Identification of cofactors influencing hypertrophy of the future liver remnant after portal vein embolization—the effect of collaterals on embolized liver volume

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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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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Preoperative Portal Vein Embolization in Hepatic Surgery: A Review about the Embolic Materials and Their Effects on Liver Regeneration and Outcome

Radiology Research and Practice ◽

10.1155/2020/9295852 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Jose Hugo M. Luz ◽

Filipe V. Gomes ◽

Elia Coimbra ◽

Nuno V. Costa ◽

Tiago Bilhim

Keyword(s):

Portal Vein ◽

Portal Vein Embolization ◽

Controlled Trial ◽

Liver Volume ◽

Future Liver Remnant ◽

Embolic Agent ◽

Cyanoacrylate Glue ◽

Liver Remnant ◽

Ethylene Vinyl Alcohol ◽

Embolic Materials

Liver volume and function after hepatectomies are directly correlated to postoperative complications and mortality. Consequently contemporary liver surgery has focused on reaching an adequate future liver remnant so as to diminish postoperative morbidity and mortality. Portal vein embolization has evolved and is the standard of care as a liver regenerative strategy in many surgery departments worldwide before major liver resections. Different embolic materials have been used for portal vein embolization including gelfoam, ethanol, polyvinyl-alcohol particles, calibrated microspheres, central vascular plugs, coils, n-butyl-cyanoacrylate glue, fibrin glue, polidocanol-foam, alcoholic prolamin solution, and ethylene vinyl alcohol copolymer, as sole occluders or in varied combinations. While to date there has been no prospective controlled trial comparing the efficacy of different embolic materials in portal vein embolization, retrospective data insinuates that the use of n-butyl-cyanoacrylate and absolute ethanol produces higher contralateral liver hypertrophies. In this review, we evaluated publications up to August 2019 to assess the technical and regenerative results of portal vein embolization accomplished with different embolic materials. Special attention was given to specific aspects, advantages, and drawbacks of each embolic agent used for portal vein embolization, its liver regenerative performance, and its influence on patient outcome.

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Efficacy of percutaneous transhepatic portal vein embolization using gelatin sponge particles and metal coils

Acta Radiologica Open ◽

10.1177/2058460118769687 ◽

2018 ◽

Vol 7 (4) ◽

pp. 205846011876968 ◽

Cited By ~ 1

Author(s):

Tomohiro Komada ◽

Kojiro Suzuki ◽

Takashi Mizuno ◽

Tomoki Ebata ◽

Masaya Matsushima ◽

...

Keyword(s):

Portal Vein ◽

Portal Vein Embolization ◽

Clinical Status ◽

Liver Volume ◽

Future Liver Remnant ◽

Gelatin Sponge ◽

Liver Remnant ◽

Total Liver Volume ◽

Gelatin Sponge Particles ◽

The Mean

Background Percutaneous transhepatic portal vein embolization (PTPE) can increase the future liver remnant (FLR) volume before extended liver resection; however, there is no current consensus regarding the best embolic material for PTPE. Purpose To evaluate the efficacy of PTPE using gelatin sponge particles and coils. Material and Methods The medical records of 136 patients who underwent PTPE using gelatin sponge particles and metal coils were retrospectively reviewed. We evaluated the procedural details, liver volume on CT, and clinical status before and after PTPE. Results The mean FLR volume increased significantly from 390 ± 147 cm3 to 508 ± 141 cm3 ( P < 0.001). A mean of 22.1 ± 9.4 days after PTPE, the mean increase in the ratio of FLR volume to total liver volume was 9.4 ± 6.5%. Complications related to PTPE occurred in five patients, including arterial damage (n = 4) and biloma (n = 1). The white blood cell count and C-reactive protein level increased significantly and then returned to baseline within seven days. Aspartate aminotransferase and alanine aminotransferase showed no significant changes. Fever (defined by the Common Terminology Criteria for Adverse Events v4.0) was reported in 74 patients (54%), but it was generally mild (Grade 1/2; n = 72). None of the patients experienced severe complications that required cancellation of surgery. Conclusion PTPE with gelatin sponge particles and coils may impose low physical stress on patients and is a safe method of inducing a significant increase of FLR.

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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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