Role of interventional radiology in the management of hepatic hydatid disease

Table 3 Summary of the various percutaneous interventions for hepatic hydatid cyst

Technique	Indications	Specific features
PAIR	CE1 and CE3a (usually > 5 cm size)	Usually not done for HHC < 5 cm due to limited space; if cysto-biliary communication is present, then PAIR should be terminated or converted into S-CAT
S-CAT	CE1 and CE3a (usually > 5 cm size)	Very useful in the presence of cysto-biliary fistulas, and if technical difficulty is encountered during PAIR; recurrence, complications, and duration of hospitalization are higher with S-CAT as compared to PAIR
MoCAT	CE2 and CE3b (significant solid component present)	Potential to replace surgery for the cyst types with a significant solid component not amenable to PAIR; lower recurrence rate as compared to PAIR and S-CAT; higher rate of complications (e.g., cysto-biliary fistula development and abscess formation)
PEVAC	CE2 and CE3b (with or without cysto-biliary communication)	Suction is applied via the inserted catheter, without the use of scolicidal agents; useful in patients with vascular or biliary obstruction, and centrally located lesions (as there is no risk of scolicidal agent entering the adjoining vital structures); higher incidence of cysto-biliary fistula formation and secondary infection of the HHC
Örmeci technique	CE1, CE2, CE3a and CE3b	A thinner puncture needle is used compared to PAIR, so the risk of cyst fluid leakage and secondary peritoneal hydatidosis is less; scolicidal agents are not re-aspirated: Increases scolicidal effect; more studies are required to validate its efficacy

CE: Cystic echinococcus; PAIR: Puncture-aspiration-injection-reaspiration; S-CAT: Standard catheterization technique; MoCAT: Modified catheterization technique; HHC: Hepatic hydatid cysts; PEVAC: Percutaneous evacuation.