Portal Vein Embolization with N-Butyl Cyanoacrylate before Partial Hepatectomy in Patients with Hepatocellular Carcinoma and Underlying Cirrhosis or Advanced Fibrosis

Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition

“…The following complications of NBCA have also been reported: brain infarcts [10,29,42 (Table 5) Infections [43], brain abscesses [31], liver abscesses [19,182], acute pancreatitis [162], thrombophlebitis [157], and portal thrombosis [48] have also been reported as complications associated with NBCA use.…”

“…In addition, NBCA has been indicated for arterial redistribution and hepatic arterial catheter fixation during hepatic arterial infusion chemotherapy [68,159,180,181]. In the venous system, retrospective studies examining the use of NBCA for percutaneous transhepatic portal venous embolization have also been reported [19,45,48,49,77], and there have been several studies about the use of NBCA for pelvic congestion syndrome and varicoceles [27,65,109,157].…”

“…The continuous column method, in which the NBCA is injected slowly but continuously to allow it to form a cast inside the lumen, is the most common method and allows controlled NBCA delivery, which prevents reflux [16,37,46,92,98,102,137,149]. In addition, intermittent injection with the aim of delivering drips of NBCA (the pumping method) and a method in which the NBCA in the catheter is pushed out with a bolus of dextrose (the sandwich technique) have also been reported [21,46,48,141]. The injection should be stopped when blood flow arrests or undesirable migration of the NBCA into the distal portion of the target vessel, the spilling of NBCA along the catheter tip, severe symptoms, or other risky situations occur [13,16,134,141].…”

Percutaneous transcatheter embolization with n-butyl cyanoacrylate of hepatic hemorrhagic lesions in urgent situations

“…It has been used in interventional radiology for more than three decades and primarily for neuro-interventional procedures, e.g., cerebral and medullar arteriovenous malformations (AVMs) (18,19) or head and neck tumors (20). Recently, its use outside the central nervous system was approved; case reports and series have been published on the treatment of gastrointestinal bleeding (21-23), varicoceles (24), peripheral arteriovenous fistulas and AVMs (25), tumor lesions (26), and portal vein embolization (27) with NBCA alone or with other embolic material.…”

Comparison of the Effectiveness of Preoperative Portal Vein Embolization in Patients with Chronic Liver Disease: Gelfoam versus Gelfoam-Coil Combination

“…However, liver resection may be contraindicated if the future liver remnant (FLR) volume is not sufficient to avoid post-hepatectomy liver failure. Patients treated with portal vein embolization (PVE) before a major liver resection for HCC show fewer postoperative complications and better cumulative survival rates than those who have not received PVE (3,4). The minimal FLR volume required following liver resection is > 25% in patients with normal livers and > 40% in those with chronic liver disease (5), and liver regeneration is slower in the non-embolized lobe paired with an injured liver than in the normal liver (6,7).…”