Portal vein embolization with n-butyl-cyanoacrylate before hepatectomy: a single-center retrospective analysis of 46 consecutive patients

Abstract

Background Preoperative portal vein embolization (PVE) is performed to induce hypertrophy of the future liver remnant enabling major liver resection in patients with various types of liver tumors. Purpose To evaluate safety and effectiveness of PVE with n-butyl-cyanoacrylate (NBCA). Material and Methods All consecutive patients referred to our hospital for PVE between July 2006 and July 2017 were retrospectively reviewed. Volumetry was performed on computed tomography images before and after PVE, segmenting the total liver volume and the future liver remnant (FLR), i.e. liver segments I–III. Results PVE was performed in 46 patients (18 women, 28 men; mean age = 61 years) using local anesthesia. The ipsilateral technique was used in 45 patients. Adverse events were rare. The mean FLR volume increase was 56%, the degree of hypertrophy was 9.7%, and the kinetic growth rate was 2.1%/week. The median ± SD period between PVE and liver surgery was 7 ± 3 weeks. Forty-two patients (91%) had surgery; liver resection was performed in 37 (80%) patients. Three patients (7%) developed transient liver failure after surgery. There was no 90-day post-PVE or postoperative mortality. Conclusion PVE using NBCA through the ipsilateral approach in local anesthesia is safe and effective in inducing hypertrophy of the future liver remnant enabling surgery, and thereby increasing survival in patients with liver tumors.

Volume and flow modulation strategies to mitigate post-hepatectomy liver failure

“…However, if segment 4 requires embolization this can be challenging from a contralateral approach. Embolization of segment 4 in addition to the right portal vein has shown increased hypertrophy and increased kinetic growth rate when compared to right PVE alone ( 10 , 11 ). As an alternative for the access to portal vein, trans-ileocecal approach is used occasionally.…”