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Portal Vein Embolization
Nathan Saucier, MD; Jennifer R. Buckley, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Outcomes

          TERMINOLOGY

          • Definitions

            • Portal vein embolization (PVE): Preoperative embolization of portal vein branches used to induce hypertrophy of unembolized portion of liver
              • Usually used in cases of diseased right lobe requiring embolization to induce hypertrophy of left lobe
              • As right lobe is normally larger than left, it is usually of sufficient size for resection of left lobe without 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

                • Preprocedural Imaging

                  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. 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):1768-1782, 2016
                                  2. 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):1897-1905.e1., 2016
                                  3. 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
                                  4. 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
                                  5. 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
                                  6. Manizate F et al: Liver functional reserve estimation: state of the art and relevance to local treatments. Oncology. 78 Suppl 1:131-4, 2010
                                  7. 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
                                  8. Furuta T et al: Hepatic segments and vasculature: projecting CT anatomy onto angiograms. Radiographics. 29(7):1-22, 2009
                                  9. 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
                                  10. Liu H et al: Present status and future perspectives of preoperative portal vein embolization. Am J Surg. 197(5):686-90, 2009
                                  11. 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
                                  12. Ribero D et al: Standardized liver volumetry for portal vein embolization. Semin Intervent Radiol. 25(2):104-9, 2008
                                  13. 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
                                  14. Michalopoulos GK et al: Hepatocyte growth factor. Hepatology. 15(1):149-55, 1992
                                  15. 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 branches used to induce hypertrophy of unembolized portion of liver
                                              • Usually used in cases of diseased right lobe requiring embolization to induce hypertrophy of left lobe
                                              • As right lobe is normally larger than left, it is usually of sufficient size for resection of left lobe without 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

                                                • Preprocedural Imaging

                                                  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. 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):1768-1782, 2016
                                                                  2. 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):1897-1905.e1., 2016
                                                                  3. 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
                                                                  4. 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
                                                                  5. 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
                                                                  6. Manizate F et al: Liver functional reserve estimation: state of the art and relevance to local treatments. Oncology. 78 Suppl 1:131-4, 2010
                                                                  7. 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
                                                                  8. Furuta T et al: Hepatic segments and vasculature: projecting CT anatomy onto angiograms. Radiographics. 29(7):1-22, 2009
                                                                  9. 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
                                                                  10. Liu H et al: Present status and future perspectives of preoperative portal vein embolization. Am J Surg. 197(5):686-90, 2009
                                                                  11. 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
                                                                  12. Ribero D et al: Standardized liver volumetry for portal vein embolization. Semin Intervent Radiol. 25(2):104-9, 2008
                                                                  13. 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
                                                                  14. Michalopoulos GK et al: Hepatocyte growth factor. Hepatology. 15(1):149-55, 1992
                                                                  15. Kinoshita H et al: Preoperative portal vein embolization for hepatocellular carcinoma. World J Surg. 10(5):803-8, 1986