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

 Hye Young Jang  ;  Kyoung Won Kim  ;  Jae Hyun Kwon  ;  Heon-Ju Kwon  ;  Bohyun Kim  ;  Nieun Seo  ;  Jeongjin Lee  ;  Gi-Won Song  ;  Sung-Gyu Lee 
 ACTA RADIOLOGICA, Vol.58(11) : 1326-1333, 2017 
Journal Title
Issue Date
Adult ; Aged ; Embolism/diagnostic imaging* ; Embolization, Therapeutic* ; Enbucrilate* ; Female ; Humans ; Liver Transplantation* ; Male ; Middle Aged ; Portal Vein/diagnostic imaging* ; Postoperative Complications/diagnostic imaging* ; Tomography, X-Ray Computed ; Ultrasonography ; Young Adult
Liver transplantation ; N-butyl-2 cyanoacrylate (NBCA) ; portosystemic shunt ; thromboembolism ; transplant recipients
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.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Seo, Nieun(서니은) ORCID logo https://orcid.org/0000-0001-8745-6454
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