European Radiology

, Volume 28, Issue 11, pp 4810–4817 | Cite as

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

  • Romain Breguet
  • Sana Boudabbous
  • Lawrence F. Pupulim
  • Christoph D. Becker
  • Laura Rubbia-Brandt
  • Christian Toso
  • Maxime Ronot
  • Sylvain TerrazEmail author



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.

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.


Portal vein Embolisation Therapeutic Ethylene vinyl alcohol copolymer Hepatectomy 



Alanine transaminase


Aspartate transaminase


Computed tomography


Dimethyl sulfoxide


Ethylene vinyl alcohol


Future liver remnant


n-butyl cyanoacrylate


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.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.


• retrospective

• observational

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Romain Breguet
    • 1
    • 2
  • Sana Boudabbous
    • 1
  • Lawrence F. Pupulim
    • 1
  • Christoph D. Becker
    • 1
    • 2
  • Laura Rubbia-Brandt
    • 2
    • 3
  • Christian Toso
    • 2
    • 4
  • Maxime Ronot
    • 1
    • 5
  • Sylvain Terraz
    • 1
    • 2
    Email author
  1. 1.Department of RadiologyUniversity Hospitals of GenevaGeneva 14Switzerland
  2. 2.Hepato-Pancreato-Biliary CentreUniversity Hospitals of GenevaGenevaSwitzerland
  3. 3.Department of Clinical PathologyUniversity Hospitals of GenevaGenevaSwitzerland
  4. 4.Department of Visceral SurgeryUniversity Hospitals of GenevaGenevaSwitzerland
  5. 5.Department of RadiologyUniversity Hospitals of BeaujonParisFrance

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