Simultaneous transarterial and portal embolization for unresectable tumors of the liver

Hepatic portal vein embolization and transcatheter arterial chemoembolization are well-defined procedures respectively introduced to increase the future remnant liver and to avoid tumor progression before a scheduled hepatectomy. If used alone, both this approaches do not always improve surgical outcome, sometimes resulting in drop out from definitive surgery because of progression of disease. Since the late 1980s, sequential approach with TACE and PVE has been introduced as a preoperative treatment in order to: prevent tumor progression during the weeks intervening before operation; strengthen the effects of PVE by embolizing possible arterio-portal shunts; improve the FRL volumetric increase through the acceleration of hepatocytes proliferation. The risk of liver parenchymal necrosis, related to the double occlusion of blood supply, is usually avoided by maintaining an interval of weeks between the two procedures (PVE performed 2-3 weeks after TACE and surgery performed 4-6 weeks after PVE), but during this period the tumor may grow, nullifying the results obtained. We herein report a literary review and our initial experience with one patient affected by hepatocellular carcinoma involving the whole right liver, treated with TACE and right PVE, both performed in the same session. Although this technique still needs validation after the treatment of a wider number of patients, it seems to be feasible and effective.