What causes the non-occluded liver to "grow" (become hyperplastic)?
A combination of increased blood flow and release of serum growth factors by the "injured" occluded liver, such as hepatocyte growth factor (HGF), IL-6, and TNF-alpha.
Is cirrhosis a contraindication to PVE?
Not necessarily. In a patient with mild cirrhosis (Child-Pugh score A) and no portal hypertension, PVE can still be performed. The future liver remnant regenerates more slowly, however.
Sequence of a portal vein embolization with n-butyl cyanoacrylate (NBCA). Approach through the right hepatic lobe.
Initial portal vein run, showing opacification of predominantly the right portal venous system. The left portal vein opacifies, but the distal branches are not yet filled. Portal pressures are taken to exclude portal hypertension.
Transcatheter instillation of n-butyl cyanoacrylate (NBCA).
Continued transcatheter instillation of n-butyl cyanoacrylate (NBCA). The patchy filling defects in the portal vein correspond to the occlusive material.
Finish run of the portal vein. Note how the distal right portal vein branches are no longer opacified and are instead filled with the embolization material. Contrast is routed into the left portal venous system.