Disastrous Portal Vein Embolization Turned into a Successful Intervention

Area of Science:

• Interventional Radiology
• Hepatobiliary Surgery
• Vascular Embolization

Background:

• Portal vein embolization (PVE) is a crucial preoperative procedure to augment the future liver remnant (FLR) volume, thereby mitigating the risk of postoperative liver insufficiency, particularly in patients undergoing major liver resections.
• This case involves a 71-year-old patient diagnosed with hilar cholangiocarcinoma requiring PVE to prepare for hemihepatectomy.

Discussion:

• The procedure utilized a mixture of n-butyl-2-cyanoacrylate and ethiodized oil for embolization, accessed via the right portal vein.
• An unexpected complication arose with nontarget embolization of the left portal vein, which proved resistant to standard aspiration techniques.
• A novel technique involving a balloon-guided relocation of the embolus into the main right portal vein was successfully employed to restore FLR perfusion.

Key Insights:

• Accidental nontarget embolization during PVE is a recognized risk, necessitating advanced interventional techniques for management.
• Successful management of an embolus obstructing FLR perfusion was achieved through a combination of balloon catheter bypass and embolus relocation.
• This case highlights the adaptability and problem-solving capabilities required in interventional radiology for complex hepatobiliary interventions.

Outlook:

• Refinement of embolization techniques and materials may further reduce the incidence of nontarget embolization.
• Development of advanced retrieval devices could offer alternative solutions for managing embolization complications.
• This successful management strategy may inform future approaches to similar complications in PVE procedures.