Double vein embolization before major hepatectomy: A single-center experience

Area of Science:

• Hepatobiliary Surgery
• Interventional Radiology
• Surgical Oncology

Background:

• Accurate future liver remnant (FLR) assessment is critical before major hepatectomy, especially for right-sided resections.
• Double vein embolization (DVE) is a preoperative strategy involving simultaneous portal and hepatic vein embolization to stimulate contralateral liver hypertrophy.
• This study evaluates the institutional experience with DVE for FLR augmentation.

Purpose of the Study:

• To assess the safety and efficacy of Double Vein Embolization (DVE) for future liver remnant (FLR) augmentation.
• To determine the degree of hypertrophy (DoH) and kinetic growth rate (KGR) of the FLR following DVE.
• To evaluate the post-surgical complication rate and mortality associated with DVE and subsequent hepatectomy.

Main Methods:

• Retrospective review of patients undergoing DVE between 2017 and 2024.
• Analysis of primary outcomes including DVE safety, FLR hypertrophy (DoH, KGR), and post-surgical complications.
• Inclusion of 30-day postoperative mortality as a key safety endpoint.

Main Results:

• Twenty-nine patients underwent DVE, most commonly for colorectal liver metastases.
• Mean FLR hypertrophy (DoH) was 10.5% ± 8.3%, with a mean kinetic growth rate (KGR) of 5.7% ± 7.0% per week.
• Twenty-seven patients proceeded to liver resection with 0 intraoperative complications, 8 postoperative complications, and 3 mortalities (none liver-failure related).

Conclusions:

• Double vein embolization (DVE) is a safe and effective procedure for augmenting future liver remnant (FLR) volume.
• DVE facilitates successful major hepatectomy by ensuring adequate FLR in patients with insufficient liver volume.
• The institutional experience supports DVE as a valuable option for preoperative FLR augmentation.