Embolization of percutaneous transhepatic portal venous access tract with N-butyl cyanoacrylate.

Abstract

OBJECTIVE: To evaluate the safety and feasibility of N-butyl cyanoacrylate

(N-BCA) embolization of percutaneous transhepatic portal venous access tract and

to establish an appropriate technique. METHODS: 40 consecutive patients underwent

percutaneous transhepatic portal venous intervention for various reasons.

Embolization of percutaneous transhepatic portal venous access tract was

performed after the procedure in all of the patients using N-BCA and Lipiodol(R)

(Lipiodol Ultra Fluide; Laboratoire Guerbet, Aulnay-sous-Bois, France) mixture.

Immediate ultrasonography and fluoroscopy were performed to evaluate perihepatic

haematoma formation and unintended embolization of more than one segmental portal

vein. Follow-up CT was performed, and haemoglobin and haematocrit levels were

checked to evaluate the presence of bleeding. RESULTS: Immediate haemostasis was

achieved in all of the patients, without development of perihepatic haematoma or

unintended embolization of more than one segmental portal vein. Complete

embolization of percutaneous access tract was confirmed in 39 out of 40 patients

by CT. Seven patients showed decreased haemoglobin and haematocrit levels. Other

complications included mild pain at the site of embolization and mild fever,

which resolved after conservative management. 16 patients died during the

follow-up period owing to progression of the underlying disease. CONCLUSION:

Embolization of percutaneous transhepatic portal vein access tract with N-BCA is

feasible and technically safe. With the appropriate technique, N-BCA can be

safely used as an alternate embolic material since it is easy to use and

inexpensive compared with other embolic materials. ADVANCES IN KNOWLEDGE: This is

the first study to investigate the efficacy of N-BCA for percutaneous

transhepatic portal venous access tract embolization.