Portal vein embolisation

Case contributed by Dr Matt A. Morgan

Presentation

Patient with hepatitis B and a resectable right lobe hepatocellular carcinoma. No cirrhosis or portal hypertension.

Patient Data

Age: 58Y
Gender: Male
Modality: DSA (angiography)

Sequence of a portal vein embolization with n-butyl cyanoacrylate (NBCA). Approach through the right hepatic lobe.

Case Discussion

Portal vein embolization (PVE) is a technique used by interventional radiologists to improve the postoperative outcome of a hepatectomy.

When a part of the liver is resected, the remaining component is referred to as the future liver remnant (FLR). If this remnant liver were too small to supply the patient's body size, then the postoperative prognosis would be poor. PVE can "grow" the FLR by preoperatively occluding the lobe to be resected (almost always the right lobe). Increased blood flow to the left hepatic lobe, and serum factors released by the injured occluded liver, induce hyperplasia in the left hepatic lobe.

PVE is a relatively safe procedure, with postprocedure mortality reported at 0% and morbidity at 2.2% 1.

Portal hypertension is a major contraindication to PVE, since it will drive up portal pressures even further, possibly resulting variceal haemorrhage.

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Case Information

rID: 35428
Case created: 6th Apr 2015
Last edited: 19th Jan 2017
Inclusion in quiz mode: Included

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