- 作者：Heung Kyu Ko ; MD ; PhD ; Gi-Young Ko ; MD ; PhD ; kogy@amc.seoul.kr" class="auth_mail" title="E-mail the corresponding author ; Kyu-Bo Sung ; MD ; PhD ; Dong-Il Gwon ; MD ; PhD ; Hyun-Ki Yoon ; MD ; PhD
- 关键词：AVP ; AMPLATZER Vascular Plug ; FLR ; future liver remnant ; HCC ; hepatocellular carcinoma ; PV ; portal vein ; PVE ; portal vein embolization
- 刊名：Journal of Vascular and Interventional Radiology
- 出版年：2016
- 出版时间：July 2016
- 年：2016
- 卷：27
- 期：7
- 页码：981-986
- 全文大小：516 K
Materials and Methods
From May 2014 to June 2015, 27 transsplenic PVEs were attempted in 26 patients. In 16 patients, transsplenic PVE was indicated because of huge or multiple tumors in the trajectory of the puncture (n = 15) or a high-positioned liver (n = 1), which prevented safe ipsilateral transhepatic access. In the remaining 10 patients, transsplenic access was planned. A perihilar splenic vein was punctured using a 21-gauge Chiba needle under ultrasound and fluoroscopic guidance. Embolization of portal venous branches was performed using gelatin sponge particles followed by application of coils, an AMPLATZER Vascular Plug (AGA Medical Corporation, Golden Valley, Minnesota), or glue to prevent recanalization. Embolization of transsplenic routes was performed using coils followed by glue.
Results
Transsplenic PVE was successful in 24 (88.9%) of 27 sessions; 3 procedures failed because of splenic vein dissection (n = 1) and failed splenic vein puncture (n = 2). Major complications occurred in 1 patient (3.8%) with splenic vein dissection. Minor complications occurred in 2 patients: a small amount of fluid collection in the splenic hilar area in 1 patient and glue migration along the splenic vein in 1 patient. Planned liver resection was performed in 24 of 26 patients at 4.9 weeks ± 3.5 after PVE.
Conclusions
Transsplenic PVE is safe and feasible and can be an effective alternative treatment for patients with a challenging ipsilateral, transhepatic route.