Central vascular plug-assisted portal vein embolization with absolute ethanol

Area of Science:

• Interventional Radiology
• Hepatobiliary Surgery
• Oncology

Background:

• Portal vein embolization (PVE) is crucial for inducing future liver remnant (FLR) hypertrophy before major liver resection.
• Traditional selective PVE involves complex, time-consuming serial cannulation of portal veins.
• A novel central vascular plug-assisted PVE technique using absolute ethanol has been developed.

Purpose of the Study:

• To compare the efficacy and procedural efficiency of central vascular plug-assisted PVE versus selective PVE.
• To evaluate FLR hypertrophy and procedural outcomes in patients undergoing PVE.

Main Methods:

• A retrospective study included 30 patients undergoing ipsilateral percutaneous transhepatic PVE between 2016 and 2023.
• Patients were divided into central vascular plug-assisted PVE (n=17) and selective PVE (n=13) groups.
• Data collected included demographics, diagnosis, volumetry, procedure time, FLR hypertrophy (DH, KGR), and surgical outcomes.

Main Results:

• Both central vascular plug-assisted PVE and selective PVE achieved comparable FLR hypertrophy (DH 13%±5 vs 11%±4; KGR 3%/week ± 2 vs 2%/week ± 2).
• Central vascular plug-assisted PVE significantly reduced procedure times (45±20 min vs 112±34 min; p<0.001).
• No adverse events were reported with central vascular plug-assisted PVE, compared to two in the selective PVE group.

Conclusions:

• Central vascular plug-assisted PVE with absolute ethanol is an effective method for inducing FLR hypertrophy.
• This technique offers significant advantages in reduced procedure time and improved safety profile.
• Central vascular plug-assisted PVE represents a more efficient and simpler approach to embolization for liver surgery preparation.