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Preoperative portal vein embolization: indications and technical considerations
Thierry de Baere1, Alban Denys, David C Madoff
1Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, France. debaere@igr.fr
Techniques in Vascular and Interventional Radiology
|November 6, 2007
Summary
Preoperative portal vein embolization (PVE) enhances future remnant liver (FRL) growth before major liver surgery. This technique may reduce surgical complications and hospital stays by improving liver function.
Area of Science:
- Hepatobiliary surgery
- Interventional radiology
- Liver regeneration
Background:
- Preoperative portal vein embolization (PVE) is crucial for select patients undergoing major hepatic resection.
- It aims to increase the size of the future remnant liver (FRL) to ensure adequate function post-surgery.
Purpose of the Study:
- To review the technical aspects, benefits, and considerations of PVE.
- To discuss indications, contraindications, and potential complications of PVE.
Main Methods:
- Review of technical considerations: ipsilateral vs. contralateral approaches.
- Selection criteria for embolic agents and liver volumetric measurements for functional reserve assessment.
- Discussion of PVE pathophysiology and outcomes.
Main Results:
- PVE redirects portal flow, inducing hypertrophy in the nondiseased liver portion.
- Potential benefits include reduced postoperative complications and shorter hospital stays.
- Considerations include chronic liver disease, combination therapies, and tumor growth concerns.
Conclusions:
- PVE is an important tool for optimizing liver function before major resection.
- Careful patient selection and technical execution are key to successful PVE outcomes.
- Further discussion on indications, contraindications, and tumor behavior is warranted.
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