PORTAL-VEIN EMBOLIZATION - UTILITY FOR INDUCING LEFT HEPATIC LOBE HYPERTROPHY BEFORE SURGERY

Right portal vein embolization (PVE) was performed in patients in need of wide hepatectomy to induce preoperative hypertrophy of the future remnant liver (FRL), which would have been insufficient for safe resec tion. PVE was achieved with cyanoacrylat or gelatin sponges by using a percutaneous subxiphoid approach in 10 patients with tumors in noncir rhotic liver. Surgery was performed in nine patients 17-48 days (mean, 34 days) after PVE. Computed tomographic liver volumetric studies wer e performed before embolization and before surgery. Clinical and biolo gic tolerance of PVE was excellent except in one case. Histopathologic studies showed occlusion of portal veins with minimal parenchymal isc hemia in eight of nine patients. The FRL volume increased by 64%, whic h represented 31% of the preresection volume of the liver. Better hype rtrophy was seen after cyanoacrylat embolization. The authors conclude that PVE is safe and well tolerated and induces marked hypertrophy of the unembolized parenchyma in noncirrhotic patients. This hypertrophy allows hepatectomy to be performed under safe conditions when the FRL volume is initially insufficient.