PURPOSE: This study explored the potential biomarkers correlated with liver hypertrophy after balloon-occluded retrograde transvenous obliteration (BRTO).

MATERIALS AND METHODS: The liver volume was calculated using volumetry with contrast-enhanced computed tomography (CT) images before and 1 month after BRTO in 18 patients (10 men, 8 women) with a median age of 66.9 years (range, 38-78 years). Patients whose liver volume increased by more than 5% after BRTO were categorized as group A, and the other patients were categorized as group B. Correlation between variables such as patient background, liver function test, and percentage increase of the alpha-fetoprotein (AFP) level and liver volume were evaluated using Pearson' s correlation coefficient. The performance of a potential biomarker of liver hypertrophy was evaluated by the receiver operating characteristic (ROC) analysis. Moreover, changes in liver profiles following BRTO were assessed in each patient group.

RESULTS: The liver volume increased by more than 5% in 7 patients (39%, 7/18; group A) after BRTO. Only the percentage increase of AFP level (r=0.77, p<0.01) was significantly correlated with the percentage increase of liver volume. The area under the ROC curve (AUC) value for percentage increase of AFP level was 0.86 (95% confident interval, 0.65-1.00) with an optimal cutoff value of 4.7%. Significant improvement in both prothrombin time (p<0.05) and Child-Pugh score (p<0.04) was observed following BRTO in group A. However, the liver profiles remained unchanged in group B.

CONCLUSION: The percentage increase of AFP level can be used as a biomarker of liver hypertrophy after BRTO, leading to liver profile improvement.

An 84-year-old man with an abdominal aortic aneurysm with a largest diameter of 50 mm was treated using endovascular aortic repair (EVAR) within the instructions for use. Computed tomography (CT) performed 3 years after the EVAR revealed significant sac expansion. The first (3 years after EVAR) and second (4 years after EVAR) transarterial embolizations demonstrated rare type II endoleaks from the vasa vasorum as multiple fluffy contrast blushes from the aortic tributaries. As sac expansion persisted at 5 years after the EVAR, translumbar direct puncture of the sac and embolization using a mixture of 25% n-butyl cyanoacrylate and lipiodol was performed. A follow-up CT 2 years after the last embolization showed sac stability without any complications.

An 82-year-old man underwent transarterial chemoembolization and radiofrequency ablation (RFA) for a 42-mm hepatocellular carcinoma in segment IV. Thirty-eight months later, he was admitted to our hospital for acute cholecystitis that had spread to the ablated area. After he started antibiotic treatment, the inflammatory reaction gradually improved, but he developed acute cholangitis, and massive hemobilia was observed during endoscopic retrograde biliary drainage. An angiogram showed both a pseudoaneurysm of the left hepatic artery (LHA) and extravasation of the microcatheter into a marginal lesion of the ablated area. The pseudoaneurysm was considered to have been formed by inflammation that perforated the ablated area and intrahepatic bile duct. After embolization of the LHA, no further bleeding was observed. A pseudoaneurysm may develop from an infection, even several years after liver RFA.