Treatment of symptomatic polycystic liver disease: transcatheter super-selective hepatic arterial embolization using a mixture of NBCA and iodized oil.

BACKGROUND: Surgical therapy for symptomatic polycystic liver disease (PLD) is effective but has substantial mortality and morbidity. Minimally invasive options such as laparoscopic fenestration, percutaneous cyst aspiration with or without injection of a sclerosing solution have had disappointing results. Because the hepatic cysts in autosomal dominant polycystic kidney disease (ADPKD) patients are mostly supplied from hepatic arteries but not from portal veins, therefore, transcatheter arterial embolization (TAE) of the hepatic artery branches that supply major hepatic cysts can lead to shrinkage of the cyst and liver size. AIM: The purpose of this study was to evaluate the safety and effectiveness of TAE using a mixture of N-butyl-2-cyanoacrylate (NBCA) and iodized oil for massive PLD in ADPKD patients. METHODS: From February 2007 to March 2011, a total of 21 patients with symptomatic PLD underwent super-selective hepatic TAE with the mixture of NBCA and iodized oil. The patients consisted of 17 women and 4 men (age range 36-64 years, average age 48.8 years). All patients underwent contrast-enhanced computed tomography (CT) of the liver before TAE, and at every 3 months for the first year after TAE and at 6-monthly intervals thereafter. Laboratory data, including routine blood tests and liver enzymes, were collected before and 1, 3, 7, and 14 days, 1, 3, 6, and 12 months after TAE. RESULTS: Technical success was achieved in all cases. No serious complications were experienced. The mean follow-up period was 34 ± 20 months (range 12-60 months). At follow-up of 6-12 months, symptoms notably improved in 18 (85.7%) of 21 patients, and these patients experienced further relief of the symptoms during the follow-up period. TAE failed to benefit in 3 patients (14.3%). No patient complained of worsening of the symptoms after the procedure. At follow-up CT, the total liver volume and total intra-hepatic cyst volume decreased significantly (p < 0.001) compared with pre-TAE in 18 (85.7%) of 21 patients at 12 months after TAE. The total liver volume decreased from 8270 ± 3016 to 6120 ± 2680 cm(3) and the total intra-hepatic cyst volume decreased from 7120 ± 3070 to 4530 ± 2600 cm(3). Mild elevation of the liver enzymes was shown in patients at 1-14 days after TAE but returned to the normal range within 1 month. CONCLUSION: The mixture of NBCA and iodized oil is an acceptable embolic agent for embolization of the hepatic artery branches that supply the hepatic cysts in ADPKD patients. This technique is an option for patient with highly symptomatic PLD who are not candidates for surgical treatment.

Transcatheter arterial embolization using ethanol in a dialysis patient for contracting enlarged polycystic kidneys.

The mass effect of nephromegaly in patients with autosomal dominant polycystic kidney disease may cause pain and symptoms by compressing the alimentary tract, lungs, and heart. Conventional therapies exist to contract enlarged polycystic kidneys including surgical and interventional procedures. A surgical nephrectomy is often difficult to perform in dialysis patients due to the associated risks related to surgery. In contrast, renal transcatheter arterial embolization (TAE) with metallic coils, which is a less invasive interventional procedure, can also be utilized to contract enlarged kidneys in dialysis patients as an effective treatment. However, metallic coils present the possibility of recanalization and cost issues. Thus, we used ethanol instead of coils in renal TAE to resolve these issues. We report a dialysis patient with enlarged polycystic kidneys and poor oral intake due to abdominal distention that was successfully treated by TAE with absolute ethanol.

Transcatheter Arterial Embolization Using Ethanol in a Dialysis Patient for Contracting Enlarged Polycystic Kidneys

The mass effect of nephromegaly in patients with autosomal dominant polycystic kidney disease may cause pain and symptoms by compressing the alimentary tract, lungs, and heart. Conventional therapies exist to contract enlarged polycystic kidneys including surgical and interventional procedures. A surgical nephrectomy is often difficult to perform in dialysis patients due to the associated risks related to surgery. In contrast, renal transcatheter arterial embolization (TAE) with metallic coils, which is a less invasive interventional procedure, can also be utilized to contract enlarged kidneys in dialysis patients as an effective treatment. However, metallic coils present the possibility of recanalization and cost issues. Thus, we used ethanol instead of coils in renal TAE to resolve these issues. We report a dialysis patient with enlarged polycystic kidneys and poor oral intake due to abdominal distention that was successfully treated by TAE with absolute ethanol.

Renal cyst ablation with n-butyl cyanoacrylate and iodized oil in symptomatic patients with autosomal dominant polycystic kidney disease: preliminary report.

Fifty renal cysts in 14 patients with autosomal dominant polycystic kidney disease (ADPKD) were treated with percutaneous needle aspiration and intracystic injection of a mixture of n-butyl cyanoacrylate and iodized oil in a ratio of 1:2. At follow-up of 1-12 months, symptoms improved in 12 (86%) of 14 patients, and 25 (81%) of 31 cysts decreased more than 50% in diameter. This procedure appears to be feasible and may be an effective modality in ablation of renal cysts in patients with ADPKD.

Intestinal obstruction in autosomal dominant polycystic kidney disease.

A 42-year-old woman with autosomal dominant polycystic kidney disease (ADPKD) was admitted to our hospital on April 29, 1999, with complaints of abdominal pain. A diagnosis of intestinal obstruction was reached on the basis of clinical findings and X-ray evidence. A computed tomography scan of the abdomen showed massively enlarged kidneys, especially the right kidney, which seemed to compress the small intestine. The patient underwent percutaneous aspiration of the largest cysts on the surface of the right kidney. The symptoms, in this rare case of intestinal obstruction by an enlarged kidney in ADPKD, were alleviated the day after the aspiration procedure.