Complications of percutaneous transhepatic portal vein embolization

Percutaneous transhepatic portal vein (PV) embolization (PTPE) is a useful preoperative procedure for extended liver resection. The purpose of the present study was to assess the frequency of technical complications of PTPE and to discuss the risks of this procedure.

PTPE was performed in 46 patients. Forty-seven procedures were performed because an initial puncture failure required that the procedure be performed twice in one patient. The technical success rate and technical complications were assessed. Complications were analyzed with regard to approach methods and puncture sites. Approach methods were categorized as contralateral or ipsilateral. Puncture sites were categorized into anterior, posterior, and lateral segments. The results were compared statistically with use of the Fisher exact test.

Technical success was achieved in 45 of 47 procedures (95.7%). Complications occurred in seven of 47 procedures (14.9%), including pneumothorax in two, subcapsular hematoma in two, arterial puncture in one, pseudoaneurysm in one, hemobilia in one, and PV thrombosis in one. Subcapsular hematoma and pseudoaneurysm occurred in the same procedure. No patient died as a result of complications. There was no significant difference between the contralateral and ipsilateral approaches. The incidence of complications was significantly higher in procedures involving puncture of the posterior segment than in those involving puncture of the anterior segment (P =.0374).

In cases in which the anterior segment cannot be visualized for puncture, PTPE via the lateral segment or transileocolic portal embolization should be considered rather than PTPE via the posterior segment.