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Semin intervent Radiol 2008; 25(2): 132-145
DOI: 10.1055/s-2008-1076686
© Thieme Medical Publishers

Percutaneous Transhepatic Portal Vein Embolization: Rationale, Technique, and Outcomes

Rony Avritscher1 , Thierry de Baere2 , Ravi Murthy1 , Frederic Deschamps2 , David C. Madoff1
  • 1Division of Diagnostic Imaging, Interventional Radiology Section, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
  • 2Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, France
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Publication History

Publication Date:
30 May 2008 (online)

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ABSTRACT

Portal vein embolization (PVE) is used to induce preoperative liver hypertrophy in patients with anticipated marginal future liver remnant (FLR) volumes who are otherwise potential candidates for resection. PVE can be performed utilizing the transhepatic contralateral and ipsilateral approaches. The transhepatic contralateral approach is the most commonly used technique worldwide, largely owing to its technical ease. However, the contralateral approach risks injuring the FLR, thereby compromising the planned surgical resection. The transhepatic ipsilateral approach offers a potentially safer alternative because the complications associated with this approach affect only the hepatic lobe that will be resected and are usually not serious enough to preclude surgery. This article discusses PVE using the transhepatic ipsilateral and contralateral approaches, including patient selection criteria, anatomical and technical considerations, and patient complications and outcomes.

