Portal vein embolization (PVE): Preoperative embolization of portal vein (PV) branches used to induce hypertrophy of unembolized portion of liver
For planned right lobe resection, perform embolization to induce hypertrophy of left lobe
Right lobe is larger, usually of sufficient size for resection of left lobe without PVE
Hepatic vein embolization (HVE): Preoperative embolization of hepatic vein branches in order to further induce hypertrophy of unembolized portion of liver, supplemental or in combination with PVE
Future liver remnant (FLR): Anticipated volume of liver remaining after partial hepatectomy
Total estimated liver volume (TELV): -794.41 + 1267.28 x body surface area
Degree of hypertrophy (DH): Difference between ratio of FLR volume to TELV before and after PVE
Kinetic growth rate (KGR): Weekly FLR growth after PVE
PREPROCEDURE
Indications
Contraindications
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
OUTCOMES
Problems
Complications
Expected Outcomes
Selected References
Ali A et al: Portal vein embolization with N-butyl cyanoacrylate glue is superior to other materials: a systematic review and meta-analysis. Eur Radiol. 31(8):5464-78, 2021
Luz JHM et al: BestFLR trial: liver regeneration at CT before major hepatectomies for liver cancer-a randomized controlled trial comparing portal vein embolization with N-butyl-cyanoacrylate plus iodized oil versus polyvinyl alcohol particles plus coils. Radiology. 299(3):715-24, 2021
Qadan M et al: Review of use of Y90 as a bridge to liver resection and transplantation in hepatocellular carcinoma. J Gastrointest Surg. 25(10):2690-9, 2021
Luz JHM et al: Preoperative portal vein embolization in hepatic surgery: a review about the embolic materials and their effects on liver regeneration and outcome. Radiol Res Pract. 2020:9295852, 2020
Niekamp AS et al: Hepatic vein embolization after portal vein embolization to induce additional liver hypertrophy in patients with metastatic colorectal carcinoma. Eur Radiol. 30(7):3862-8, 2020
Gabr A et al: Neoadjuvant radiation lobectomy as an alternative to portal vein embolization in hepatocellular carcinoma. Semin Nucl Med. 49(3):197-203, 2019
Yamashita S et al: Efficacy of preoperative portal vein embolization among patients with hepatocellular carcinoma, biliary tract cancer, and colorectal liver metastases: a comparative study based on single-center experience of 319 cases. Ann Surg Oncol. 24(6):1557-68, 2017
Eshmuminov D et al: Meta-analysis of associating liver partition with portal vein ligation and portal vein occlusion for two-stage hepatectomy. Br J Surg. 103(13):1768-82, 2016
Jaberi A et al: Comparison of clinical outcomes following glue versus polyvinyl alcohol portal vein embolization for hypertrophy of the future liver remnant prior to right hepatectomy. J Vasc Interv Radiol. 27(12):1897-905.e1, 2016
Sarwar A et al: Trans-splenic portal vein embolization: a technique to avoid damage to the future liver remnant. Cardiovasc Intervent Radiol. 39(10):1514-8, 2016
Shindoh J et al: Safety and efficacy of portal vein embolization before planned major or extended hepatectomy: an institutional experience of 358 patients. J Gastrointest Surg. 18(1):45-51, 2014
Vennarecci G et al: The ALPPS procedure: a surgical option for hepatocellular carcinoma with major vascular invasion. World J Surg. 38(6):1498-503, 2014
de Baere T et al: Predictive factors for hypertrophy of the future remnant liver after selective portal vein embolization. Ann Surg Oncol. 17(8):2081-9, 2010
Manizate F et al: Liver functional reserve estimation: state of the art and relevance to local treatments. Oncology. 78 Suppl 1:131-4, 2010
Truty MJ et al: Uses and limitations of portal vein embolization for improving perioperative outcomes in hepatocellular carcinoma. Semin Oncol. 37(2):102-9, 2010
Furuta T et al: Hepatic segments and vasculature: projecting CT anatomy onto angiograms. Radiographics. 29(7):1-22, 2009
Hwang S et al: Sequential preoperative ipsilateral hepatic vein embolization after portal vein embolization to induce further liver regeneration in patients with hepatobiliary malignancy. Ann Surg. 249(4):608-16, 2009
Liu H et al: Present status and future perspectives of preoperative portal vein embolization. Am J Surg. 197(5):686-90, 2009
van den Esschert JW et al: Volumetric and functional recovery of the remnant liver after major liver resection with prior portal vein embolization: recovery after PVE and liver resection. J Gastrointest Surg. 13(8):1464-9, 2009
Ribero D et al: Standardized liver volumetry for portal vein embolization. Semin Intervent Radiol. 25(2):104-9, 2008
Madoff DC et al: Transhepatic ipsilateral right portal vein embolization extended to segment IV: improving hypertrophy and resection outcomes with spherical particles and coils. J Vasc Interv Radiol. 16:215-25, 2005
Michalopoulos GK et al: Hepatocyte growth factor. Hepatology. 15(1):149-55, 1992
Kinoshita H et al: Preoperative portal vein embolization for hepatocellular carcinoma. World J Surg. 10(5):803-8, 1986
Related Anatomy
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References
Tables
Tables
KEY FACTS
Terminology
