Percutaneous ipsilateral portal vein embolization using a modified four-lumen balloon catheter with fibrin glue: initial clinical experience.
The purpose of the present study was to show the feasibility and safety of ipsilateral portal vein embolization (PVE) using an improved four-lumen balloon catheter with fibrin glue. To improve the ipsilateral PVE with fibrin glue, we modified a commercially available four-lumen balloon catheter to create a catheter comprising one lumen with a catheter tip for a guidewire, one lumen for an occlusion balloon, and two lumens, each with a side-hole just proximal to the balloon. Eight patients had hepatobiliary disease (three with bile duct carcinoma, two with gallbladder carcinoma, one with hepatocellular carcinoma, one with Caroli disease, and one with metastatic carcinoma). All embolization procedures were technically successful. After embolization, the volume of the future remnant liver increased a mean of 131%. There was no inadvertent embolization of portal vein branches and no major procedure-related complications. Our method is potentially easier and safer than the traditional ipsilateral method with fibrin glue using a three-lumen balloon catheter because the fourth lumen makes possible the use of a guidewire to access the targeted portal vein and measurement of any portal vein pressure elevation following PVE via the fourth lumen.