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Portal Vein Embolization
Wylie T. Foss, MD; Joshua Kuban, MD; Nathan Saucier, MD
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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

                                1. 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
                                2. 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
                                3. 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
                                4. 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
                                5. 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
                                6. 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
                                7. 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
                                8. 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
                                9. 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
                                10. 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
                                11. 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
                                12. 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
                                13. 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
                                14. Manizate F et al: Liver functional reserve estimation: state of the art and relevance to local treatments. Oncology. 78 Suppl 1:131-4, 2010
                                15. 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
                                16. Furuta T et al: Hepatic segments and vasculature: projecting CT anatomy onto angiograms. Radiographics. 29(7):1-22, 2009
                                17. 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
                                18. Liu H et al: Present status and future perspectives of preoperative portal vein embolization. Am J Surg. 197(5):686-90, 2009
                                19. 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
                                20. Ribero D et al: Standardized liver volumetry for portal vein embolization. Semin Intervent Radiol. 25(2):104-9, 2008
                                21. 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
                                22. Michalopoulos GK et al: Hepatocyte growth factor. Hepatology. 15(1):149-55, 1992
                                23. 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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                                Related Differential Diagnoses
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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

                                                              1. 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
                                                              2. 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
                                                              3. 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
                                                              4. 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
                                                              5. 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
                                                              6. 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
                                                              7. 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
                                                              8. 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
                                                              9. 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
                                                              10. 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
                                                              11. 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
                                                              12. 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
                                                              13. 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
                                                              14. Manizate F et al: Liver functional reserve estimation: state of the art and relevance to local treatments. Oncology. 78 Suppl 1:131-4, 2010
                                                              15. 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
                                                              16. Furuta T et al: Hepatic segments and vasculature: projecting CT anatomy onto angiograms. Radiographics. 29(7):1-22, 2009
                                                              17. 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
                                                              18. Liu H et al: Present status and future perspectives of preoperative portal vein embolization. Am J Surg. 197(5):686-90, 2009
                                                              19. 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
                                                              20. Ribero D et al: Standardized liver volumetry for portal vein embolization. Semin Intervent Radiol. 25(2):104-9, 2008
                                                              21. 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
                                                              22. Michalopoulos GK et al: Hepatocyte growth factor. Hepatology. 15(1):149-55, 1992
                                                              23. Kinoshita H et al: Preoperative portal vein embolization for hepatocellular carcinoma. World J Surg. 10(5):803-8, 1986