title: 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 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.
authors.affiliation: 1 Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.|2 Department of Radiology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Republic of Korea.
authors.forename: Hye Young
authors.initials: HY
authors.lastname: Jang
authors.affiliation: 1 Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Kyoung Won
authors.initials: KW
authors.lastname: Kim
authors.affiliation: 3 Division of Liver Transplantation and Hepatobiliary Surgery, Departments of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Kwon
authors.affiliation: 4 Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Heon-Ju
authors.initials: HJ
authors.lastname: Kwon
authors.affiliation: 5 Department of Radiology, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Bohyun
authors.initials: B
authors.lastname: Kim
authors.affiliation: 6 Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Nieun
authors.initials: N
authors.lastname: Seo
authors.affiliation: 7 School of Computer Science and Engineering, Soongsil University, Seoul, Republic of Korea.
authors.forename: Jeongjin
authors.initials: J
authors.lastname: Lee
authors.affiliation: 3 Division of Liver Transplantation and Hepatobiliary Surgery, Departments of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Gi-Won
authors.initials: GW
authors.lastname: Song
authors.affiliation: 3 Division of Liver Transplantation and Hepatobiliary Surgery, Departments of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D004617:Embolism / Q000000981:diagnostic imaging*; D004621:Embolization, Therapeutic; D004659:Enbucrilate; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D004659:Enbucrilate
keywords: Liver transplantation; N-butyl-2 cyanoacrylate (NBCA); portosystemic shunt; thromboembolism; transplant recipients