Preoperative portal vein embolization using an amplatzer vascular plug

Abstract

The purpose was to evaluate the safety and efficacy of preoperative portal vein embolization (PVE) using an Amplatzer vascular plug (AVP). Forty-one patients who underwent PVE using gelatin sponge particles and the AVP were enrolled. The right portal branches were embolized using gelatin sponges (1-8 mm(3)) through a 5-F catheter, and the AVP was deployed at the first- or second-order right portal vein. Technical success and complications, recanalization, and changes of total estimated liver volumes (TELV), future liver remnant (FLR), and FLR/TELV were evaluated. Follow-up CT performed 6-43 days (median, 16 days) after PVE was used to evaluate volume parameters. PVE was technically successful in 40 of 41 patients. Major complications occurred in two patients, with one each having extensive portal vein thrombosis and liver abscess. Partial recanalization of the occluded portal vein was seen in one patient. The mean FLR volume (653 +/- 174 ml vs. 532 +/- 154 ml, p < 0.001) and mean FLR/TELV ratio (43 +/- 8% vs 36 +/- 7%, p < 0.001) were significantly higher after than before PVE. PVE using the AVP seems to be a relatively safe and effective technique for inducing hypertrophy of the FLR with minimal risk of recanalization.

Portal vein embolization with plug/coils improves hepatectomy outcome

“…Some major complications using plug or coils in the PVE setting like portal vein thrombosis or portovenous fistula have been described [32,35] but we did not observe any major complications in our series. There were no statistical differences regarding severe complication rates after PVE between study groups (Fig.…”

Factors influencing hypertrophy of the left lateral liver lobe after portal vein embolization

“…A variety of methods for occlusion of portal vein branches have been described, such as n-butyl cyanoacrylate [28], ethiodized oil and fibrin glue [31], ethanol [32], other microparticles (e.g. trisacryl gelatin [33]), vascular plugs [34] as well as coils [32]. However, latest studies tend to use polyvinyl alcohol particles combined with other embolization agents [35].…”

Gastric Varices and Hepatic Encephalopathy: Treatment with Vascular Plug and Gelatin Sponge–assisted Retrograde Transvenous Obliteration—A Primary Report

“…Moreover, balloon rupture during the BRTO procedure can result in symptomatic pulmonary embolism, treatment failure, and recurrent variceal bleeding (22). Vascular plugs (Amplatzer Vascular Plug; AGA Medical, Golden Valley, Minn) have been shown to be safe and effective for the treatment of various vascular diseases and for portal vein embolization (23)(24)(25)(26). Therefore, we anticipated that a combination of a vascular plug and gelatin sponges (Gelfoam; Upjohn, Kalamazoo, Mich) used without sclerosing agents would induce embolization of the gastrorenal shunt and subsequent obliteration of GV.…”