Initial experience of coaxial percutaneous liver biopsy with tract embolization using N-Butyl cyanoacrylate

Abstract

Objective

Bleeding occurs after liver biopsy in up to 10.9% cases, and patients with impaired hemostasis or ascites are considered to have absolute or relative contraindications. N-butyl cyanoacrylate enables immediate hemostasis, even in lethal situations. Therefore, percutaneous liver biopsy combined with tract embolization using N-butyl cyanoacrylate is expected to enable safe biopsy, even in patients for whom conventional biopsy is contraindicated. Here we describe our initial experience with coaxial percutaneous biopsy with tract embolization using N-butyl cyanoacrylate.

Materials and methods

Eighty-six patients who underwent tract embolization using N-butyl cyanoacrylate between October 2014 and July 2020, including 21 patients who had absolute or relative contraindications for liver biopsy, were retrospectively analyzed. Tract embolization using N-butyl cyanoacrylate comprised two steps: (1) liver biopsy with a biopsy needle inserted via a coaxial introducer needle and (2) embolization of the puncture route by injecting N-butyl cyanoacrylate via the coaxial needle.

Results

No complications occurred in any patient. The mean number of biopsies per patient was 3.30 (range, 1–7). Histologically adequate samples were acquired in all cases, and pathological diagnoses were obtained. The mean time required for tract embolization was 52.8 s (range, 6–132 s). The mean peak skin dose was 9.97 mGy (range, 2–68 mGy), which is far below the 3-Gy threshold dose for temporary erythema.

Conclusions

This proposed technique may be a promising and straightforward alternative to improve the management of patients with severe liver disease by allowing safer biopsy, including patients for whom conventional liver biopsy is contraindicated.

Keywords:

• Image-guided biopsy
• hemostatic technique
• tissue adhesives
• hemostasis
• hemorrhage

Author contributions

Yohsuke Suyama: drafting of the manuscript, data analysis, and interpretation, Shigeyoshi Soga: study concept and design, data acquisition, and drafting of the manuscript, Ayako Mikoshi: drafting of the manuscript and data acquisition, Ryota Hokari; study supervision, and revision of the manuscript, Hiroshi Shinmoto: study supervision, and funding acquisition, Kengo Tomita: critical revision of the manuscript for important intellectual content.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The authors state that this work has not received any funding.