Successful Thrombectomy via a Surgically Reopened Umbilical Vein for Extended Portal Vein Thrombosis Caused by Portal Vein Embolization prior to Extended Liver Resection

Selective portal vein embolization (PVE) before extended liver surgery is an accepted method to stimulate growth of the future liver remnant. Portal vein thrombosis (PVT) of the main stem and the non-targeted branches to the future liver remnant is a rare but major complication of PVE, requiring immediate revascularization. Without revascularization, curative liver surgery is not possible, resulting in a potentially life-threatening situation. We here present a new surgical technique to revascularize the portal vein after PVT by combining a surgical thrombectomy with catheter-based thrombolysis via the surgically reopened umbilical vein. This technique was successfully applied in a patient who developed thrombosis of the portal vein main stem, as well as the left portal vein and its branches to the left lateral segments after selective right-sided PVE in preparation for an extended right hemihepatectomy. The advantage of this technique is the avoidance of an exploration of hepatoduodenal ligament and a venotomy of the portal vein. The minimal surgical trauma facilitates additional intravascular thrombolytic therapy as well as the future right extended hemihepatectomy. We recommend this technique in patients with extensive PVT in which percutaneous less invasive therapies have been proven unsuccessful.

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Preoperative Portal Vein Embolization with N-Butyl Cyanoacrylate Plus Ethiodized Oil: More Rapid and Robust Hypertrophy of the Future Liver Remnant!

Radiology ◽

10.1148/radiol.2021210368 ◽

2021 ◽

pp. 210368

Author(s):

Ronald S. Arellano

Keyword(s):

Portal Vein ◽

Portal Vein Embolization ◽

Future Liver Remnant ◽

Liver Remnant ◽

The Future ◽

Ethiodized Oil

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Comparison of Clinical Outcomes following Glue versus Polyvinyl Alcohol Portal Vein Embolization for Hypertrophy of the Future Liver Remnant prior to Right Hepatectomy

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2016.05.023 ◽

2016 ◽

Vol 27 (12) ◽

pp. 1897-1905.e1 ◽

Cited By ~ 16

Author(s):

Arash Jaberi ◽

Sundeep S. Toor ◽

Dheeraj K. Rajan ◽

Oleg Mironov ◽

John R. Kachura ◽

...

Keyword(s):

Portal Vein ◽

Polyvinyl Alcohol ◽

Clinical Outcomes ◽

Portal Vein Embolization ◽

Future Liver Remnant ◽

Right Hepatectomy ◽

Liver Remnant ◽

The Future

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Trans-Splenic Portal Vein Embolization: A Technique to Avoid Damage to the Future Liver Remnant

CardioVascular and Interventional Radiology ◽

10.1007/s00270-016-1359-5 ◽

2016 ◽

Vol 39 (10) ◽

pp. 1514-1518 ◽

Cited By ~ 3

Author(s):

Ammar Sarwar ◽

Olga R. Brook ◽

Jeffrey L. Weinstein ◽

Khalid Khwaja ◽

Muneeb Ahmed

Keyword(s):

Portal Vein ◽

Portal Vein Embolization ◽

Future Liver Remnant ◽

Liver Remnant ◽

The Future

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Portal Vein Embolization with PVA and Coils before Major Hepatectomy: Single-Center Retrospective Analysis in Sixty-Four Patients

Journal of Oncology ◽

10.1155/2019/4634309 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

R. Camelo ◽

J. H. Luz ◽

F. V. Gomes ◽

E. Coimbra ◽

N. V. Costa ◽

...

Keyword(s):

Portal Vein ◽

Liver Tumor ◽

Portal Vein Embolization ◽

Liver Surgery ◽

Major Hepatectomy ◽

Tumor Resection ◽

Future Liver Remnant ◽

Mean Value ◽

Liver Remnant ◽

Hepatic Artery Branch

Objectives. Portal vein embolization (PVE) stimulates hypertrophy of the future liver remnant (FLR) and improves the safety of extended hepatectomy. This study evaluated the efficacy of PVE, performed with PVA and coils, in relation to its effect on FLR volume and ratio. Secondary endpoints were the assessment of PVE complications, accomplishment of liver surgery, and patient outcome after hepatectomy. Materials and Methods. All patients who underwent PVE before planned major hepatectomy between 2013 and 2017 were retrospectively analyzed, comprising a total of 64 patients. Baseline patient clinical characteristics, imaging records, liver volumetric changes, complications, and outcomes were analyzed. Results. There were 45 men and 19 women with a mean age of 64 years. Colorectal liver metastasis was the most frequent liver tumor. The majority of patients (n = 53) had a right PVE. FLR increased from a mean value of 484 ml ± 242 to 654 ml ± 287 p<0.001 after PVE. Two major complications were experienced after PVE: 1 case of left hepatic artery branch laceration and 1 case of hemoperitoneum and hemothorax. A total of 44 (69%) patients underwent liver surgery. Twenty-one patients were not taken to surgery due to disease progression (n = 18), liver insufficiency (n = 1), and insufficient FLR volume (n = 1), and one patient declined surgery (n = 1). Conclusions. PVE with PVA and coils was accomplished safely and promoted a high FLR hypertrophy yield, enabling most of our patients to be submitted to the potentially curative treatment of liver tumor resection.

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Predictive Factors for Hypertrophy of the Future Liver Remnant After Portal Vein Embolization: A Systematic Review

CardioVascular and Interventional Radiology ◽

10.1007/s00270-021-02877-3 ◽

2021 ◽

Author(s):

E. A. Soykan ◽

B. M. Aarts ◽

M. Lopez-Yurda ◽

K. F. D. Kuhlmann ◽

J. I. Erdmann ◽

...

Keyword(s):

Systematic Review ◽

Portal Vein ◽

Portal Vein Embolization ◽

Future Liver Remnant ◽

Liver Remnant ◽

The Future ◽

Quantitative Synthesis ◽

Neo Adjuvant Chemotherapy ◽

Meta Analyses ◽

Subsequent Literature

AbstractThis systematic review was conducted to determine factors that are associated with the degree of hypertrophy of the future liver remnant following portal vein embolization. An extensive search on September 15, 2020, and subsequent literature screening resulted in the inclusion of forty-eight articles with 3368 patients in qualitative analysis, of which 18 studies were included in quantitative synthesis. Meta-analyses based on a limited number of studies showed an increase in hypertrophy response when additional embolization of segment 4 was performed (pooled difference of medians = − 3.47, 95% CI − 5.51 to − 1.43) and the use of N-butyl cyanoacrylate for portal vein embolization induced more hypertrophy than polyvinyl alcohol (pooled standardized mean difference (SMD) = 0.60, 95% CI 0.30 to 0.91). There was no indication of a difference in degree of hypertrophy between patients who received neo-adjuvant chemotherapy and those who did not receive pre-procedural systemic therapy(pooled SMD = − 0.37, 95% CI − 1.35 to 0.61), or between male and female patients (pooled SMD = 0.19, 95% CI − 0.12 to 0.50).The study was registered in the International Prospective Register of Systematic Reviews on April 28, 2020 (CRD42020175708).

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