Portal vein embolization by fine needle ethanol injection: experimental and clinical studies

AIM:To improve the technique of intraportal embolization (PVE) therapy,a new embolic method, was devised and the safety, effectiveness and feasibility were evaluated.METHODS:PVE with intraportal ethanol injection via a fine needle was performed in 28 normal dogs, 22 SD rats, and 24 cirrhotic SD rats. After PVE, portography, histological and functional alteration of the liver were evaluated in dogs and rats, and the changes in portal hemodynamics as well as hepatic anatomy were observed in rats. In the clinical study, PVE by ethanol injection was performed in 61 patients with hepatocellular carcinoma under the guidance of portoechography with intraportal injection of CO(2). The effect of PVE was evaluated by ultrasonography and laparotomy.RESULTS:The effectiveness and toxicity were depen-dent on the dose of ethanol. In the dogs, 0.25mg/kg of ethanol caused incomplete embolization with least liver damage, while 1.0mg/kg induced complete embolization with a high mortality of 57.1% (4/7) due to respiratory arrest. The dose of 0.5mg/kg resulted in complete embolization with slight toxicity to the liver. In the rats, the survival rate was 100% in normal group but 40.9% in cirrhotic models after ethanol injection by dose of 0.05mg/100g. PVE for cirrhotic rats with 0.03mg/100g of ethanol induced satisfactory embolization with significant hypertrophy in nonembolized lobe-s, and only slight damage to the hepatic parenchyma, and transient alteration in liver function, portal pressure and portal flow. In the clinical study, 12 cases with reverse portal flow were excluded judged by portoechography. Satisfactory embolizati on was gained in 90.2% (55/61) of the remaining patients determined by ultrasonography and surgery. All cases ran an uneventful postembolization course with no aberrant embolization.CONCLUSION:PVE with intraportal ethanol injection of appropriate dosage via a fine needle is safe and effective and has several advantages comparing with transcatheter method. Portoechography is a mandatory approach for the prevention of aberrant embolization.