Intrahepatic hemodynamic changes following portal vein embolization: a prospective Doppler study

The aim of this study was to describe the intrahepatic hemodynamic modifica tions induced by right portal vein embolization (RPVE) using Doppler ultras ound. Eighteen patients with hepatocellular carcinoma (n = 8), liver metast ases (n = 9), or multiple adenomas, underwent RPVE 1 month before right hep atectomy in order to increase the size of future remnant liver. Doppler ult rasound was performed before and 1 month after RPVE. The portal vein flow a nd the hepatic artery resistive index in right and left lobes (segments V a nd III) were calculated,We recorded simultaneously artery and portal vein o f segment III to measure the arterioportal ratio calculated as follows: (ma ximal arterial systolic velocity minus maximal portal vein velocity)/maxima l arterial systolic velocity. Results were compared in cirhotic patients (g roup A) and in healthy liver patients (group B). In both groups, porta] flo w was not significantly modified following RPVE. In the left lobe, in both groups the hepatic artery resistive index was not significantly modified. I n group B, the arterioportal ratio decreased significantly (0.71 +/- 0.18 a nd 0.42 +/- 0.23, respectively, before and after embolization; p < 0.01), w hereas it was not statistically modified in group A (0.75 +/- 0.17 and 0.69 +/- 0.14, respectively, before and after embolization). The right hepatic arterial resistive index decreased significantly both groups after emboliza tion (0.74 +/- 0.07 to 0.66 +/- 0.07, p < 0.05; and 0.66 +/- 0.07 to 0.61 /- 0.06, p < 0.05, respectively before and after VE for groups A and B). To tal portal flow was changed after RPVE (750 +/- 337 ml/mn and 696 +/- 231ml /mn, respectively, before and after RPVE). The hepatic artery resistive ind ex was unchanged before and after embolization in the left probe (0.75 +/- 0.13 and 0.74 +/- 0.14, respectively), but significantly decreased in the r ight lobe (0.7 +/- 0.08 and 0.62 +/- 0.06 respectively, p , 0.05). The left arterioportal ratio decreased significantly from 0.76 +/- 0.17 to 0.52 +/- 0.23 after PVE, p < 0.02). Our confirms that right portal occlusion induce s a ase in hepatic artery resistive index in the right and does not modify total portal flow. The left and right lobes of the liver have separate arte rioportal regulation.