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Ethylene vinyl alcohol copolymer for occlusion of specific portal branches during preoperative portal vein embolisation with n-butyl-cyanoacrylate

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the safety and efficacy of ethylene vinyl alcohol copolymer (EVOH) injection for selective occlusion of portal branches considered at risk for non-target embolisation during preoperative portal vein embolisation (PVE).

Methods

Twenty-nine patients (mean age, 57 ± 17 years) submitted to PVE with n-butyl-cyanoacrylate (NBCA) and additional EVOH for selected portal branches were retrospectively analysed. Indications for the use of EVOH and the selected portal branches were evaluated. Degree of hypertrophy of the future liver remnant (FLR) and kinetic growth were assessed by CT volumetry performed before and 3–6 weeks after PVE. Clinical outcome and histopathological analysis of portal veins occluded with EVOH were reviewed.

Results

EVOH was indicated intraoperatively for embolisation of selected portal branches that the operator reported at risk to provoke non-target embolisation with NBCA. Indications for the use of EVOH were embolisation of segment IV (n = 21), embolisation of segmental portal branches with early bifurcation (n = 7) and PVE in a 1-year-old girl with cystic hamartomas. All targeted portal branches were successfully embolised. There were no cases with non-target embolisation by EVOH. The degree of hypertrophy of the FLR was 14.3 ± 8.1% and the kinetic growth rate was 2.7 ± 1.8% per week.

Conclusion

EVOH is safe and effective for embolisation of selected portal vein branches considered at risk for non-target embolisation.

Key Points

• EVOH is another effective liquid embolic agent for preoperative PVE.

• EVOH is relatively simple to handle with a minimal risk of non-target embolisation.

• During PVE, some portal branches considered complicated to occlude with NBCA may be efficiently embolised with EVOH.

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Abbreviations

ALT:

Alanine transaminase

AST:

Aspartate transaminase

CT:

Computed tomography

DMSO:

Dimethyl sulfoxide

EVOH:

Ethylene vinyl alcohol

FLR:

Future liver remnant

NBCA:

n-butyl cyanoacrylate

PVE:

Portal vein embolisation

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland

    Romain Breguet, Sana Boudabbous, Lawrence F. Pupulim, Christoph D. Becker, Maxime Ronot & Sylvain Terraz

  2. Hepato-Pancreato-Biliary Centre, University Hospitals of Geneva, Geneva, Switzerland

    Romain Breguet, Christoph D. Becker, Laura Rubbia-Brandt, Christian Toso & Sylvain Terraz

  3. Department of Clinical Pathology, University Hospitals of Geneva, Geneva, Switzerland

    Laura Rubbia-Brandt

  4. Department of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland

    Christian Toso

  5. Department of Radiology, University Hospitals of Beaujon, Paris, France

    Maxime Ronot

Authors
  1. Romain Breguet
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  2. Sana Boudabbous
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  3. Lawrence F. Pupulim
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  4. Christoph D. Becker
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  7. Maxime Ronot
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  8. Sylvain Terraz
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Correspondence to Sylvain Terraz.

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The scientific guarantor of this publication is Professor Sylvain Terraz.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the institutional review board.

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Methodology

• retrospective

• observational

• performed at one institution

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Breguet, R., Boudabbous, S., Pupulim, L.F. et al. Ethylene vinyl alcohol copolymer for occlusion of specific portal branches during preoperative portal vein embolisation with n-butyl-cyanoacrylate. Eur Radiol 28, 4810–4817 (2018). https://doi.org/10.1007/s00330-018-5476-1

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  • DOI: https://doi.org/10.1007/s00330-018-5476-1

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