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Digestive Disease Interventions 2023; 07(02): 118-127
DOI: 10.1055/s-0043-1762566
Review Article

Portal Vein Embolization: Indications, Outcomes, and Complications

Chandler Fountain 
1   Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, Unversity of Virginia Health System, Charlottesville, Virginia
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Abstract

Portal vein embolization (PVE) is performed with the goal of causing hypertrophy of the future liver remnant (FLR) in patients prior to partial liver resections for either hepatocellular carcinoma or metastatic liver tumors. Since its earliest description in 1984, PVE has evolved technically and has proven to be a safe and effective means of causing predictable FLR hypertrophy. PVE allows patients who would have otherwise not been candidates to proceed with safe hepatic resection, particularly extended hepatic resections. Despite advances in equipment and techniques, complications do occur with PVE. This article discusses the indications, outcomes, and complications of PVE while providing historical perspective and technical insights.

Keywords

portal vein embolization - hepatocellular carcinoma - interventional radiology


Publication History

Received: 31 December 2022

Accepted: 11 January 2023

Article published online:
13 February 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Makuuchi M, Takayasu K, Takuma T. et al. Preoperative transcatheter embolization of the portal venous branch for patients receiving extended lobectomy due to the bile duct carcinoma. J Jpn Pract Surg Soc 1984; 45 (12) 1558-1564
    PubMedGoogle Scholar
  • 2 Kinoshita H, Sakai K, Hirohashi K, Igawa S, Yamasaki O, Kubo S. Preoperative portal vein embolization for hepatocellular carcinoma. World J Surg 1986; 10 (05) 803-808
    CrossrefPubMedGoogle Scholar
  • 3 Honjo I, Suzuki T, Ozawa K, Takasan H, Kitamura O, Ishikawa T. Ligation of a branch of the portal vein for carcinoma of the liver. Am J Surg 1975; 130 (03) 296-302
    CrossrefPubMedGoogle Scholar
  • 4 Honjo I, Kozaka S. Extensive resection of the liver in two stages. Rev Int Hepatol 1965; 15: 309-319
    PubMedGoogle Scholar
  • 5 Makuuchi M, Thai BL, Takayasu K. et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 1990; 107 (05) 521-527
    PubMedGoogle Scholar
  • 6 Guglielmi A, Ruzzenente A, Conci S, Valdegamberi A, Iacono C. How much remnant is enough in liver resection?. Dig Surg 2012; 29 (01) 6-17
    CrossrefPubMedGoogle Scholar
  • 7 Abdalla EK, Barnett CC, Doherty D, Curley SA, Vauthey JN. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg 2002; 137 (06) 675-680 , discussion 680–681
    CrossrefPubMedGoogle Scholar
  • 8 Madoff DC, Abdalla EK, Vauthey JN. Portal vein embolization in preparation for major hepatic resection: evolution of a new standard of care. J Vasc Interv Radiol 2005; 16 (06) 779-790
    CrossrefPubMedGoogle Scholar
  • 9 Harada H, Imamura H, Miyagawa S, Kawasaki S. Fate of the human liver after hemihepatic portal vein embolization: cell kinetic and morphometric study. Hepatology 1997; 26 (05) 1162-1170
    PubMedGoogle Scholar
  • 10 Duncan JR, Hicks ME, Cai SR, Brunt EM, Ponder KP. Embolization of portal vein branches induces hepatocyte replication in swine: a potential step in hepatic gene therapy. Radiology 1999; 210 (02) 467-477
    CrossrefPubMedGoogle Scholar
  • 11 Beppu T, Yamamura K, Okabe H, Imai K, Hayashi H. Oncological benefits of portal vein embolization for patients with hepatocellular carcinoma. Ann Gastroenterol Surg 2020; 5 (03) 287-295
    CrossrefPubMedGoogle Scholar
