Portal Vein Embolization Using a Histoacryl/Lipiodol Mixture before Right Liver Resection

Abstract

Key Word sPortal vein embolization ؒ Histoacryl/Lipiodol mixture ؒ Liver lobe volume Abst ractPur pose: The purpose of this retrospective study was to evaluate the efficacy and safety of percutaneous transhepatic portal vein embolization (PVE) of the right liver lobe using Histoacryl/Lipiodol mixture to induce contralateral liver hypertrophy before right-sided (or extended rightsided) hepatectomy in patients with primarily unresectable liver tumors. Methods: Twenty-one patients (9 females and 12 males) underwent PVE due to an insufficient future liver remnant; 17 showed liver metastases and 4 suffered from biliary cancer. Imaging was performed prior to and 4 weeks after PVE. Surgery was scheduled for 1 week after a CT or MRI control. The primary study end point was technical success, defined as complete angiographical occlusion of the portal vein. The secondary study end point was evaluation of liver hypertrophy by CT and MRI volumetry and transfer to operability. Results: In all the patients, PVE could be performed with a Histoacryl/Lipiodol mixture (n = 20) or a Histoacryl/ Lipiodol mixture with microcoils (n = 1). No procedure-related complications occurred. The volume of the left liver lobe increased significantly (p < 0.0001) by 28% from a mean of 549 ml to 709 ml. Eighteen of twenty-one patients (85.7%) could be transferred to surgery, and the intended resection could be performed as planned in 13/18 (72.3%) patients. Conclusion: Preoperative right-sided PVE using a Histoacryl/ Lipiodol mixture is a safe technique and achieves a sufficient hypertrophy of the future liver remnant in the left liver lobe.

Portal Vein Embolization via Percutaneous Transsplenic Access prior to Major Hepatectomy for Patients with Insufficient Future Liver Remnant

“…Various permanent embolic materials, including coils, glue, absolute alcohol, or AVP, are frequently applied with or without small-particle embolic materials to prevent recanalization (20)(21)(22)(23)(24)(25)(26). In the present study, we performed PVE using a combination of gelatin sponge particles followed by glue, coils, or AVP.…”

Indications for portal vein embolization in perihilar cholangiocarcinoma

“…After critical evaluation of the remaining full‐text articles, 59 articles were included. Finally, we excluded 14 articles with insufficient data and included 45 publications in the analysis (Fig. ), which resulted in the consideration of a total of 3033 patients in the study.…”

“…). The PCCA group included 836 cases (perihilar cholangiocarcinoma in 597 patients, gallbladder cancer in 188 patients, and other hepatic tumors in 51 patients) , and the OHT group included 2197 patients (metastatic liver tumor in 1132 patients, hepatocellular carcinoma in 722 patients, and other hepatic tumors in 343 patients) . Mean ages were 64.2 years and 60.2 years in the PCCA and OHT groups, respectively, and the ratio of men to women was 506:330 and 1230:636 (data were not available in 331 cases of OHT), respectively.…”

Identification of cofactors influencing hypertrophy of the future liver remnant after portal vein embolization—the effect of collaterals on embolized liver volume

“…12,13 Recent work published by Geisel et al 40 shows that results using particles alone can be improved with a combination of particles plus coils and plugs. In the above mentioned systematic review, the use of n-butyl cyanoacrylate seems to have a greater effect on hypertrophy, but differences between the other analyzed embolization materials did not reach statistical significance.…”

“…Consequently, in recent literature, a residual volume, the "standardized FLR" (sFLR) of 25-30% has been described as the benchmark in patients with normal liver function 7 and volumes of at least 40% in patients with parenchymal liver disease. 8,9 Three methods to enlarge FLR are possible in this situation before ERH: (1) surgical right-sided portal vein ligation (PVL), 10,11 (2) portal vein embolization (PVE) as an interventional approach used by various centres [12][13][14] and (3) the surgical approach of "associating liver partition with PVL for staged hepatectomy". [15][16][17] However, as hypertrophy following PVE is necessary but highly variable, we retrospectively analyzed data from our patient cohort for differences in those with good hypertrophy (increase to .25% of the sFLR) and those with a less beneficial increase in size of sFLR.…”