37 - Portal Vein Embolization

Abstract

Portal vein (PV) embolization (PVE) is embolization of the intrahepatic portal branches of the future resected liver to induce hypertrophy of the future remnant liver during the preoperative period. Many embolic agents are used, but in animals and in a small randomized trial in humans, cyanoacrylate seems to be more efficient than spherical particles. Expected hypertrophy of the future remnant liver is in the range of 3% to 70% in volume after 1 month. Disparities may be explained by different delays before surgery (2 to 4 weeks), use of diverse embolic agents, and different proportions of patients with compromised liver in the respective studies, in the knowledge that cirrhotic livers usually provide a lesser degree of hypertrophy. When hypertrophy is not enough or is not fast enough after PVE, several solutions have been proposed to alter hypertrophy after portal embolization. These include a combination of intraarterial chemoembolization and PVE, a combination of selective internal radiation therapy with PVE, combining liver partition and portal vein ligation for staged hepatectomy with 20% morbidity/mortality, embolization of the right hepatic vein to achieve liver venous deprivation.