Preprocedure
Procedure
Outcomes
TERMINOLOGY
Definitions
Portal vein embolization (PVE): Preoperative embolization of portal vein (PV) branches used to induce hypertrophy of unembolized portion of liver
For planned right lobe resection, perform embolization to induce hypertrophy of left lobe
Right lobe is larger, usually of sufficient size for resection of left lobe without PVE
Hepatic vein embolization (HVE): Preoperative embolization of hepatic vein branches in order to further induce hypertrophy of unembolized portion of liver, supplemental or in combination with PVE
Future liver remnant (FLR): Anticipated volume of liver remaining after partial hepatectomy
Total estimated liver volume (TELV): -794.41 + 1267.28 x body surface area
Degree of hypertrophy (DH): Difference between ratio of FLR volume to TELV before and after PVE
Kinetic growth rate (KGR): Weekly FLR growth after PVE
PREPROCEDURE
Indications
Contraindications
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
OUTCOMES
Problems
Complications
Expected Outcomes
Selected References
Ali A et al: Portal vein embolization with N-butyl cyanoacrylate glue is superior to other materials: a systematic review and meta-analysis. Eur Radiol. 31(8):5464-78, 2021
Luz JHM et al: BestFLR trial: liver regeneration at CT before major hepatectomies for liver cancer-a randomized controlled trial comparing portal vein embolization with N-butyl-cyanoacrylate plus iodized oil versus polyvinyl alcohol particles plus coils. Radiology. 299(3):715-24, 2021
Qadan M et al: Review of use of Y90 as a bridge to liver resection and transplantation in hepatocellular carcinoma. J Gastrointest Surg. 25(10):2690-9, 2021
Luz JHM et al: Preoperative portal vein embolization in hepatic surgery: a review about the embolic materials and their effects on liver regeneration and outcome. Radiol Res Pract. 2020:9295852, 2020
Niekamp AS et al: Hepatic vein embolization after portal vein embolization to induce additional liver hypertrophy in patients with metastatic colorectal carcinoma. Eur Radiol. 30(7):3862-8, 2020
Gabr A et al: Neoadjuvant radiation lobectomy as an alternative to portal vein embolization in hepatocellular carcinoma. Semin Nucl Med. 49(3):197-203, 2019
Yamashita S et al: Efficacy of preoperative portal vein embolization among patients with hepatocellular carcinoma, biliary tract cancer, and colorectal liver metastases: a comparative study based on single-center experience of 319 cases. Ann Surg Oncol. 24(6):1557-68, 2017
Eshmuminov D et al: Meta-analysis of associating liver partition with portal vein ligation and portal vein occlusion for two-stage hepatectomy. Br J Surg. 103(13):1768-82, 2016
Jaberi A et al: Comparison of clinical outcomes following glue versus polyvinyl alcohol portal vein embolization for hypertrophy of the future liver remnant prior to right hepatectomy. J Vasc Interv Radiol. 27(12):1897-905.e1, 2016
Sarwar A et al: Trans-splenic portal vein embolization: a technique to avoid damage to the future liver remnant. Cardiovasc Intervent Radiol. 39(10):1514-8, 2016
Shindoh J et al: Safety and efficacy of portal vein embolization before planned major or extended hepatectomy: an institutional experience of 358 patients. J Gastrointest Surg. 18(1):45-51, 2014
Vennarecci G et al: The ALPPS procedure: a surgical option for hepatocellular carcinoma with major vascular invasion. World J Surg. 38(6):1498-503, 2014
de Baere T et al: Predictive factors for hypertrophy of the future remnant liver after selective portal vein embolization. Ann Surg Oncol. 17(8):2081-9, 2010
Manizate F et al: Liver functional reserve estimation: state of the art and relevance to local treatments. Oncology. 78 Suppl 1:131-4, 2010
Truty MJ et al: Uses and limitations of portal vein embolization for improving perioperative outcomes in hepatocellular carcinoma. Semin Oncol. 37(2):102-9, 2010
Furuta T et al: Hepatic segments and vasculature: projecting CT anatomy onto angiograms. Radiographics. 29(7):1-22, 2009
Hwang S et al: Sequential preoperative ipsilateral hepatic vein embolization after portal vein embolization to induce further liver regeneration in patients with hepatobiliary malignancy. Ann Surg. 249(4):608-16, 2009
Liu H et al: Present status and future perspectives of preoperative portal vein embolization. Am J Surg. 197(5):686-90, 2009
van den Esschert JW et al: Volumetric and functional recovery of the remnant liver after major liver resection with prior portal vein embolization: recovery after PVE and liver resection. J Gastrointest Surg. 13(8):1464-9, 2009
Ribero D et al: Standardized liver volumetry for portal vein embolization. Semin Intervent Radiol. 25(2):104-9, 2008
Madoff DC et al: Transhepatic ipsilateral right portal vein embolization extended to segment IV: improving hypertrophy and resection outcomes with spherical particles and coils. J Vasc Interv Radiol. 16:215-25, 2005
Michalopoulos GK et al: Hepatocyte growth factor. Hepatology. 15(1):149-55, 1992
Kinoshita H et al: Preoperative portal vein embolization for hepatocellular carcinoma. World J Surg. 10(5):803-8, 1986
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