Portal vein embolization: rationale, technique and future prospects

Background: Advances in surgery have reduced the mortality rate after major liver resection, but complications resulting from inadequate postresection hepatic size and function remain. Portal vein embolization (PVE) was propo sed to induce hypertrophy of the anticipated liver remnant in order to redu ce such complications. The techniques, measurement methods and indications for this treatment remain controversial. Methods: A Medline search was performed to identify papers reporting the us e of PVE before hepatic resection. Techniques, complications and results ar e reviewed. Results: Complications of PVE typically occur in less than 5 per cent of pa tients. No specific substance (cyanoacrylate, thrombin, coils or absolute a lcohol) emerged as superior. The increase in remnant liver volume averages 12 per cent of the total liver. The morbidity rate of resection after treat ment is less than 15 per cent and the mortality rate is 6-7 per cent with c irrhosis and 0-6.5 per cent without cirrhosis. Embolization is currently us ed for patients with a normal liver when the anticipated liver remnant volu me is 25 per cent or less of the total liver volume, and for patients with compromised liver function when the liver remnant volume is 40 per cent or less. Conclusion: This treatment does not increase the risks associated with majo r liver resection. It may be indicated in selected patients before major re section. Future prospective studies are needed to define more clearly the i ndications for this evolving technique.