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Abstract

Background

An N-butyl-2 cyanoacrylate (NBCA) embolus in the graft portal vein was frequently observed after an intraoperative embolization of portosystemic collaterals performed to prevent portal steal in liver transplant (LT) recipients. The radiological and clinical features of NBCA emboli have not yet been described.

Purpose

To describe radiological and clinical features of NBCA embolus in graft portal vein after portosystemic collateral embolization in LT recipients.

Material and Methods

A total of 165 consecutive LT recipients who had undergone intraoperative NBCA embolization of varix were found in single institution’s computerized databases of a clinical cohort of LT. Patients were evaluated for NBCA emboli (categorized into major and minor emboli according to location) on first postoperative computed tomography (CT). All electronic medical records and radiologic studies including follow-up was evaluated to determine any radiological and clinical abnormality associated with NBCA embolus.

Results

NBCA emboli were found in 24% (39/165) of recipients. Although most patients had minor emboli (77%, 30/39) without remarkable ultrasonography (US) abnormalities, seven (78%) of nine recipients with major emboli showed intraluminal echogenic lesions in graft portal vein on grayscale US, and five of them (71%) showed partial portal flow obstruction, although none exhibited any abnormality on contrast-enhanced US. Recipients with NBCA portal emboli showed no significant clinical abnormalities and were discharged safely. NBCA embolus eventually disappeared mostly within six months (82%, 32/39).

Conclusion

NBCA emboli are frequently observed after portosystemic collateral embolization in LT recipients and are not associated with poor clinical outcome. They may mimic ordinary thromboemboli on US.

Keywords

Liver transplantation transplant recipients portosystemic shunt N-butyl-2 cyanoacrylate (NBCA)thromboembolism

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References

Christensen

. Prognostic models including the Child-Pugh, MELD and Mayo risk scores–where are we and where should we go? J Hepatol 2004; 41: 344–350.

Lee

Moon

Ahn

et al.

Ligation of left renal vein for large spontaneous splenorenal shunt to prevent portal flow steal in adult living donor liver transplantation. Transpl Int 2007; 20: 45–50.

Wachsberg

Bahramipour

Sofocleous

et al.

Hepatofugal flow in the portal venous system: pathophysiology, imaging findings, and diagnostic pitfalls. Radiographics 2002; 22: 123–140.

Horrow

Phares

Viswanadhan

et al.

Vascular steal of the portal vein after orthotopic liver transplant: intraoperative sonographic diagnosis. J Ultrasound Med 2010; 29: 125–128.

De Carlis

Del Favero

Rondinara

et al.

The role of spontaneous portosystemic shunts in the course of orthotopic liver transplantation. Transpl Int 1992; 5: 9–14.

Kim

Jeong

et al.

Radiologic evaluation of portal steal phenomenon in recipients of liver transplantation. Acta Radiol 2016; 57: 914–922.

Kim

Song

et al.

Portal flow steal after liver transplantation. Clin Mol Hepatol 2015; 21: 314–317.

Kita

Harihara

Sano

et al.

Reversible hepatofugal portal flow after liver transplantation using a small-for-size graft from a living donor. Transpl Int 2001; 14: 217–222.

Kim

Sung

et al.

Transvenous variceal embolization during or after living-donor liver transplantation to improve portal venous flow. J Vasc Interv Radiol 2009; 20: 1454–1459.

10.

Sekido

Matsuo

Takeda

et al.

Severe fatty change of the graft liver caused by a portosystemic shunt of mesenteric varices. Transpl Int 2002; 15: 259–262.

11.

Vaidya

Tozer

Chen

. An overview of embolic agents. Semin Intervent Radiol 2008; 25: 204–215.

12.

Pollak

White

Jr . The use of cyanoacrylate adhesives in peripheral embolization. J Vasc Interv Radiol 2001; 12: 907–913.

13.

Gupta

Vasishta

Dutta

et al.

Embolization of cyanoacrylate glue in systemic circulation in a case of hepatocellular carcinoma: an autopsy report. Diagn Pathol 2009; 4: 45–45.

14.

Wang

Cheng

. Histopathological study of vascular changes after intra-arterial and intravenous injection of N-butyl-2-cyanoacrylate. Chin J Dig Dis 2006; 7: 175–179.

15.

Takeuchi

Morishita

Sato

et al.

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. Jpn J Radiol 2014; 32: 500–517.

16.

Di Stefano

de Baere

Denys

et al.

Preoperative percutaneous portal vein embolization: evaluation of adverse events in 188 patients. Radiology 2005; 234: 625–630.

17.

Natarajan

Born

Ghodke

et al.

Histopathological changes in brain arteriovenous malformations after embolization using Onyx or N-butyl cyanoacrylate. Laboratory investigation. J Neurosurg 2009; 111: 105–113.

18.

Jang

Kim

Jeong

et al.

Influence of preoperative portal hypertension and graft size on portal blood flow velocity in recipient after living donor liver transplantation with right-lobe graft. Am J Roentgenol 2010; 194: W165–170.

19.

Machi

Sigel

Roberts

et al.

Oversaturation of color may obscure small intraluminal partial occlusions in color Doppler imaging. J Ultrasound Med 1994; 13: 735–741.

N-butyl-2 cyanoacrylate (NBCA) embolus in the graft portal vein after portosystemic collateral embolization in liver transplantation recipient: what is the clinical significance?

Abstract

Background

Purpose

Material and Methods

Results

Conclusion

Keywords

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References