  • 12 Yasuda A, Kurokawa T, Nakao N. et al. Necrosis of large hepatocellular carcinoma induced by preoperative portal vein embolization: a case report. Dig Dis Sci 2013; 58 (09) 2729-2732
    CrossrefPubMedGoogle Scholar
  • 13 Suzuki M, Maeyama S, Okuse N. et al. A case of complete necrosis of well-differentiated early hepatocellular carcinoma by percutaneous transhepatic portal embolization. Hepatol Res 2002; 22 (01) 74-82
    CrossrefPubMedGoogle Scholar
  • 14 Kokudo N, Tada K, Seki M. et al. Proliferative activity of intrahepatic colorectal metastases after preoperative hemihepatic portal vein embolization. Hepatology 2001; 34 (02) 267-272
    CrossrefPubMedGoogle Scholar
  • 15 Hayashi S, Baba Y, Ueno K. et al. Acceleration of primary liver tumor growth rate in embolized hepatic lobe after portal vein embolization. Acta Radiol 2007; 48 (07) 721-727
    CrossrefPubMedGoogle Scholar
  • 16 Pamecha V, Levene A, Grillo F, Woodward N, Dhillon A, Davidson BR. Effect of portal vein embolisation on the growth rate of colorectal liver metastases. Br J Cancer 2009; 100 (04) 617-622
    CrossrefPubMedGoogle Scholar
  • 17 Golfieri R, Cappelli A, Cucchetti A. et al. Efficacy of selective transarterial chemoembolization in inducing tumor necrosis in small (<5 cm) hepatocellular carcinomas. Hepatology 2011; 53 (05) 1580-1589
    CrossrefPubMedGoogle Scholar
  • 18 Makary MS, Khandpur U, Cloyd JM, Mumtaz K, Dowell JD. Locoregional therapy approaches for hepatocellular carcinoma: recent advances and management strategies. Cancers (Basel) 2020; 12 (07) 1914
    CrossrefPubMedGoogle Scholar
  • 19 Taub R. Liver regeneration: from myth to mechanism. Nat Rev Mol Cell Biol 2004; 5 (10) 836-847
    CrossrefPubMedGoogle Scholar
  • 20 Yokoyama Y, Nagino M, Nimura Y. Mechanisms of hepatic regeneration following portal vein embolization and partial hepatectomy: a review. World J Surg 2007; 31 (02) 367-374
    CrossrefPubMedGoogle Scholar
  • 21 Schweizer W, Duda P, Tanner S. et al. Experimental atrophy/hypertrophy complex (AHC) of the liver: portal vein, but not bile duct obstruction, is the main driving force for the development of AHC in the rat. J Hepatol 1995; 23 (01) 71-78
    CrossrefPubMedGoogle Scholar
  • 22 Iwao Y, Ojima H, Kobayashi T. et al. Liver atrophy after percutaneous transhepatic portal embolization occurs in two histological phases: hepatocellular atrophy followed by apoptosis. World J Hepatol 2017; 9 (32) 1227-1238
    CrossrefPubMedGoogle Scholar
  • 23 de Baere T, Denys A, Paradis V. Comparison of four embolic materials for portal vein embolization: experimental study in pigs. Eur Radiol 2009; 19 (06) 1435-1442
    CrossrefPubMedGoogle Scholar
  • 24 Tanaka H, Hirohashi K, Kubo S. et al. Influence of histological inflammatory activity on regenerative capacity of liver after percutaneous transhepatic portal vein embolization. J Gastroenterol 1999; 34 (01) 100-104
    CrossrefPubMedGoogle Scholar
  • 25 Luz JHM, Gomes FV, Coimbra E, Costa NV, Bilhim T. Preoperative portal vein embolization in hepatic surgery: a review about the embolic materials and their effects on liver regeneration and outcome. Radiol Res Pract 2020; 2020: 9295852
    PubMedGoogle Scholar
  • 26 Strasberg SM, Belghiti J, Clavien PA. et al. The Brisbane 2000 terminology of liver anatomy and resections. HPB (Oxford) 2000; 2 (03) 333-339
    CrossrefPubMedGoogle Scholar
  • 27 Truant S, El Amrani M, Skrzypczyk C. et al. Factors associated with fatal liver failure after extended hepatectomy. HPB (Oxford) 2017; 19 (08) 682-687
    CrossrefPubMedGoogle Scholar
  • 28 Jarnagin WR, Gonen M, Fong Y. et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 2002; 236 (04) 397-406 , discussion 406–407
