Hepatic artery embolization is a new treatment for polycystic liver disease that shows promise as a treatment for people who cannot undergo standard surgeries.
Polycystic liver disease is a rare disease involving multiple cysts on the liver which may consideraby enlarge its size. It is not considered life-threatening, but a small percentage of patients may eventually need surgical treatments for painful symptoms.
For patients with chronic and painful symptoms, invasive treatments such as cyst deroofing and liver resection and fenestration are among the current treatment of choice. However, when researching my new book, Polycystic Liver Disease: Information for Patients, I discovered doctors in Asia working on a new non-surgical treatment which may be an option for people who cannot undergo surgery.
Hepatic artery embolization uses X-ray guidance to insert intravascular coils, polyvinyl alcohol particles, or even surgical glue into arteries providing blood to particular segments of the liver. Since hepatic arteries provide much of the blood supply to liver cysts, selectively blocking particular arteries decreases blood flow and reduces the size of cysts and the affected segment of the liver.
In a trial in Kanagawa, Japan, 30 patients with polycystic liver disease, most already on dialysis because of kidney failure, were treated with transcatheter artery embolization. Pain and fever experienced by patients after the treatment resolved within five days. Followed up from 18-37 months after therapy, average reduction in liver size was 22 percent. No serious complications were reported, and quality of life was reported improved in almost all patients.
In another study published in the Journal of Korean Medical Science, doctors used hepatic artery embolization techniques developed to treat liver cancer to reduce liver cyst size in four patients with polycystic liver disease. Arteries supplying the dominant segments were blocked using polyvinyl alcohol particles and micro-coils. Two of three patients followed up a year after treatment saw liver and cyst volume substantially decreased. Adverse events reported were fever, pain, nausea, and vomiting.
A third study published in 2013 used a mixture of N-butyl-2-cyanoacrylate (NBCA) tissue glue and iodized oil to block selected arteries in 21 patients with massive symptomatic polycystic liver disease and achieved similar results.
Researchers concluded that the technique could be a safe, effective option for patients with polycystic kidney disease and liver pain who are not candidates for standard surgical treatments which are currently the treatments of choice..
According to the National Institute of Health’s Office of Rare Diseases, polycystic liver disease is a rare disease which affects less than 200,000 people in the United States.
SOURCES
National Institutes of Health/Office of Rare Diseases Research, rarediseases.info.nih.gov
Park H C, et al, “Transcatheter Arterial Embolization Therapy for a Massive Polycystic Liver in Autosomal Dominant Polycystic Kidney Disease Patients,” J Korean Med Sci. 2009 February, 24(1) 57-61.
Takei R, et al, “Percutaneous transcatheter hepatic artery embolization for liver cysts in autosomal dominant polycystic kidney disease,” Am J Kidney Dis. 2007 Jun;49(6):744-52.
Wang MQ, et al, “Treatment of symptomatic polycystic liver disease: transcatheter super-selected hepatic arterial embolization using a mixture of NBCA and iodized oil,” Abdom Imaging. 2013 Jun;38(3):465-73. Doi: 10.1007/s00261-012-993-1.
