scholarly journals Induction of Robust Future Liver Remnant Hypertrophy Before Hepatectomy With a Modified Liver Venous Deprivation Technique Using a Trans-venous Access for Hepatic Vein Embolization

2021 ◽  
Vol 1 ◽  
Author(s):  
Nils Degrauwe ◽  
Rafael Duran ◽  
Emmanuel Melloul ◽  
Nermin Halkic ◽  
Nicolas Demartines ◽  
...  
Keyword(s):  
Hepatic Vein ◽  
Surgical Outcome ◽  
Primary Liver Cancer ◽  
Future Liver Remnant ◽  
Venous Access ◽  
Liver Remnant ◽  
Wide Range ◽  
Oncologic Patients ◽  
Flr Hypertrophy ◽  
Hepatic Vein Embolization

Purpose: Hepatic and/or portal vein embolization are performed before hepatectomy for patients with insufficient future liver remnant and usually achieved with a trans-hepatic approach. The aim of the present study is to describe a modified trans-venous liver venous deprivation technique (mLVD), avoiding the potential risks and limitations of a percutaneous approach to hepatic vein embolization, and to assess the safety, efficacy, and surgical outcome after mLVD.Materials and Methods: Retrospective single-center institutional review board-approved study. From March 2016 to June 2019, consecutive oncologic patients with combined portal and hepatic vein embolization were included. CT volumetric analysis was performed before and after mLVD to assess liver hypertrophy. Complications related to mLVD and surgical outcome were obtained from medical records.Results: Thirty patients (62.7 ± 14.5 years old, 20 men) with liver metastasis (60%) or primary liver cancer (40%) underwent mLVD. Twenty-one patients (70%) had hepatic vein anatomic variants. Technical success of mLVD was 100%. Four patients had complications (three minor and one major). FLR hypertrophy was 64.2% ± 51.3% (mean ± SD). Twenty-four patients (80%) underwent the planned hepatectomy and no surgery was canceled as a consequence of mLVD complications or insufficient hypertrophy. Fifty percent of patients (12/24) had no or mild complications after surgery (Clavien-Dindo 0–II), and 45.8% (11/24) had more serious complications (Clavien-Dindo III–IV). Thirty-day mortality was 4.2% (1/24).Conclusion: mLVD is an effective method to induce FLR hypertrophy. This technique is applicable in a wide range of oncologic situations and in patients with complex right liver vein anatomy.

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.

Future liver remnant portal or hepatic vein reconstruction at stage I of ALPPS—How far can we push the boundaries?

2019 ◽  
Author(s):  
Andrea Schlegel ◽  
Yuhki Sakuraoka ◽  
Marit Kalisvaart ◽  
Chris Coldham ◽  
John Isaac ◽  
...  
Keyword(s):  
Hepatic Vein ◽  
Future Liver Remnant ◽  
Stage I ◽  
Liver Remnant ◽  
Hepatic Vein Reconstruction

scholarly journals Partial Hepatectomy with Middle Hepatic Vein Reconstruction Using a Left Inferior Vena Cava Graft

2017 ◽  
Vol 11 (2) ◽  
pp. 320-328 ◽  
Author(s):  
Yusuke Kawamoto ◽  
Yusuke Ome ◽  
Kazuyuki Kawamoto
Keyword(s):  
Inferior Vena Cava ◽  
Partial Hepatectomy ◽  
Hepatic Vein ◽  
Inferior Vena ◽  
Vena Cava ◽  
Future Liver Remnant ◽  
Middle Hepatic Vein ◽  
Venous Graft ◽  
Liver Remnant ◽  
Hepatic Vein Reconstruction

Duplicated inferior vena cava (IVC) is a rare congenital anomaly. We describe the utility of a new graft from the left IVC in a patient with duplicated IVC for reconstructing the middle hepatic vein (MHV) after partial hepatectomy with MHV resection. A 67-year-old woman with hepatitis C was found to have a liver tumor. Magnetic resonance imaging confirmed that the tumor, which was attached to the MHV, was hepatocellular carcinoma. Central bisectionectomy (S4, S5, and S8 resection) could not be tolerated because of poor liver function and a low future liver remnant volume. Therefore, partial hepatectomy with MHV resection was performed. The left IVC was harvested as a venous graft and was substituted for the resected MHV. She recovered uneventfully and was discharged on postoperative day 12. To the best of our knowledge, this is the first report of using the left IVC as a venous graft. The left IVC is a good candidate graft for the MHV or for portal vein reconstruction because of its length, diameter, and easy harvesting (it did not require an extra incision) in a patient with duplicated IVC.