    CrossrefPubMedGoogle Scholar
  • 29 May BJ, Madoff DC. Portal vein embolization: rationale, technique, and current application. Semin Intervent Radiol 2012; 29 (02) 81-89
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Vauthey JN, Chaoui A, Do KA. et al. Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations. Surgery 2000; 127 (05) 512-519
    CrossrefPubMedGoogle Scholar
  • 31 Urata K, Kawasaki S, Matsunami H. et al. Calculation of child and adult standard liver volume for liver transplantation. Hepatology 1995; 21 (05) 1317-1321
    CrossrefPubMedGoogle Scholar
  • 32 Vauthey JN, Abdalla EK, Doherty DA. et al. Body surface area and body weight predict total liver volume in Western adults. Liver Transpl 2002; 8 (03) 233-240
    CrossrefPubMedGoogle Scholar
  • 33 Kishi Y, Abdalla EK, Chun YS. et al. Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry. Ann Surg 2009; 250 (04) 540-548
    CrossrefPubMedGoogle Scholar
  • 34 Ribero D, Chun YS, Vauthey JN. Standardized liver volumetry for portal vein embolization. Semin Intervent Radiol 2008; 25 (02) 104-109
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Cucchetti A, Ercolani G, Vivarelli M. et al. Is portal hypertension a contraindication to hepatic resection?. Ann Surg 2009; 250 (06) 922-928
    CrossrefPubMedGoogle Scholar
  • 36 Madoff DC, Hicks ME, Vauthey JN. et al. Transhepatic portal vein embolization: anatomy, indications, and technical considerations. Radiographics 2002; 22 (05) 1063-1076
    CrossrefPubMedGoogle Scholar
  • 37 Denys A, Madoff DC, Doenz F. et al. Indications for and limitations of portal vein embolization before major hepatic resection for hepatobiliary malignancy. Surg Oncol Clin N Am 2002; 11 (04) 955-968
    CrossrefPubMedGoogle Scholar
  • 38 Nagino M, Nimura Y, Kamiya J, Kondo S, Kanai M. Selective percutaneous transhepatic embolization of the portal vein in preparation for extensive liver resection: the ipsilateral approach. Radiology 1996; 200 (02) 559-563
    CrossrefPubMedGoogle Scholar
  • 39 Madoff DC, Hicks ME, Abdalla EK, Morris JS, Vauthey JN. Portal vein embolization with polyvinyl alcohol particles and coils in preparation for major liver resection for hepatobiliary malignancy: safety and effectiveness – study in 26 patients. Radiology 2003; 227 (01) 251-260
    CrossrefPubMedGoogle Scholar
  • 40 May BJ, Madoff DC. Controversies of preoperative portal vein embolization. Hepat Oncol 2016; 3 (02) 155-166
    CrossrefPubMedGoogle Scholar
  • 41 Kodama Y, Shimizu T, Endo H, Miyamoto N, Miyasaka K. Complications of percutaneous transhepatic portal vein embolization. J Vasc Interv Radiol 2002; 13 (12) 1233-1237
    CrossrefPubMedGoogle Scholar
  • 42 Sarwar A, Brook OR, Weinstein JL, Khwaja K, Ahmed M. Trans-splenic portal vein embolization: a technique to avoid damage to the future liver remnant. Cardiovasc Intervent Radiol 2016; 39 (10) 1514-1518
    CrossrefPubMedGoogle Scholar
  • 43 Ko HK, Ko GY, Sung KB, Gwon DI, Yoon HK. Portal vein embolization via percutaneous transsplenic access prior to major hepatectomy for patients with insufficient future liver remnant. J Vasc Interv Radiol 2016; 27 (07) 981-986
    CrossrefPubMedGoogle Scholar
  • 44 Nagino M, Kamiya J, Kanai M. et al. Right trisegment portal vein embolization for biliary tract carcinoma: technique and clinical utility. Surgery 2000; 127 (02) 155-160
    CrossrefPubMedGoogle Scholar
  • 45 Kishi Y, Madoff DC, Abdalla EK. et al. Is embolization of segment 4 portal veins before extended right hepatectomy justified?. Surgery 2008; 144 (05) 744-751
    CrossrefPubMedGoogle Scholar
