Treatment of symptomatic polycystic liver disease: transcatheter super-selective

abdom imaging. 2012 jun 29. [epub ahead of print]

treatment of symptomatic polycystic liver disease: transcatheter super-selective
hepatic arterial embolization using a mixture of nbca and iodized oil.

wang mq, duan f, liu fy, wang zj, song p.

department of interventional radiology, chinese pla general hospital, 28, fuxing北京301医院介入放射科王茂强
rd., beijing, 100853, china, [e-mail].

background: surgical therapy for symptomatic polycystic liver disease (pld) is
effective but has substantial mortality and morbidity. minimally invasive options
such as laparoscopic fenestration, percutaneous cyst aspiration with or without
injection of a sclerosing solution have had disappointing results. because the
hepatic cysts in autosomal dominant polycystic kidney disease (adpkd) patients
are mostly supplied from hepatic arteries but not from portal veins, therefore,
transcatheter arterial embolization (tae) of the hepatic artery branches that
supply major hepatic cysts can lead to shrinkage of the cyst and liver size. aim:
the purpose of this study was to evaluate the safety and effectiveness of tae
using a mixture of n-butyl-2-cyanoacrylate (nbca) and iodized oil for massive pld
in adpkd patients. methods: from february 2007 to march 2011, a total of 21
patients with symptomatic pld underwent super-selective hepatic tae with the
mixture of nbca and iodized oil. the patients consisted of 17 women and 4 men
(age range 36-64 years, average age 48.8 years). all patients underwent
contrast-enhanced computed tomography (ct) of the liver before tae, and at every
3 months for the first year after tae and at 6-monthly intervals thereafter.
laboratory data, including routine blood tests and liver enzymes, were collected
before and 1, 3, 7, and 14 days, 1, 3, 6, and 12 months after tae. results:
technical success was achieved in all cases. no serious complications were
experienced. the mean follow-up period was 34 ± 20 months (range 12-60 months).
at follow-up of 6-12 months, symptoms notably improved in 18 (85.7%) of 21
patients, and these patients experienced further relief of the symptoms during
the follow-up period. tae failed to benefit in 3 patients (14.3%). no patient
complained of worsening of the symptoms after the procedure. at follow-up ct, the
total liver volume and total intra-hepatic cyst volume decreased significantly
(p < 0.001) compared with pre-tae in 18 (85.7%) of 21 patients at 12 months after
tae. the total liver volume decreased from 8270 ± 3016 to 6120 ± 2680 cm(3) and
the total intra-hepatic cyst volume decreased from 7120 ± 3070 to
4530 ± 2600 cm(3). mild elevation of the liver enzymes was shown in patients at
1-14 days after tae but returned to the normal range within 1 month. conclusion:
the mixture of nbca and iodized oil is an acceptable embolic agent for
embolization of the hepatic artery branches that supply the hepatic cysts in
adpkd patients. this technique is an option for patient with highly symptomatic
pld who are not candidates for surgical treatment.