Portal vein embolization

Portal vein embolization (PVE) is a preoperative procedure performed to increase the future liver remnant (FLR) before major hepatectomy. The procedure involves the occlusion of the portal vein branches supplying the part of the liver that is to be resected. This results in atrophy of the embolized liver segments and compensatory hypertrophy of the non-embolized segments, thereby increasing the size of the FLR.

Indications

PVE is indicated in patients who are planned for major hepatectomy but have an insufficient FLR. The procedure is also indicated in patients with hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) who are planned for major hepatectomy.

Procedure

The procedure is performed under local anesthesia and sedation. A needle is inserted into the portal vein under ultrasound guidance. A catheter is then advanced into the portal vein branches supplying the liver segments to be resected. An embolic agent is then injected to occlude these branches.

Complications

Complications of PVE include hemorrhage, infection, portal vein thrombosis, and liver failure.

Prognosis

The prognosis after PVE is generally good, with most patients experiencing significant hypertrophy of the non-embolized liver segments. This increases the safety of subsequent hepatectomy.

See also

• Hepatectomy
• Hepatocellular carcinoma
• Colorectal cancer