Percutaneous transhepatic portal embolization using foam ethanolamine oleate and carbon dioxide (CO₂): a pilot study.

Abstract

BACKGROUND:

Percutaneous transhepatic portal embolization (PTPE) can induce atrophy of the embolized- and hypertrophy of the residual area. These effects are advantageous in patients scheduled for extended hepatectomy.

PURPOSE:

To evaluate the clinical safety and effectiveness of foam sclerotherapy with foam ethanolamine oleate (EO) and carbon dioxide (CO2) for PTPE before hepatectomy.

MATERIAL AND METHODS:

We performed sclerotherapy for PTPE in 15 patients with: hepatocellular carcinoma (HHC; n = 9), bile duct carcinoma (n = 5), or metastatic liver tumor from colon cancer (n = 1). The foam contained 5% EO iopamidol (EOI) and CO2 at a 1:2 ratio. We compared the percentage of the pre- and post-PTPE future liver remnant (FLR) volumes and calculated the percent FLR volume (%FLR) increase after PTPE.

RESULTS:

The amount of EOI used (range, 14-20 mL; median, 16.8 mL) was based on the volume of the target portal vein. Technical success was achieved in 14 of 15 patients (93%); the other patient presented with computed tomography evidence of recanalization 1 week after PTPE. The FLR volume before and after portal vein embolization was 599 ± 342 and 691 ± 318 cm(3), respectively (P < 0.01); the mean %FLR volume increase was 29.5%. There was no significant difference in the mean platelet count, total bilirubin, total aspartate aminotransferase, and total creatinine before and after PTPE. One patient suffered intra-abdominal bleeding that required transcatheter arterial embolization. No other patients developed major complications higher than grade 3.

CONCLUSION:

Sclerotherapy using foam EOI and CO2 is clinically safe and effective for PTPE before hepatectomy.

• Authors: Seijiro Inoue, Osamu Ikeda, Yutaka Nakasone, Toru Beppu, Toshiro Masuda, Koichi Yokoyama, Daisuke Utsunomiya, Hideo Baba, Yasuyuki Yamashita
• Journal: Acta radiologica (Stockholm, Sweden : 1987) (Acta Radiol) Vol. 56 Issue 11 Pg. 1361-7 (Nov 2015) ISSN: 1600-0455 [Electronic] England
• PMID: 26113740 (Publication Type: Journal Article)
• Copyright: © The Foundation Acta Radiologica 2015.

Chemical References

• Oleic Acids
• Sclerosing Solutions
• Carbon Dioxide
• ethanolamine oleate

Topics

• Aged
• Aged, 80 and over
• Angiography, Digital Subtraction
• Balloon Occlusion
• Bile Duct Neoplasms (diagnostic imaging, therapy)
• Carbon Dioxide (therapeutic use)
• Carcinoma, Hepatocellular (diagnostic imaging, therapy)
• Embolization, Therapeutic (methods)
• Female
• Hepatectomy
• Humans
• Liver Function Tests
• Liver Neoplasms (diagnostic imaging, therapy)
• Male
• Middle Aged
• Oleic Acids (therapeutic use)
• Pilot Projects
• Portal Vein
• Retrospective Studies
• Sclerosing Solutions (therapeutic use)
• Tomography, X-Ray Computed
• Treatment Outcome