10 - Distal migration of two liquid embolic agents after coil embolization: in-vitro study using an ex-vivo perfusion model

To evaluate the rates of distal migration of LAVA (ethylene vinyl alcohol) vs glue (n-Butyl-2 Cyanoacrylate) after portal vein coil embolization using a perfused ex -vivo liver porcine model.

Materials and Methods:

A fresh porcine liver was connected to a pump with a flow of water at 290 ml/min.     

A DSA was performed to evaluate the patency of the portal branches, and the size of the vessels were assessed visually. Similar size and location branches of the portal vein were embolized with coils using either light (1) or dense (2) packing with coils with the same size and configuration. After the coil embolization either LAVA 34 or Histoacryl to Lipiodol at 1:2 ratio was injected under slow constant fluoroscopic guidance. The end point was the formation of a cast of embolic agents filling the vessel lumen proximal and inside the coil package. The incidence of liquid agent migration distal to the coil package was compared between the two agents and the type of coiling density.

Results:

A total of 21 embolizations were  performed in 6 porcine livers, 10 with LAVA and 11 with glue. Light packing with one coil was performed in 8 experiments with coils from 4 -10 mm in diameter and 14- 20 cm in length. Dense packing with two coil sizes was performed in 13 experiments using coils from 5-12 mm in diameter and 3-20 cm in length. The incidence of distal migration for glue was 64% (4/4 with light packing and 3/7 for dense packing), while no distal migration (0%) was observed for LAVA regardless of the coil packing density (p < 0.001).

Conclusion:

In this ex- vivo portal vein embolization porcine model, LAVA had no distal migration through the coil package regardless of coil packing density , while distal glue embolization was always observed with light packing and partially prevented using a denser coil deployment.