KEYWORDS

Portal vein embolization - liver cancer - liver resection - liver hypertrophy

REFERENCES

  • 1 Ribero D, Abdalla E K, Madoff D C, Donadon M, Loyer E M, Vauthey J N. Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome.  Br J Surg. 2007;  94 1386-1394
    CrossrefPubMedGoogle Scholar
  • 2 Ferrero A, Vigano L, Polastri R et al.. Postoperative liver dysfunction and future remnant liver: where is the limit? Results of a prospective study.  World J Surg. 2007;  31 1643-1651
    CrossrefPubMedGoogle Scholar
  • 3 Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up.  Ann Surg. 2006;  243 364-372
    CrossrefPubMedGoogle Scholar
  • 4 Madoff D C, Abdalla E K, Vauthey J N. Portal vein embolization in preparation for major hepatic resection: evolution of a new standard of care.  J Vasc Interv Radiol. 2005;  16 779-790
    PubMedGoogle Scholar
  • 5 Kodama Y, Shimizu T, Endo H, Miyamoto N, Miyasaka K. Complications of percutaneous transhepatic portal vein embolization.  J Vasc Interv Radiol. 2002;  13 1233-1237
    CrossrefPubMedGoogle Scholar
  • 6 Perarnau J M, Daradkeh S, Johann M, Deneuville M, Weinling P, Coniel C. Transjugular preoperative portal embolization (TJPE): a pilot study.  Hepatogastroenterology. 2003;  50 610-613
    PubMedGoogle Scholar
  • 7 Makuuchi M, Thai B L, Takayasu K et al.. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report.  Surgery. 1990;  107 521-527
    Google Scholar
  • 8 Yokoyama Y, Nagino M, Nimura Y. Mechanisms of hepatic regeneration following portal vein embolization and partial hepatectomy: a review.  World J Surg. 2007;  31 367-374
    CrossrefPubMedGoogle Scholar
  • 9 Bucher N L, Swaffield M N. The rate of incorporation of labeled thymidine into the deoxyribonucleic acid of regenerating rat liver in relation to the amount of liver excised.  Cancer Res. 1964;  24 1611-1625
    PubMedGoogle Scholar
  • 10 Lee K C, Kinoshita H, Hirohashi K, Kubo S, Iwasa R. Extension of surgical indications for hepatocellular carcinoma by portal vein embolization.  World J Surg. 1993;  17 109-115
    Google Scholar
  • 11 Kinoshita H, Sakai K, Hirohashi K, Igawa S, Yamasaki O, Kubo S. Preoperative portal vein embolization for hepatocellular carcinoma.  World J Surg. 1986;  10 803-808
    Google Scholar
  • 12 de Baere T, Roche A, Vavasseur D et al.. Portal vein embolization: utility for inducing left hepatic lobe hypertrophy before surgery.  Radiology. 1993;  188 73-77
    PubMedGoogle Scholar
  • 13 de Baere T, Roche A, Elias D, Lasser P, Lagrange C, Bousson V. Preoperative portal vein embolization for extension of hepatectomy indications.  Hepatology. 1996;  24 1386-1391
    PubMedGoogle Scholar
  • 14 Abdalla E K, Hicks M E, Vauthey J N. Portal vein embolization: rationale, technique and future prospects.  Br J Surg. 2001;  88 165-175
    CrossrefPubMedGoogle Scholar
  • 15 Abdalla E K, Barnett C C, Doherty D, Curley S A, Vauthey J N. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization.  Arch Surg. 2002;  137 675-680 discussion 680-671
    CrossrefPubMedGoogle Scholar
  • 16 Kawarada Y, Sanda M, Kawamura K, Suzaki M, Nakase I, Mizumoto R. Simultaneous extensive resection of the liver and the pancreas in dogs.  Gastroenterol Jpn. 1991;  26 747-756
    PubMedGoogle Scholar
  • 17 Elias D, Lasser P, Spielmann M et al.. Surgical and chemotherapeutic treatment of hepatic metastases from carcinoma of the breast.  Surg Gynecol Obstet. 1991;  172 461-464
    PubMedGoogle Scholar
  • 18 Vauthey J N, Abdalla E K, Doherty D A et al.. Body surface area and body weight predict total liver volume in Western adults.  Liver Transpl. 2002;  8 233-240
    CrossrefPubMedGoogle Scholar
  • 19 Denys A L, De Baere T, Doenz F. Portal vein embolization: a plea for strict patient selection.  AJR Am J Roentgenol. 2006;  187 W125 , author reply 126
    CrossrefPubMedGoogle Scholar
  • 20 Abdalla E K, Denys A, Chevalier P, Nemr R A, Vauthey J N. Total and segmental liver volume variations: implications for liver surgery.  Surgery. 2004;  135 404-410
    CrossrefPubMedGoogle Scholar
  • 21 Nagino M, Nimura Y, Kamiya J et al.. Right or left trisegment portal vein embolization before hepatic trisegmentectomy for hilar bile duct carcinoma.  Surgery. 1995;  117 677-681
    PubMedGoogle Scholar
  • 22 Vauthey J N, Chaoui A, Do K A et al.. Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations.  Surgery. 2000;  127 512-519
    CrossrefPubMedGoogle Scholar
  • 23 Nagino M, Nimura Y, Kamiya J, Kondo S, Kanai M. Selective percutaneous transhepatic embolization of the portal vein in preparation for extensive liver resection: the ipsilateral approach.  Radiology. 1996;  200 559-563
    PubMedGoogle Scholar
  • 24 Gibo M, Unten S, Yogi A et al.. Percutaneous ipsilateral portal vein embolization using a modified four-lumen balloon catheter with fibrin glue: initial clinical experience.  Radiat Med. 2007;  25 164-172
    CrossrefPubMedGoogle Scholar
  • 25 Nishio H, Nagino M, Kamiya J et al.. Most informative projection for portography: quantitative analysis of 47 percutaneous transhepatic portograms.  World J Surg. 2003;  27 433-436
    CrossrefPubMedGoogle Scholar
  • 26 Madoff D C, Abdalla E K, Wallace M J, Ng C S, Ribero D, Vauthey J N. Portal vein embolization: a preoperative approach to improve the safety of major hepatic resection.  Curr Med Imaging Rev. 2006;  2 385-404
    PubMedGoogle Scholar
  • 27 Di Stefano D R, de Baere T, Denys A et al.. Preoperative percutaneous portal vein embolization: evaluation of adverse events in 188 patients.  Radiology. 2005;  234 625-630
    CrossrefPubMedGoogle Scholar
  • 28 Madoff D C, Abdalla E K, Gupta S 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. 2005;  16 215-225
    CrossrefPubMedGoogle Scholar
  • 29 Ogasawara K, Uchino J, Une Y, Fujioka Y. Selective portal vein embolization with absolute ethanol induces hepatic hypertrophy and makes more extensive hepatectomy possible.  Hepatology. 1996;  23 338-345
    CrossrefPubMedGoogle Scholar
  • 30 Yamakado K, Takeda K, Nishide Y et al.. Portal vein embolization with steel coils and absolute ethanol: a comparative experimental study with canine liver.  Hepatology. 1995;  22 1812-1818
    PubMedGoogle Scholar
  • 31 Matsuoka T. Experimental studies of intrahepatic portal vein embolization and embolic materials.  , [in Japanese] Nippon Igaku Hoshasen Gakkai Zasshi. 1989;  49 593-606
    PubMedGoogle Scholar
  • 32 Madoff D C, Hicks M E, Abdalla E K, Morris J S, Vauthey J N. Portal vein embolization with polyvinyl alcohol particles and coils in preparation for major liver resection for hepatobiliary malignancy: safety and effectiveness-study in 26 patients.  Radiology. 2003;  227 251-260
    CrossrefPubMedGoogle Scholar
  • 33 Abulkhir A, Limongelli P, Healey A J et al.. Preoperative portal vein embolization for major liver resection: a meta-analysis.  Ann Surg. 2008;  247 49-57
    CrossrefPubMedGoogle Scholar
  • 34 Farges O, Belghiti J, Kianmanesh R et al.. Portal vein embolization before right hepatectomy: prospective clinical trial.  Ann Surg. 2003;  237 208-217
    Google Scholar

David C MadoffM.D. 

Division of Diagnostic Imaging, Interventional Radiology Section, Unit 325, The University of Texas M. D. Anderson Cancer Center

1515 Holcombe Boulevard, Houston, TX 77030-4009

Email: dmadoff@di.mdacc.tmc.edu

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