Portal vein embolisation

Portal vein embolisation (PVE) is a technique used to selectively occlude the blood supply to one of the liver lobes, allowing the the other lobe to undergo hyperplasia. This increases the size of the post hepatectomy future liver remnant (FLR), and improves surgical outcomes.

PVE is a procedure performed by interventional radiology.

First published in 1990 by Makuuchi et al. 2

  • FLR that would be too small for the patient's body mass, post hepatectomy (typically <20%)
  • elevated ICG-R15 serum values 15 minutes after injection
    • ICG (indocyanine green) binds to albumin and is excreted by the biliary system
    • elevated values imply decreased hepatic reserve
  • patients with hepatic steatosis
  • patients who underwent hepatotoxic chemotherapy
  • cirrhosis, Child-Pugh class A, ICG-R15 <10%, if FLR <40%
  • ipsilateral tumour thrombus
  • portal hypertension  (procedure exacerbates portal hypertension)

Can be performed on an outpatient basis. The FLR (on CT or MRI) should be obtained prior undertaking this procedure.

Technique

The right lobe is almost always targeted.  The approach is usually through the right lobe, as well.

Different embolic agents have been used, including:

  • n-butyl cyanoacrylate (NBCA)
  • ethiodized oil
  • fibrin glue
  • ethanol
  • microparticles (such as polyvinyl alcohol, PVA)
  • microspheres followed by coils are used by some.

The portal vein can be approached surgically through a transileocolic approach, but interventional radiology usually approaches the portal vein transhepatically.  Portal vein pressures are checked pre-procedure, to ensure that there is no portal hypertension.

Postprocedural care
  • minor fluctuations in postprocedure liver function tests (50%)
  • liver synthetic functions usually not affected
  • nausea, fever, and pain are rare
  • reported 0% procedure-related mortality 3
  • reported overall morbidity of 2.2% 3
  • nontarget embolization
  • complete portal vein thrombus
  • risks similar to other transhepatic procedures

Patients with otherwise normal livers regenerate two weeks postprocedure at 12-21 cm3 / day (9 cm3 / day for cirrhotic patients) 5. 2-4 weeks is usually enough for most patients with normal liver function (>4 weeks for patients with cirrhosis).

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Article Information

rID: 35426
Tags: liver, cases
Synonyms or Alternate Spellings:
  • Portal vein embolisations
  • PVE
  • Portal vein embolization

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Cases and Figures

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    Case 1: delivery of n-butyl cyanoacrylate
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    Case 1: post embolization run
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