Portal Vein Embolization with Ethylene Vinyl Alcohol Copolymer for Contralateral Lobe Hypertrophy before Liver Resection: Safety, Feasibility, and Initial Experience

Objectives: To report the preliminary experience with preoperative portal vein embolization (PVE) using ethylene vinyl alcohol (EVOH) copolymer liquid embolic agent. Methods: Patients with right-sided liver malignancies scheduled for extensive surgery and receiving induction of liver hypertrophy via right PVE with EVOH copolymer as the only embolic agent between 2014 and 2018 in two academic centers were retrospectively evaluated. Liver segments S2/3 were used to assess hypertrophy. Technical success rate, percentage of future liver remnant (FLR) increase, degree of hypertrophy of FLR, kinetic growth rate (KGR), complications, and resection rate were assessed. Degree of hypertrophy of the FLR and KGR were assessed by computed tomography (CT) volumetry performed before and 3–6 weeks after PVE. Results: Twenty-six patients (male, 17; mean age, 58.7 years, range 32–79) submitted to PVE with EVOH copolymer before major right hepatectomy for primary or secondary hepatic malignancies were retrospectively analyzed. Ten patients presented an underlying hepatopathy. Technical success was achieved in 100%. All targeted portal branches were successfully embolized. There were no cases with nontarget embolization by EVOH. The percentage of FLR increase was 52.9% ± 32.5%. The degree of hypertrophy of the FLR was 16.7% ± 6.8%. The KGR was 4.4% ± 2.0% per week. PVE produced adequate FLR hypertrophy in all patients. The resection rate was 84.5%. Four minor complications following PVE (2 low-grade fever and 2 abdominal discomforts) were reported, successfully managed with symptomatic treatment. One death during surgery time occurred, unrelated to PVE. Conclusion: Preoperative PVE with EVOH copolymer is feasible, safe, and effective to induce hypertrophy of the FLR. EVOH copolymer could be another embolic option for PVE.

 

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Artikel online veröffentlicht:
26. April 2021