scholarly journals MINI-ALPPS achieves adequate future liver remnant (FLR) hypertrophy to allow safe two stage liver resection

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S941
Author(s):  
T. Duncan ◽  
S. Junnarkar ◽  
Z. Kaposztas ◽  
D. O'Reilly ◽  
J. Rees ◽  
...  
Keyword(s):  
Liver Resection ◽  
Future Liver Remnant ◽  
Two Stage ◽  
Liver Remnant ◽  
Flr Hypertrophy

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.

scholarly journals A Comparison of Portal Vein Embolization With Poly(2-hydroxyethylmethacrylate) and a Histoacryl/Lipiodol Mixture in Patients Scheduled for Extended Right Hepatectomy

2015 ◽  
pp. 841-848 ◽  
Author(s):  
J. H. PEREGRIN ◽  
R. JANOUŠEK ◽  
D. KAUTZNEROVÁ ◽  
M. OLIVERIUS ◽  
E. STICOVÁ ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Future Liver Remnant ◽  
Right Hepatectomy ◽  
Portal Vein Branch ◽  
Liver Remnant ◽  
Extended Right Hepatectomy ◽  
The Right ◽  
Transhepatic Access ◽  
Flr Hypertrophy

ght hepatectomy and whether it is as effective as the currently used agent (a histoacryl/lipiodol mixture). Two groups of nine patients each scheduled for extended right hepatectomy for primary or secondary hepatic tumor, had right portal vein embolization in an effort to induce future liver remnant (FLR) hypertrophy. One group had embolization with PHEMA, the other one with the histoacryl/lipiodol mixture. In all patients, embolization was performed using the right retrograde transhepatic access. Embolization was technically successful in all 18 patients, with no complication related to the embolization agent. Eight patients of either group developed FLR hypertrophy allowing extended right hepatectomy. Likewise, one patient in each group had recanalization of a portal vein branch. Histology showed that both embolization agents reach the periphery of portal vein branches, with PHEMA penetrating somewhat deeper into the periphery. PHEMA has been shown to be an agent suitable for embolization in the portal venous system comparable with existing embolization agent (histoacryl/lipiodol mixture).

scholarly journals Training, Implementation, and Safety Evaluation of Portal and Hepatic Vein Embolization (PVE/HVE) to Accelerate FLR Hypertrophy – First Worldwide DRAGON 1 Experience

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S740-S741
Author(s):  
R. Korenblik ◽  
B. Olij ◽  
M.H.A. Bemelmans ◽  
C. Binkert ◽  
C. van der Leij ◽  
...  
Keyword(s):  
Hepatic Vein ◽  
Safety Evaluation ◽  
Flr Hypertrophy ◽  
Hepatic Vein Embolization

Radiation Lobectomy: An Overview of Concept and Applications, Technical Considerations, Outcomes

2021 ◽  
Vol 38 (04) ◽  
pp. 419-424
Author(s):  
Pouya Entezari ◽  
Ahmed Gabr ◽  
Kristie Kennedy ◽  
Riad Salem ◽  
Robert J. Lewandowski
Keyword(s):  
Early Stage ◽  
Future Liver Remnant ◽  
High Dose ◽  
Hepatic Malignancy ◽  
Curative Intent ◽  
Liver Remnant ◽  
Y90 Radioembolization ◽  
Flr Hypertrophy ◽  
Hepatic Malignancies ◽  
Technical Considerations

AbstractSurgical resection has long been considered curative for patients with early-stage hepatocellular carcinoma (HCC). However, inadequate future liver remnant (FLR) renders many patients not amenable to surgery. Recently, lobar administration of yttrium-90 (Y90) radioembolization has been utilized to induce FLR hypertrophy while providing disease control, eventually facilitating resection in patients with hepatic malignancy. This has been termed “radiation lobectomy (RL).” The concept is evolving, with modified approaches combining RL and high-dose curative-intent radioembolization (radiation segmentectomy) to achieve tumor ablation. This article provides an overview of the concept and applications of RL, including technical considerations and outcomes in patients with hepatic malignancies.

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