BestFLR Trial: Liver Regeneration at CT before Major Hepatectomies for Liver Cancer—A Randomized Controlled Trial Comparing Portal Vein Embolization with <i>N</i>-Butyl-Cyanoacrylate Plus Iodized Oil versus Polyvinyl Alcohol Particles Plus Coils

Luz, José Hugo Mendes; Gomes, Filipe Veloso; Costa, Nuno Vasco; Vasco, Inês Conde; Coimbra, Élia; Luz, Paula M.; Marques, Hugo P.; Coelho, João Santos; Mega, Raquel; Ribeiro, Vasco; Lamelas, Jorge; Sobral, Maria Mafalda de Sampaio Nunes E; Silva, Sílvia Raquel Gomes da; Carrelha, Ana Sofia de Teixeira; Rodrigues, Susana; Figueiredo, António; Santos, Margarida Varela dos; Bilhim, Tiago

doi:10.1148/radiol.2021204055

Cited by 34 publications

(20 citation statements)

References 32 publications

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“…Pooled data showed a statistically significant higher degree of hypertrophy after embolization with NBCA compared to PVA ± coils. Superior increase in liver volume with NBCA plus iodized oil versus PVA plus coils was also reported in a recently published randomized controlled trial by Luz et al [60].…”

Section: Discussionsupporting

confidence: 70%

Predictive Factors for Hypertrophy of the Future Liver Remnant After Portal Vein Embolization: A Systematic Review

Soykan

Aarts

López-Yurda

et al. 2021

Cardiovasc Intervent Radiol

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This systematic review was conducted to determine factors that are associated with the degree of hypertrophy of the future liver remnant following portal vein embolization. An extensive search on September 15, 2020, and subsequent literature screening resulted in the inclusion of forty-eight articles with 3368 patients in qualitative analysis, of which 18 studies were included in quantitative synthesis. Meta-analyses based on a limited number of studies showed an increase in hypertrophy response when additional embolization of segment 4 was performed (pooled difference of medians = − 3.47, 95% CI − 5.51 to − 1.43) and the use of N-butyl cyanoacrylate for portal vein embolization induced more hypertrophy than polyvinyl alcohol (pooled standardized mean difference (SMD) = 0.60, 95% CI 0.30 to 0.91). There was no indication of a difference in degree of hypertrophy between patients who received neo-adjuvant chemotherapy and those who did not receive pre-procedural systemic therapy(pooled SMD = − 0.37, 95% CI − 1.35 to 0.61), or between male and female patients (pooled SMD = 0.19, 95% CI − 0.12 to 0.50).The study was registered in the International Prospective Register of Systematic Reviews on April 28, 2020 (CRD42020175708).

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Section: Discussionsupporting

confidence: 70%

Predictive Factors for Hypertrophy of the Future Liver Remnant After Portal Vein Embolization: A Systematic Review

Soykan

Aarts

López-Yurda

et al. 2021

Cardiovasc Intervent Radiol

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“…It has been found that a combination of coils/vascular plugs and particles yields increased FLR growth compared to particles alone [ 5 ]. Several studies have indicated a benefit of using NBCA over particles [ 6 – 8 ] and this was recently confirmed in a randomized controlled trial including 60 patients [ 9 ]. Furthermore, a technique has been described where vascular plugs are combined with NBCA embolization to avoid non-target embolization of the FLR and reduce the re-canalization rate [ 7 , 10 ], but there is no study demonstrating the actual benefit of this technique compared to embolization with NBCA alone.…”

Section: Introductionmentioning

confidence: 88%

Portal Vein Embolization Using N-Butyl Cyanoacrylate-Glue: What Impact Does a Central Vascular Plug Have?

Carling

Røsok

Berger

et al. 2021

Cardiovasc Intervent Radiol

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Purpose To examine if the addition of a central vascular plug (CVP) to portal vein embolization (PVE) with N-butyl cyanoacrylate-glue (NBCA) increases future liver remnant (FLR) growth. Material and Methods This is a single-center retrospective study of 115 consecutive patients with colorectal liver metastases undergoing PVE in 2013–2019. All patients were embolized with NBCA as the main embolic agent. In 2017–2019 NBCA was combined with a CVP in the central part of the right portal vein. Growth of the FLR and standardized FLR (sFLR) including degree of hypertrophy (DH) and kinetic growth rate (KGR) were analyzed, as well as procedure data such as use of cone-beam CT (CBCT), dose area product (DAP), fluoroscopy time and contrast dose. Results A total of 40 patients (35%) underwent PVE with a combination of CVP and NBCA. The DH was higher in these patients after 4 weeks, mean 13.6% (SD 7.8) vs. 10.5% (SD 6.4; p = 0.022), verified in multivariate analysis (coefficient 4.1, p = 0.015). A CVP did not significantly increase the resection rate (90% vs 82%, p = 0.4). Cone beam CT was used in 65 patients (57%). Use of CBCT did not affect FLR growth, and fluoroscopy time and contrast doses were not different in patients having a CBCT or not. Slightly lower DAP (median 3375 vs. 4499 cGy*cm2; p = 0.09) was seen in procedures where CBCT was used. Conclusion A CVP in addition to NBCA embolization was associated with increased growth of the FLR compared to NBCA alone.

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“…Portal vein embolization (PVE) is highly recommended to promote liver growth before extensive hepatectomy in patients with liver cancer and an initially insufficient liver reserve. Evidence now exists that portal vein embolization with NBCA generates faster and greater liver regeneration compared with standard PVA particles and coils, allowing for earlier hepatectomy [ 35 , 36 , 37 , 38 ]. PVE with NBCA is also associated with smaller contrast volumes and shorter fluoroscopy times.…”

Section: Clinical Applicationsmentioning

confidence: 99%

Endovascular Use of Cyanoacrylate-Lipiodol Mixture for Peripheral Embolization: Properties, Techniques, Pitfalls, and Applications

Comby¹,

Guillen²,

Chevallier³

et al. 2021

JCM

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Endovascular embolization agents are particles and fluids that can be released into the bloodstream through a catheter to mechanically and/or biologically occlude a target vessel, either temporarily or permanently. Vascular embolization agents are available as solids, liquids, and suspensions. Although liquid adhesives (glues) have been used as embolic agents for decades, experience with them for peripheral applications is generally limited. Cyanoacrylates are the main liquid adhesives used for endovascular interventions and have a major role in managing vascular abnormalities, bleeding, and many vascular diseases. They can only be injected as a mixture with ethiodized oil, which provides radiopacity and modulates the polymerization rate. This review describes the characteristics, properties, mechanisms of action, modalities of use, and indications of the cyanoacrylate-Lipiodol® combination for peripheral embolization.

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BestFLR Trial: Liver Regeneration at CT before Major Hepatectomies for Liver Cancer—A Randomized Controlled Trial Comparing Portal Vein Embolization with N-Butyl-Cyanoacrylate Plus Iodized Oil versus Polyvinyl Alcohol Particles Plus Coils

Cited by 34 publications

References 32 publications

Predictive Factors for Hypertrophy of the Future Liver Remnant After Portal Vein Embolization: A Systematic Review

Predictive Factors for Hypertrophy of the Future Liver Remnant After Portal Vein Embolization: A Systematic Review

Portal Vein Embolization Using N-Butyl Cyanoacrylate-Glue: What Impact Does a Central Vascular Plug Have?

Endovascular Use of Cyanoacrylate-Lipiodol Mixture for Peripheral Embolization: Properties, Techniques, Pitfalls, and Applications

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