Ethylene vinyl alcohol copolymer for occlusion of specific portal branches during preoperative portal vein embolisation with n-butyl-cyanoacrylate
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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).
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.
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.
EVOH is safe and effective for embolisation of selected portal vein branches considered at risk for non-target embolisation.
• 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.
KeywordsPortal vein Embolisation Therapeutic Ethylene vinyl alcohol copolymer Hepatectomy
Ethylene vinyl alcohol
Future liver remnant
Portal vein embolisation
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Professor Sylvain Terraz.
Conflict of interest
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.
Written informed consent was waived by the institutional review board.
Institutional review board approval was obtained.
• performed at one institution