Andreas Koops MD, Presenter: Nothing to Disclose

Christian Wilms, Abstract Co-Author: Nothing to Disclose

Jochen Herrmann MD, Abstract Co-Author: Nothing to Disclose

Niels Heits, Abstract Co-Author: Nothing to Disclose

Gerrit Krupski MD, Abstract Co-Author: Nothing to Disclose

Gerhard B. Adam MD, Abstract Co-Author: Nothing to Disclose

Transarterial embolization for preoperative induction of contra-lateral liver hypertrophy had been proposed as an alternative to portal vein embolization. It was the aim to evaluate clinical outcome and efficiency of this technique.

In 11 mini-pigs all but the right-lateral segmental hepatic arteries were embolized with lipiodol/histoacryl-mixture using transfemoral access. In-vivo angiography and ex-vivo specimen angiography were repeated at termination after 4 weeks. Arterial patency and flow-parameters were obtained by intraoperative ultrasound before and after the embolization, as well as after 4 weeks.

The radiological intervention was successful in 10/11 cases. In one animal subtotal occlusion of all arterial branches occurred. For avoiding such right-lateral arterial occlusion, proximal minor sub-segmental branches of the right-middle segment remained patent in 30% of angiograms, 50% of ultrasound examinations performed periinterventionally showed reduced but detectable flow in the right middle segment. After 4 weeks all 9 surviving animals had developed extensive collaterals with arterial reperfusion of almost all (26/27) segments in angiography as well as ultrasound. The animal with subtotal embolization died after two days of liver failure, one other animal after 7 days of multi-organ failure. 78% of the surviving animals presented biliary duct necrosis with hepatic abscesses at autopsy. All had signs of cholangitis with irregular dilation of the biliary ducts in the specimen cholangiography.

Compared to portal vein embolization, the distinctive arterial collateralisation observed limits chances of effective hypertrophy in the contra-lateral segment. Because of the high rate of necrotic and inflammatory damage to the biliary system, arterial hepatic embolization for induction of hepatic regeneration should not be considered suitable for human application.

Segmental arterial embolization can not be recommended for induction of liver hypertrophy as the complication rate is too high.

Koops, A, Wilms, C, Herrmann, J, Heits, N, Krupski, G, Adam, G, Is Hepatic Arterial Embolization a Reasonable Alternative to Portal Vein Embolization in Preoperative Induction of Liver Hypertrophy?.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5015261.html