Efficacy and safety of preoperative percutaneous transhepatic portal embolization with absolute ethanol: A clinical study

Shimamura, Tsuyoshi; Nakajima, Yasuaki; Une, Yoshie; Namieno, Tsutomu; Ogasawara, Kunio; Yamashita, Kazuo; Haneda, Tsutomu; Nakanishi, Koji; Kimura, Junko; Matsushita, Michiaki; Sato, Naoki; Uchino, Junichi

doi:10.1016/s0039-6060(97)90282-8

Cited by 151 publications

(91 citation statements)

References 18 publications

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“…We selected EOH plus iodized oil as the embolic materials for PVE due to their combined efficacy, manageability, and low costs. According to 2 reports, the mean volumes of EOH used for PVE were 20.7 mL (n ¼ 7) and 32 mL (n ¼ 14), respectively, 13,14 more than that in the present study (20 mL). It was reported that the volume of EOH positively correlated with the maximum levels of AST and ALT, but was not related to changes in liver volume after PVE.…”

Section: Discussioncontrasting

confidence: 55%

“…17 The present study showed that levels of AST and ALT were elevated after PVE, and were usually the highest on the following day and returned to initial conditions about 2 weeks after PVE. These recoveries required little longer period than those in patients in other reports, 7 to 14 days 13 and within 7 days. 17 The levels of a group of biliary tract enzymes (ALP, GGT, T-Bil) after PVE were almost equal to those before PVE, as compared with AST and ALT.…”

Section: Discussionmentioning

confidence: 43%

“…Since the initial description of preoperative PVE by Kinoshita in 1986, 13 many authors have studied the In a recent systematic review, the mean hypertrophy ratio was reported to be 37.9% 6 0.1%, which was measured 25.9 6 10.1 days after PVE. 1 In the present study, the mean hypertrophy ratio was 41.1% 6 34.5% in 16.3 6 5.0 days.…”

Section: Discussionmentioning

confidence: 99%

“…There are some reports about PVE with EOH that showed microscopic findings including periportal inflammatory reaction and fibrosis, portal vein endothelial injury, portal obstruction with leukocyte infiltration and scattered foci of hepatocyte necrosis. [13][14][15] This may be the reason why EOH could induce liver damage and subsequent atrophy of the embolized lobe, and hypertrophy of the nonembolized lobe in a short time.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of Portal Vein Embolization Using Absolute Ethanol Before Major Hepatectomy

Yamamoto

Mihara

Yoshizawa

et al. 2016

International Surgery

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Portal vein embolization (PVE) is widely considered to improve the safety and extend the indication of major hepatectomy. There are various embolization materials and techniques in each facility. The safety and efficacy of absolute ethanol (EOH) in PVE were analyzed. Fifty-one patients who underwent PVE prior to major hepatectomy were enrolled in this study. Two types of embolization techniques were performed: transileocolic portal vein embolization (TIPE) and percutaneous transhepatic portal vein embolization (PTPE). The embolization material consisted of 20 mL of EOH and 2 mL of iodized oil. Multislice computed tomography (CT) scans were performed before and after PVE. The mean time interval between PVE and the follow-up CT scan was 16.3 6 5.0 days. The mean future liver remnant ratio to total liver (FLR%) significantly increased from 32.1% 6 7.6% to 43.5% 6 9.5% after PVE (P , 0.001). The mean hypertrophy ratio was 41.1% 6 34.5%. There were 3 major complications, subcutaneous hematoma in the TIPE group, hemobilia, and bile leakage in the PTPE group. Although the levels of aspartate transaminase and alanine transaminase increased dramatically after PVE, they subsequently returned to pre-PVE levels. There were no patients whose liver dysfunction was prolonged until hepatectomy. In conclusion, PVE using EOH is a safe and effective method to induce hypertrophy in the future remnant liver before major hepatectomy.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Analysis of Portal Vein Embolization Using Absolute Ethanol Before Major Hepatectomy

Yamamoto

Mihara

Yoshizawa

et al. 2016

International Surgery

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“…Ethanol is a liquid embolic agent that causes immediate vascular sclerosis and occlusion by a combination of direct toxic effect on the vascular wall and clumping of damaged erythrocytes and denatured proteins [24][25][26] . It has been used widely in the treatment of renal cell carcinoma, esophageal varices, and arteriovenous malformations [24][25][26][27][28][29][30][31][32][33][34][35] . Similar to the treatment of arteriovenous malformation, injecting ethanol into APS results in clot formation, denudes the endothelium and causes embolization by penetrating into the capillaries.…”

Section: Discussionmentioning

confidence: 99%

Comparison of long-term effects between intra-arterially delivered ethanol and Gelfoam for the treatment of severe arterioportal shunt in patients with hepatocellular carcinoma

Huang

Q²,

Jiang³

et al. 2004

WJG

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AIM:To evaluate long-term effect of ethanol embolization for the treatment of hepatocellular carcinoma (HCC) with severe hepatic arterioportal shunt (APS), compared with Gelfoam embolization. METHODS:Sixty-four patients (ethanol group) and 33 patients (Gelfoam group) with HCC and APS were respectively treated with ethanol and Gelfoam for APS before the routine interventional treatment for the tumor. Frequency of recanalization of shunt, complete occlusion of the shunt, side effects, complications, and survival rates were analyzed between the two groups. RESULTS:The occlusion rate of APS after initial treatment in ethanol group was 70.3%(45/64), and recanalization rate of 1 month after embolization was 17.8%(8/45), and complete occlusion rate was 82.8%(53/64). Those in Gelfoam group were 63.6%(21/33), 85.7%(18/21), and 18.2%(6/33). There were significant differences in recanalization rate and complete occlusion rate between the two groups (P<0.05). The survival rates in ethanol group were 78% at 6 months, 49% at 12 months, 25% at 24 months, whereas those in Gelfoam group were 58% at 6 months, 23% at 12 months, 15% at 24 months. The ethanol group showed significantly better survival than Gelfoam group (P<0.05). In the ethanol group, there was a significant prolongation of survival in patients with monofocal HCC (P<0.05) and Child class A (P<0.05). There were no significant differences in survival rate in the Gelfoam group with regard to the number of tumor and Child class (P>0.05). The incidence rate of abdominal pain during procedure in ethanol group was 82.8%. There was no significant difference in postembolization syndromes between two groups. Procedure-related hepatic failure did not occur in ethanol group. CONCLUSION:Ethanol embolization for patients with HCC and severe APS is efficacious and safe, and may contribute to prolongation of the life span versus Gelfoam embolization.Huang MS, Lin Q, Jiang ZB, Zhu KS, Guan SH, Li ZR, Shan H. Comparison of long-term effects between intra-arterially delivered ethanol and Gelfoam for the treatment of severe arterioportal shunt in patients with hepatocellular carcinoma.

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Ethanol ablation for refractory bile leakage after complex hepatectomy

Ito

Yokoyama

Igami

et al. 2018

British Journal of Surgery

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Efficacy and safety of preoperative percutaneous transhepatic portal embolization with absolute ethanol: A clinical study

Cited by 151 publications

References 18 publications

Analysis of Portal Vein Embolization Using Absolute Ethanol Before Major Hepatectomy

Analysis of Portal Vein Embolization Using Absolute Ethanol Before Major Hepatectomy

Comparison of long-term effects between intra-arterially delivered ethanol and Gelfoam for the treatment of severe arterioportal shunt in patients with hepatocellular carcinoma

Ethanol ablation for refractory bile leakage after complex hepatectomy

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