Transarterial Embolization for Treatment of Symptomatic Polycystic Liver Disease

Abstract

Background:Currently, treatment of symptomatic polycystic liver disease (PLD) is still a challenging problem, especially for these patients who are not feasible for surgery. Minimally invasive options such as laparoscopic fenestration and percutaneous cyst aspiration with sclerotherapy demonstrated disappointing results due to multiple lesions. Because the cysts in PLD are mostly supplied from hepatic arteries but not from portal veins, transcatheter arterial embolization (TAE) of the hepatic artery branches that supply the major hepatic cysts can lead to shrinkage of the cyst and liver size, relieve symptoms, and improve nutritional status. This study aimed to evaluate the effectiveness of TAE with a mixture of N-butyl-2-cyanoacrylate (NBCA) and iodized oil for patients with severe symptomatic PLD during a more than 2-year follow-up.Methods:Institutional review board had approved this study. Written informed consent was obtained from all patients. From February 2007 to December 2014, twenty-three patients (20 women and 3 men; mean age, 49.0 ± 14.5 years) infeasible for surgical treatments underwent TAE. Changes in the abdominal circumferences, volumes of intrahepatic cysts, hepatic parenchyma volume, and whole liver, clinical symptoms, laboratory data, and complications were evaluated after TAE.Results:Technical success was achieved in all cases. No procedure-related major complications occurred. The median follow-up period after TAE was 48.5 months (interquartile range, 30.0–72.0 months). PLD-related severe symptoms were improved remarkably in 86% of the treated patients; TAE failed to benefit in four patients (four patients did not benefit from TAE). The mean maximum abdominal circumference decreased significantly from 106.0 ± 8.0 cm to 87.0 ± 15.0 cm (P = 0.021). The mean intrahepatic cystic volume reduction rates compared with pre-TAE were 36% at 12 months, 37% at 24 months, and 38% at 36 months after TAE (P < 0.05). The mean liver volume reduction rates were 32% at 12 months, 31% at 24 months, and 33% at 36 months (P < 0.05).Conclusions:TAE with the mixture of NBCA and iodized oil appears to be a safe and effective treatment method for patients with symptomatic PLD, especially for those who are not good candidates for surgical treatments, to improve both hepatic volume and hepatic cysts volume.

Massive Polycystic Liver with a Poor Performance Status Successfully Treated by ABO-incompatible Adult Living-donor Liver Transplantation While Overcoming Complications

“…The efficacy of TAE has been also reported (6,7). However, previous studies have included only a small number of patients, so large-scale studies are needed in order to investigate the efficacy and safety of TAE.…”

“…As hepatocellular insufficiency is rarely a feature of PLD, unlike renal involvement ( 5 ), treatments for PLD are generally indicated when patients become symptomatic. Some interventional approaches, such as transcatheter arterial embolization (TAE) ( 6 , 7 ) and needle aspiration with sclerotherapy ( 8 ), have been attempted, but outcomes were insufficient. Treatment for symptoms of PLD, such as pain and digestive and/or respiratory discomfort due to hepatomegaly, thus remains largely surgical, ranging from fenestration with or without partial hepatic resection to liver transplantation (LT) ( 9 ).…”

Transcatheter arterial embolization for hemorrhagic rupture of a simple hepatic cyst: A case report

“…To our knowledge, no report has described the course of a simple hepatic cyst following TAE. In limited facilities, TAE has become an accepted treatment option for patients with symptomatic PCLD [21] . In cystic lesions, almost all hepatic arterial branches are well developed, and they predominate over portal vein branches [22] .…”

Transarterial embolisation with bleomycin and N-butyl-2-cyanoacrylate –Lipiodol mixture for symptomatic polycystic liver disease: preliminary experience

“…patients and concluded this is an acceptable embolic agent. More than 2-years follow-up by Zhang et al, 15 certified that the NBCAeLipiodol mixture (NL) for PLD appears to be a safe and effective embolic material. The mean liver cystic volume reduction rates compared with pre-TAE were 23% at 6 months, 36% at 12 months, 37% at 24 months, and 38% at 36 months after TAE.…”