Simultaneous Portal and Hepatic Vein Versus Portal Vein Embolizations for Hypertrophy of the Future Liver Remnant

2000 ◽  
Author(s):  
Keyword(s):  
Portal Vein ◽  
Hepatic Vein ◽  
Future Liver Remnant ◽  
Liver Remnant ◽  
The Future

Rescue partial ALPPS for left hemihepatectomy with reconstruction of the middle hepatic vein

2021 ◽  
Author(s):  
Masaharu Kogure ◽  
Takaaki Arai ◽  
Hirokazu Momose ◽  
Ryota Matsuki ◽  
Yutaka Suzuki ◽  
...  
Keyword(s):  
Portal Vein ◽  
Hepatic Vein ◽  
Retention Rate ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Middle Hepatic Vein ◽  
Liver Remnant ◽  
Total Liver Volume ◽  
Left Hemihepatectomy ◽  
Icg R15

Major hepatectomy in patients with insufficient future liver remnant (FLR) volume and impaired liver functional reserve has considerable risks for posthepatectomy liver failure (PHLF). The patient was a male in his 70 with an intrahepatic cholangiocarcinoma (ICC) in left hemiliver, involving the middle hepatic vein (MHV). Although FLR volume after left hemihepatectomy was estimated to be 64.4% of the total liver volume, an indocyanine green retention rate at 15 min (ICG-R15) value was 24.2%, thus the patient underwent left portal vein embolization (PVE). The FLR volume increased to 71.3%, however, the non-congestive FLR volume was re-estimated as 45.8% after resection of the MHV, the ICG-R15 value was 29.0%, and ICG-Krem was calculated as 0.037. We performed partial rescue ALPPS (Associating Liver Partition and Portal vein occlusion for Staged hepatectomy) for left hemihepatectomy with the MHV reconstruction. On the first stage, partial liver partition was done along Rex-Cantlie’s line, preserving the MHV and sacrificing the remaining branches to segment 8. The FLR volume increased to 77.4% on day 14. The ICG-R15 value was 29.6%, but ICG-Krem after MHV reconstruction was estimated to be 0.059. The second stage operation on day 21 was left hemihepatectomy with the MHV reconstruction using the left superficial femoral vein graft. The usage of rescue partial ALPPS may contribute to preventing PHLF by introducing occlusion of the portal and/or venous branches in the left hemiliver before curative hepatectomy.

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

2020 ◽  
Vol 14 (2) ◽  
pp. 320-328
Author(s):  
Wouter J.M. Derksen ◽  
Iris E.M. de Jong ◽  
Carlijn I. Buis ◽  
Koen M.E.M. Reyntjens ◽  
G. Matthijs Kater ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Portal Vein Embolization ◽  
Liver Surgery ◽  
Umbilical Vein ◽  
Future Liver Remnant ◽  
Main Stem ◽  
Liver Remnant ◽  
Vein Thrombosis ◽  
The Future

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.

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

2016 ◽  
Vol 39 (10) ◽  
pp. 1514-1518 ◽  
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

scholarly journals Combined simultaneous embolization of the portal vein and hepatic vein (double vein embolization) – a technical note about embolization sequence

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Arash Najafi ◽  
Erik Schadde ◽  
Christoph A. Binkert
Keyword(s):  
Portal Vein ◽  
Hepatic Vein ◽  
Future Liver Remnant ◽  
Technical Note ◽  
Hepatic Veins ◽  
Liver Remnant ◽  
Clinical Complications ◽  
First Case ◽  
Increased Risk ◽  
Reduced Flow

Abstract Background Simultaneous portal vein embolization (PVE) and hepatic vein embolization (HVE) has been shown to be feasible, safe and lead to a faster growth of future liver remnant (FLR) than PVE alone. The objective of this study is to highlight different technical aspects as well as importance of embolization order. Materials and methods Seven patients were treated with simultaneous PVE and HVE. In three cases, HVE was performed first followed by PVE and in four cases the other way around. Portal vein branches were embolized using Glubran-Lipiodol mixture in all cases. Hepatic veins were embolized using Amplatzer II plugs sized 8–20 mm. Specific consideration was given to depth of glue penetration in the portal vein defined by visible branch order on the treated side. Results Six of seven patients were discharged home the same day. One patient with infected tumor necrosis died of liver failure 40 days later, otherwise there were no periprocedural clinical complications. Median glue penetration was to the 5th order (4th – 5th) when PVE was performed first and 3rd order (2nd - 4th) when PVE was performed after HVE. In one PVE first case, glue spillage was seen due to marked reduced flow in the right portal vein. There was sufficient FLR growth for subsequent surgical resection in the remaining six patients. Conclusion PVE should be performed prior to HVE because the reduced flow in the portal vein after HVE leads to less deep glue penetration with presumably increased risk of contralateral spillage.

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