  • 46 Avritscher R, de Baere T, Murthy R, Deschamps F, Madoff DC. Percutaneous transhepatic portal vein embolization: rationale, technique, and outcomes. Semin Intervent Radiol 2008; 25 (02) 132-145
    Article in Thieme ConnectPubMedGoogle Scholar
  • 47 Geisel D, Malinowski M, Powerski MJ. et al. Improved hypertrophy of future remnant liver after portal vein embolization with plugs, coils and particles. Cardiovasc Intervent Radiol 2014; 37 (05) 1251-1258
    CrossrefPubMedGoogle Scholar
  • 48 Madoff DC, Abdalla EK, Gupta S. et al. Transhepatic ipsilateral right portal vein embolization extended to segment IV: improving hypertrophy and resection outcomes with spherical particles and coils. J Vasc Interv Radiol 2005; 16 (2, Pt 1): 215-225
    CrossrefPubMedGoogle Scholar
  • 49 Sakuhara Y, Abo D, Hasegawa Y. et al. Preoperative percutaneous transhepatic portal vein embolization with ethanol injection. AJR Am J Roentgenol 2012; 198 (04) 914-922
    CrossrefPubMedGoogle Scholar
  • 50 Guiu B, Bize P, Gunthern D, Demartines N, Halkic N, Denys A. Portal vein embolization before right hepatectomy: improved results using n-butyl-cyanoacrylate compared to microparticles plus coils. Cardiovasc Intervent Radiol 2013; 36 (05) 1306-1312
    CrossrefPubMedGoogle Scholar
  • 51 van Lienden KP, van den Esschert JW, de Graaf W. et al. Portal vein embolization before liver resection: a systematic review. Cardiovasc Intervent Radiol 2013; 36 (01) 25-34
    CrossrefPubMedGoogle Scholar
  • 52 Jaberi A, Toor SS, Rajan DK. et al. Comparison of clinical outcomes following glue versus polyvinyl alcohol portal vein embolization for hypertrophy of the future liver remnant prior to right hepatectomy. J Vasc Interv Radiol 2016; 27 (12) 1897-1905.e1
    CrossrefPubMedGoogle Scholar
  • 53 Ali A, Ahle M, Björnsson B, Sandström P. Portal vein embolization with N-butyl cyanoacrylate glue is superior to other materials: a systematic review and meta-analysis. Eur Radiol 2021; 31 (08) 5464-5478
    CrossrefPubMedGoogle Scholar
  • 54 Ganeshan DM, Szklaruk J. Portal vein embolization: cross-sectional imaging of normal features and complications. AJR Am J Roentgenol 2012; 199 (06) 1275-1282
    CrossrefPubMedGoogle Scholar
  • 55 Yokoyama Y, Ebata T, Igami T, Sugawara G, Mizuno T, Nagino M. The adverse effects of preoperative cholangitis on the outcome of portal vein embolization and subsequent major hepatectomies. Surgery 2014; 156 (05) 1190-1196
    CrossrefPubMedGoogle Scholar
  • 56 Di Stefano DR, de Baere T, Denys A. et al. Preoperative percutaneous portal vein embolization: evaluation of adverse events in 188 patients. Radiology 2005; 234 (02) 625-630
    CrossrefPubMedGoogle Scholar
  • 57 Yeom YK, Shin JH. Complications of portal vein embolization: evaluation on cross-sectional imaging. Korean J Radiol 2015; 16 (05) 1079-1085
    CrossrefPubMedGoogle Scholar
  • 58 Holbert BL, Baron RL, Dodd III GD. Hepatic infarction caused by arterial insufficiency: spectrum and evolution of CT findings. AJR Am J Roentgenol 1996; 166 (04) 815-820
    CrossrefPubMedGoogle Scholar
  • 59 Huang JY, Yang WZ, Li JJ, Jiang N, Zheng QB. Portal vein embolization induces compensatory hypertrophy of remnant liver. World J Gastroenterol 2006; 12 (03) 408-414
    CrossrefPubMedGoogle Scholar
  • 60 Shinkawa H, Takemura S, Tanaka S, Kubo S. Portal vein embolization: history and current indications. Visc Med 2017; 33 (06) 414-417
    CrossrefPubMedGoogle Scholar
  • 61 Alvarez FA, Castaing D, Figueroa R. et al. Natural history of portal vein embolization before liver resection: a 23-year analysis of intention-to-treat results. Surgery 2018; 163 (06) 1257-1263
    CrossrefPubMedGoogle Scholar