Portal Vein Embolization with PVA and Coils before Major Hepatectomy: Single-Center Retrospective Analysis in Sixty-Four Patients

Abstract

Objectives Portal vein embolization (PVE) stimulates hypertrophy of the future liver remnant (FLR) and improves the safety of extended hepatectomy. This study evaluated the efficacy of PVE, performed with PVA and coils, in relation to its effect on FLR volume and ratio. Secondary endpoints were the assessment of PVE complications, accomplishment of liver surgery, and patient outcome after hepatectomy. Materials and Methods All patients who underwent PVE before planned major hepatectomy between 2013 and 2017 were retrospectively analyzed, comprising a total of 64 patients. Baseline patient clinical characteristics, imaging records, liver volumetric changes, complications, and outcomes were analyzed. Results There were 45 men and 19 women with a mean age of 64 years. Colorectal liver metastasis was the most frequent liver tumor. The majority of patients (n = 53) had a right PVE. FLR increased from a mean value of 484 ml ± 242 to 654 ml ± 287 (p < 0.001) after PVE. Two major complications were experienced after PVE: 1 case of left hepatic artery branch laceration and 1 case of hemoperitoneum and hemothorax. A total of 44 (69%) patients underwent liver surgery. Twenty-one patients were not taken to surgery due to disease progression (n = 18), liver insufficiency (n = 1), and insufficient FLR volume (n = 1), and one patient declined surgery (n = 1). Conclusions PVE with PVA and coils was accomplished safely and promoted a high FLR hypertrophy yield, enabling most of our patients to be submitted to the potentially curative treatment of liver tumor resection.

Portal vein embolization with ethylene-vinyl alcohol copolymer for contralateral lobe hypertrophy before liver resection: safety, feasibility and initial experience

“…In keeping with this finding, KGR values above 2% have been reported to correlate with favorable surgical outcomes, and the KGR of 4.4±2.0 per week in our study was thus well into the safety zone (28). Thus, EVOH, with a FLRV increase of 52.9% in our study, might be among the most effective agents for inducing liver hypertrophy as compared to the existing literature (Table 5) (37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55). One explanation could be the distal and inflammatory nature of EVOH embolization.…”

Preoperative Portal Vein Embolization for Liver Resection: An updated meta-analysis

“…PVA particles are easily available and provide persistent occlusion of portal branched with acceptable side effects. Hence, PVA is recommended to apply alone or with other materials in the majority of centers 44 , 45 . In general, large clinical studies comparing different embolization materials are still necessary to seek the optimal materials.…”

“…Author PVE indications Okabe [46] ICG≤10% and FLR<35% or 10%<ICG<20% and FLR<60% Yamashita [2] FLR≤40% Shindoh [6] FLR≤20% in patients with normal liver or FLR≤30% in patients with liver fibrosis Fischman [37] FLR≤20% in patients with normal liver or FLR≤30% in patients with history of chemotherapy or FLR≤40% in patients with liver fibrosis Luz [41] FLR≤25% in patients with normal liver or FLR≤40% in patients with liver fibrosis Alvarez [23] FLR≤30% in patients with normal liver or FLR≤40% in patients with liver fibrosis Marti [24] FLR≤40% Tsurusaki [32] NR Cotroneo [25] FLR≤25% Giraudo [33] FLR≤30% in patients with normal liver or FLR≤40% in patients with liver fibrosis Ribero [9] FLR≤20% in patients with normal liver or FLR≤30% in patients with history of chemotherapy or FLR≤40% in patients with liver fibrosis Kakizawa [42] NR Beal [48] NR Elias [16] FLR≤30% in patients with normal liver or FLR≤40% in patients with history of chemotherapy Madoff [36] FLR≤25% Jaberi [44] FLR<30% in patients with normal liver or FLR<40% in patients with history of chemotherapy Hemming [26] FLR≤25% in patients with normal liver or FLR≤40% in patients with liver fibrosis Sofue [43] ICG<15% and FLR<40% Geisel [38] FLR≤25% in patients with normal liver or FLR≤40% in patients with liver fibrosis Ratti [27] FLR<30% in patients with normal liver or FLR<40% in patients with history of chemotherapy Radeleff [39] FLR≤25% in patients with normal liver or FLR≤45% in patients with liver fibrosis Cazejust [40] FLR≤25% in patients with normal liver or FLR≤30% in patients with history of chemotherapy or FLR≤40% in patients with liver fibrosis Kuo [17] NR Camelo [45] NR Loveday [28] FLR≤40% Yamashita [29] ICG<10% and FLR≤40% or 10%<ICG≤20% and FLR<50% Abbreviation: PVE: portal vein embolization; ICG: indocyanine green; FLR: future liver remnant; NR: not reported. [23,24,41] Absolute ethanol [23,…”

“…All patients with complications received expectant treatment without affecting subsequent liver resection (Table 4). [16,17,23,25,27] 69 Fever [16,23,25,27,33,36,45] 81 Coil displacement [6,9,23,29,33,37,40,41] 42 Portal vein thrombosis [6,9,23,29,36,41,43,48] 30 Subcapsular hematoma [6,9,29,32,33,36,39] 14 Nausea and vomiting [33,44,45] 12 Hepatic abscess [23,43,44] 7 Subcapsular biloma [38,41] 5 Esophageal bleeding [6,9] 2 Liver failure [23] 4 Hemoperitoneum [33,45] 2 Portal hypertension [40]...…”

Portal vein embolization: rationale, techniques, outcomes and novel strategies

“…A combination of PVA (for distal embolization) and coils (for proximal embolization to prevent venous inflow) is widely used. Camelo et al reported an increased FLR volume of 40%, and an increased FLR/TLV ratio of 11%, p < 0.001) [ 33 ].…”