J Korean Med Sci.  2009 Feb;24(1):57-61. 10.3346/jkms.2009.24.1.57.

Transcatheter Arterial Embolization Therapy for a Massive Polycystic Liver in Autosomal Dominant Polycystic Kidney Disease Patients

• Park HC
• Kim CW
• Ro H
• Moon JY
• Oh KH
• Kim Y
• Lee JS
• Yin YH
• Jae HJ
• Chung JW
• Ahn C
• Hwang YH

• KMID: 1794407
• DOI: http://doi.org/10.3346/jkms.2009.24.1.57

Abstract

Polycystic liver is the most common extra-renal manifestation associated with autosomal dominant polycystic kidney disease (ADPKD), comprising up to 80% of all features. Patients with polycystic liver often suffer from abdominal discomfort, dyspepsia, or dyspnea; however, there have been few ways to relieve their symptoms effectively and safely. Therefore, we tried transcatheter arterial embolization (TAE), which has been used in treating hepatocellular carcinoma. We enrolled four patients with ADPKD in Seoul National University Hospital, suffering from enlarged polycystic liver. We embolized the hepatic arteries supplying the dominant hepatic segments replaced by cysts using polyvinyl alcohol particles and micro-coils. The patients were evaluated 12 months after embolization for the change in both liver and cyst volumes. Among four patients, one patient was lost in follow up and 3 patients were included in the analysis. Both liver (33%; 10%) and cyst volume (47.7%; 11.4%) substantially decreased in two patients. Common adverse events were fever, epigastric pain, nausea, and vomiting. We suggest that TAE is effective and safe in treating symptomatic polycystic liver in selected ADPKD patients.

Keyword

Polycystic Kidney, Autosomal Dominant; Embolization, Therapeutic

MeSH Terms

Aged
Catheterization
Cysts/*therapy
Embolization, Therapeutic/instrumentation/*methods
Female
Hepatic Artery
Humans
Liver/pathology/physiology
Liver Diseases/pathology/*therapy
Middle Aged
Polycystic Kidney, Autosomal Dominant/diagnosis/*therapy
Polyvinyl Alcohol/therapeutic use
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Transcatheter arterial embolization of selective hepatic artery using PVA particles and micro-coils (Case No.1).

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  Fig. 2 Representative computed tomographic images (Case No.1). (A) Before hepatic TAE, this patient's total liver, intra-hepatic cyst, and hepatic parenchymal volumes were 9,435, 6,076, and 3,359 cm3, respectively. Hepatic cysts were numerous and limited to hepatic segment 1, 3, 4, 5, 8. (B) The same patient 12 months after hepatic TAE. Total liver and intra-hepatic cyst volumes decreased to 6,316 and 3,906 cm3, respectively. Hepatic parenchymal volume also decreased to 2,410 cm3 in this patient.

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  Fig. 3 (A) Total liver volume before and after hepatic TAE. Total liver volume at 12 month after hepatic TAE decreased in all patients, showing as much as 33% reduction from pretreatment liver volume. (B) Intra-hepatic cyst volume before and after hepatic TAE. Total volume of hepatic cysts decreased in two cases, showing as much as 35% reduction from pretreatment cyst volume.

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