Liver Vein Deprivation: Rationale, Technique, and Review of the Literature

Liver resection can improve survival in patients with primary or secondary liver tumors, but insufficient future liver remnant (FLR) volume can be a contraindication to surgery in these patients. Portal vein embolization (PVE) has been the standard preoperative strategy used to induce FLR hypertrophy in this population; however, PVE provides only modest hypertrophy over a relatively long time frame. The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) technique offers rapid hypertrophy but is a more invasive and complex procedure. Liver vein deprivation (LVD) has therefore been introduced as an alternative, less invasive technique for inducing preoperative liver hypertrophy. This article outlines the rationale underlying the LVD procedure and the techniques that are commonly used for percutaneous portal and hepatic vein embolization. The literature is then reviewed to assess the outcomes associated with LVD vs with PVE and ALPPS. Contemporary case series have demonstrated that LVD is safe and more effective than PVE in achieving adequate FLR hypertrophy within a shorter interval. Additionally, although ALPPS remains the fastest method for FLR augmentation, LVD offers a less invasive alternative. LVD therefore expands the interventional radiologist's armamentarium for liver regeneration, addressing PVE's limitations by achieving greater and quicker hypertrophy without the surgical stress of ALPPS. Early clinical experience and emerging data suggest that LVD can improve the odds of successful resection and may narrow the gap between endovascular and surgical hypertrophy techniques.