Portal Vein Embolization Using N-Butyl Cyanoacrylate-Glue: What Impact Does a Central Vascular Plug Have?

Abstract

Purpose To examine if the addition of a central vascular plug (CVP) to portal vein embolization (PVE) with N-butyl cyanoacrylate-glue (NBCA) increases future liver remnant (FLR) growth. Material and Methods This is a single-center retrospective study of 115 consecutive patients with colorectal liver metastases undergoing PVE in 2013–2019. All patients were embolized with NBCA as the main embolic agent. In 2017–2019 NBCA was combined with a CVP in the central part of the right portal vein. Growth of the FLR and standardized FLR (sFLR) including degree of hypertrophy (DH) and kinetic growth rate (KGR) were analyzed, as well as procedure data such as use of cone-beam CT (CBCT), dose area product (DAP), fluoroscopy time and contrast dose. Results A total of 40 patients (35%) underwent PVE with a combination of CVP and NBCA. The DH was higher in these patients after 4 weeks, mean 13.6% (SD 7.8) vs. 10.5% (SD 6.4; p = 0.022), verified in multivariate analysis (coefficient 4.1, p = 0.015). A CVP did not significantly increase the resection rate (90% vs 82%, p = 0.4). Cone beam CT was used in 65 patients (57%). Use of CBCT did not affect FLR growth, and fluoroscopy time and contrast doses were not different in patients having a CBCT or not. Slightly lower DAP (median 3375 vs. 4499 cGy*cm2; p = 0.09) was seen in procedures where CBCT was used. Conclusion A CVP in addition to NBCA embolization was associated with increased growth of the FLR compared to NBCA alone.

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

“…In a retrospective study comparing PVE performed using NBCA alone versus PVE performed using NBCA with AVP assistance, NBCA plus AVP assistance was associated with greater increases in degree of hypertrophy ( p = 0.02) and kinetic growth rate of the FLR ( p = 0.07), as well as reduced fluoroscopy time ( p < 0.01). 32 These results support our hypothesis that the better outcomes seen with NBCA plus AVP assistance are related to the complete embolization of the PV branches and reduced recanalization seen with this technique. AVP assistance may also reduce the need for subsegmental catheterization of PV branches for embolization, leading to reduced procedure and fluoroscopy times and lower contrast requirements.…”

“…AVP assistance may also reduce the need for subsegmental catheterization of PV branches for embolization, leading to reduced procedure and fluoroscopy times and lower contrast requirements. 32,33 Liver Venous Deprivation Technique…”

“…18 At our center, we prefer embolization using AVP assistance, as studies have demonstrated the safety and superior efficacy of this method. 32,33 AVP-assisted NBCA embolization can be performed through access to the portal venous system from either transhepatic (ipsilateral or contralateral) or transsplenic routes.…”

Portal vein embolization versus dual vein embolization for management of the future liver remnant in patients undergoing major hepatectomy: meta-analysis

“…All patients in this study also underwent PVE with N-butyl cyanoacrylate glue with varied hypertrophy rates. Some studies have demonstrated that the addition of a central vascular plug or coil in PVE alone is associated with increased hypertrophy rates which may be related to revascularization of the portal vein 38 . Therefore, the technique for PVE used in these studies may be associated with an inferior hypertrophy than more current techniques; however, the technique for PVE was the same for the DVE and PVE groups of each study included.…”

Sodium Phytate‐Incorporated Gelatin‐Silicate Nanoplatelet Composites for Enhanced Cohesion and Hemostatic Function of Shear‐Thinning Biomaterials

“…[3a] However, these products are generally associated with serious limitations: Onyx™ is a popular catheter-injectable embolic agent based on ethylene(vinyl alcohol) (EVOH) dissolved in dimethyl sulfoxide (DMSO), which induces cytotoxicity at the injection site. [4] Histoacryl®, another embolic agent based on adhesive n-butyl cyanoacrylates (NBCAs), [5] suffers from catheter clogging (due to its uncontrollable curing), exothermic solidification, [6] as well as stiffness mismatch with the surrounding soft tissues. [7] Injectable hydrogels have received enormous attention due to their versatility for integration with minimally invasive platforms, e.g., in transcatheter embolization.…”