Portal and hepatic vein embolization prior to major hepatectomy

Introduction Portal vein embolization has been widely accepted procedure for liver hypertrophy before major liver resections. The safety and effectiveness of simultaneous portal and hepatic vein embolization (PHVE) or sequential hepatic vein embolization (HVE) compared to portal vein embolization (PVE) have not been completely addressed, yet.

Methods Patients undergoing PVE, PHVE or HVE at our tertiary care center between 2018 and 2020 were retrospectively included. Future remnant liver volume (FRLV), standardized FRLV (sFRLV) and sFRLV growth rate per day were assessed via volumetry, as well as laboratory parameters.

Results 36 patients with median age of 64.5 years (f=15, m=21) were treated in this period. 16 patients received PHVE and 20 patients PVE, of which 4 sustained sequential HVE. There was no procedure associated major complications. Laboratory parameters did not increase significantly after embolization. Left portal vein thrombosis (LPVT) was observed after PHVE in six patients and in one patient after PVE. Significant increase of FRLV was achieved with both PVE and PHVE compared to baseline (p< 0.0001). sFRLV growth rate did not significantly differ following PHVE (2.2±1.2%/d) or PVE (2.2±1.7%/d, p=0.94). Sequential HVE showed a considerably high growth rate of 1.42±0.45%/d after PVE.

Conclusion Both PVE and PHVE effectively induce FRL hypertrophy with comparable sFRLV growth rate, however PHVE lead to higher LPVT incidence. Sequential HVE further induces hypertrophy after insufficient growth following PVE.

Publication History

Article published online:
07 September 2021