

Feasibility of gel-like radiopaque embolic material using gelatin sponge and contrast agent for tract embolization after percutaneous treatment

Nota¹,

Kageyama²,

Yamamoto³

et al. 2023

PLoS ONE

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Objectives Tract embolization has been performed to prevent bleeding after trans-organ puncture. This study evaluated clinical outcomes of tract embolization using a gel-like radiopaque material comprising two sheets of gelatin sponge and 3 mL of contrast agent, and experimentally confirmed its viscosity and hemostatic efficacy. Methods Three study phases were planned. In a clinical setting, 57 consecutive patients who underwent tract embolization after transhepatic puncture were retrospectively analyzed. Clinical success was evaluated as absence of bleeding complications for 30 days after the procedure. In a basic experiment, viscosity of the material was analyzed. In an animal experiment, rabbit kidney puncture site was embolized via a 7-Fr sheath using this material, coils, or N-butyl-2-cyanoacrylate glue or received no embolization while removing the sheath. Amounts of tract bleeding were measured for 1 min and compared between groups. Results Embolization was successfully completed in all clinical cases. No postoperative bleeding requiring intervention was encountered. The basic experiment revealed the material was highly viscous. In the animal experiment, mean weights of bleeding in the control, gel-like embolic material, coil, and N-butyl-2-cyanoacrylate glue groups were 1.04±0.32 g, 0.080±0.056 g, 0.20±0.17 g and 0.11±0.10 g, respectively. No significant differences were seen among embolization groups, while the control group showed significantly more bleeding than any embolization group. Conclusion Tract embolization with this gel-like radiopaque embolic material appears safe and feasible. Advances in knowledge Tract embolization using this embolic material with two sheets of gelatin sponge and 3 mL of contrast agent offers a safe, feasible, and economical procedure after trans-organ puncture, because the material offers the following characteristics: visibility under X-ray; viscosity facilitating retention in the tract; ability to allow repeated puncture via the same route; and low cost.

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Section: Discussionmentioning

confidence: 99%

Feasibility of gel-like radiopaque embolic material using gelatin sponge and contrast agent for tract embolization after percutaneous treatment

Nota¹,

Kageyama²,

Yamamoto³

et al. 2023

PLoS ONE

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show abstract

“…Embolization of the percutaneous trans-hepatic access tracts of the portal vein to prevent hemorrhage has previously been reported. Various materials are utilized to embolize the access tracts after PVE, including fibrin glue, 2,8 NBCA, 9,10 gelatin sponge particles, 11,12 vascular plugs, 13 and coils. [14][15][16][17] The use of these various embolic materials will increase procedural expenditure, operation difficulty, and duration.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, in transhepatic PVE procedures, bleeding is the most common postoperative complication, occurring in approximately 2% to 4% of patients after PVE. 6,7 The risk of hemorrhage is reduced when materials such as embolization fibrin glue, 2,8 n-butyl cyanoacrylate (NBCA), 9,10 gelatin sponge particles,, 11,12 vascular plugs, 13 and coils [14][15][16][17] are used to embolize the tract. These various embolic materials not only increase procedure expenditure but also increase operation difficulty and duration.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and Safety of Delayed Catheter Removal Technique in Percutaneous Trans-Hepatic Portal Vein Embolization

Yang

2022

Technol Cancer Res Treat

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Background: This retrospective study aimed to evaluate the technical feasibility and safety of the delayed catheter removal technique in trans-hepatic portal vein embolization (PVE) and to explore a suitable technique. Methods: This was a retrospective study. In 278 consecutive patients, the puncture tract of the trans-hepatic PVE was treated using the delayed catheter removal technique after PVE. The existence of peripheral hepatic hematoma formation was assessed using ultrasound (US). Follow-up examinations such as magnetic resonance imaging (MRI), computed tomography (CT), and/or US were performed to evaluate perihepatic hematoma formation, hemoperitoneum, and other major complications. Results: Instant hemostasis was achieved in all patients after the procedure. PVE-associated complications were observed in 9 patients (3.24%). No perihepatic hematoma or hemoperitoneum was found in any of the patients. Conclusion: With the appropriate technique, the delayed catheter removal technique can be reliably utilized as a substitute for hemostasis as it is simple and free. This technique should be further evaluated and compared with other methods. Advances in knowledge: This study is the first to investigate the safety and feasibility of the delayed catheter removal technique for embolizing the puncture tract of the trans-hepatic PVE.

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“…We suggest using a Lipiodol/glue ratio lower that 3 to obtain rapid polymerization and prevent non-target embolisation. The performance of other devices proposed for PVCC, in particular, plugs (Dollinger et al 2013 ), vascular closure kits (Tan et al 2020 ), and microfibrillar collagen paste (Gaba et al 2017 ), was not assessed, as was the recently described PVCC via the mesenteric vein (Onishi et al 2021 ).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Feasibility of Mynxgrip®-Assisted Percutaneous Transhepatic Portal Venous Access Closure

Cited by 5 publications

References 7 publications

Feasibility of gel-like radiopaque embolic material using gelatin sponge and contrast agent for tract embolization after percutaneous treatment

Feasibility of gel-like radiopaque embolic material using gelatin sponge and contrast agent for tract embolization after percutaneous treatment

Feasibility and Safety of Delayed Catheter Removal Technique in Percutaneous Trans-Hepatic Portal Vein Embolization

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

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