Preoperative percutaneous portal vein embolization: evaluation of adverse events in 188 patients.

Details

Serval ID
serval:BIB_B1B248934794
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Preoperative percutaneous portal vein embolization: evaluation of adverse events in 188 patients.
Journal
Radiology
Author(s)
Di Stefano D.R., de Baere T., Denys A., Hakime A., Gorin G., Gillet M., Saric J., Trillaud H., Petit P., Bartoli J.M., Elias D., Delpero J.R.
ISSN
0033-8419
Publication state
Published
Issued date
2005
Peer-reviewed
Oui
Volume
234
Number
2
Pages
625-30
Language
english
Notes
Publication types: Evaluation Studies ; Journal Article - Publication Status: ppublish
Abstract
PURPOSE: To retrospectively assess the frequency of adverse events related to percutaneous preoperative portal vein embolization (PPVE). MATERIALS AND METHODS: Institutional review board did not require its approval or patient informed consent for this study. The adverse events that occurred during PPVE or until planned hepatic surgery was performed or cancelled were retrospectively obtained from clinical, imaging, and laboratory data files in 188 patients (109 male and 79 female patients; mean age, 60 years; range, 16-78 years). Liver resection was planned for metastases (n = 137), hepatocarcinoma (n = 31), cholangiocarcinoma (n = 15), fibrolamellar hepatoma (n = 1), and benign disease (n = 4). PPVE was performed with a single-lumen 5-F catheter and a contralateral approach with n-butyl cyanoacrylate mixed with iodized oil as the main embolic agent. The rate of complications in patients with cirrhosis was compared with that in patients without cirrhosis by using the chi(2) test. RESULTS: Adverse events occurred in 24 (12.8%) of 188 patients, including 12 complications and 12 incidental imaging findings. Complications included thrombosis of the portal vein feeding the future remnant liver (n = 1); migration of emboli in the portal vein feeding the future remnant liver, which necessitated angioplasty (n = 2); hemoperitoneum (n = 1); rupture of a metastasis in the gallbladder (n = 1); transitory hemobilia (n = 1); and transient liver failure (n = 6). Incidental findings were migration of small emboli in nontargeted portal branches (n = 10) and subcapsular hematoma (n = 2). Among the 187 patients in whom PPVE was technically successful, there was a significant difference (P < .001) between the occurrence of liver failure after PPVE in patients with cirrhosis (five of 30) and those without (one of 157). Sixteen liver resections were cancelled due to cancer progression (n = 12), insufficient hypertrophy of the nonembolized liver (n = 3), and complete portal thrombosis (n = 1). CONCLUSION: PPVE is a safe adjuvant technique for hypertrophy of the initially insufficient liver reserve. Post-PPVE transient liver failure is more common in patients with cirrhosis than in those without cirrhosis.
Keywords
Acrylates, Adolescent, Adult, Aged, Cholangiocarcinoma, Disease Progression, Embolization, Therapeutic, Female, Hematoma, Hemobilia, Hepatectomy, Humans, Iodized Oil, Liver Cirrhosis, Liver Diseases, Liver Failure, Liver Neoplasms, Male, Middle Aged, Portal Vein, Preoperative Care, Retrospective Studies, Thrombosis
Pubmed
Web of science
Create date
11/04/2008 12:23
Last modification date
20/08/2019 15:20
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