Can Detachable Embolization Coils Decrease the Cost of Materials for Portal Vein Embolization Procedures?

Rationale and Objectives: Preoperative Portal Vein Embolization (PVE) can induce hypertrophy of the Future Liver Remnant (FLR) prior to partial hepatectomy for malignancy. Beyond allowing better control during embolization, detachable coils are available in longer lengths, which could decrease the number of coils needed, and thus the cost of embolization materials. However, they are more expensive. The purpose of this study was to compare the use of Detachable Coils (DC) to Conventional Coils (CC) in PVE. Materials and Methods: We retrospectively reviewed the clinical data from patients who underwent preoperative PVE, after obtaining IRB approval. Cross-sectional imaging was performed before and after PVE to assess the FLR. Demographics, liver volumes, particles and coils used, procedure times, contrast volumes, and radiation dose metrics were compared between the two groups. Results: The study included 14 subjects in the CC group and 5 in the DC group. The right portal vein was embolized in all subjects, and 2 in the CC group also had segment 4 embolized. There was no significant difference between the groups for demographic data, volume of particles used, number of branches embolized, liver growth parameters, procedure time, contrast dose, and radiation dose metrics. A mean of 11.9 coils was used in the CC group versus 7.4 coils in the DC group (p=0.006), with a mean cost for embolization coils of $1,014 and $5,360 (p=0.0001) respectively. Conclusion: Significantly fewer detachable coils are needed for a successful PVE procedure compared to conventional coils, but the total coil cost is much higher.