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Portal Vein Embolization for Liver Resection

Preoperative interventional embolization to induce contralateral liver hypertrophy and enable major hepatectomy.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Portal Vein Embolization for Liver Resection?

Portal vein embolization (PVE) is an image-guided interventional radiology procedure used preoperatively to redirect portal blood flow toward the future liver remnant (FLR), inducing compensatory hypertrophy. It is indicated when the FLR is insufficient (<25-40% depending on liver function) to permit safe major hepatectomy.

The procedure is performed by percutaneous transhepatic access to the portal vein and selective embolization with materials such as polyvinyl alcohol particles, microspheres, ethanol, glue or coils. Sequential portal vein and hepatic vein embolization (liver venous deprivation) and ALPPS are alternatives for accelerated hypertrophy.

Volumetric assessment with CT or MRI is performed approximately 4-6 weeks after PVE to confirm adequate hypertrophy. Contraindications include severe portal hypertension, biliary obstruction in the embolized lobe and tumor in the FLR. Complications are rare but include thrombosis, infection and abscess.

Symptoms

Hepatocellular carcinoma needing major resection
Colorectal liver metastases
Cholangiocarcinoma requiring hepatectomy
Insufficient future liver remnant
Borderline hepatic functional reserve
Need for parenchyma-sparing surgery
Bilobar disease with planned staged surgery

Risk Factors

Right hepatectomy or extended resection planned
Underlying chronic liver disease
Prior chemotherapy with hepatic toxicity
Steatosis or steatohepatitis
Cirrhosis
Borderline indocyanine green clearance
Cholestasis

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Planned major hepatectomy with insufficient FLR
  • Liver tumor amenable to surgical resection
  • Underlying liver disease requiring evaluation
  • Failed conventional preoperative optimization
  • Need for staged hepatectomy
  • Multidisciplinary tumor board referral

Treatment Methods

01
Percutaneous transhepatic PVE
02
Particle, glue or coil embolization
03
Sequential portal and hepatic vein embolization
04
ALPPS as alternative
05
Volumetric CT/MRI follow-up
06
Multidisciplinary tumor board
07
Major hepatectomy after hypertrophy

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.