A single-centred retrospective review of the effectiveness of percutaneous transhepatic portal vein embolisation (PVE) in hypertrophy of the future remnant liver (FRL).

Abstract

Purpose: To determine the time course, degree of liver hypertrophy, complication rate, and difference in embolic agent used for PVE. Methods and Materials: A retrospective analysis of prospectively collected data on all patients undergoing PVE was performed including demographic data, indication, technique, liver volumetry on CT pre-and post-PVE, and complication of the procedure. Result(s): There were 36 patients who underwent PVE between 2009 to 2021 prior to planned liver resection. Eleven patients were excluded from the study due to incomplete data, with remaining 25 patients of which there were 12 female and 13 male, with an average age of 59 (range from 29 to 74). Embolisation was performed using either polyvinyl alcohol particles (PVA) and coils in 17 patients or histoacryl glue, lipiodol in 8 patients. The clinical indications for PVE were for planned resection of colorectal metastases in 17 patients, cholangiocarcinoma in 6 patients, gallbladder carcinoma in 1 patient, and neuroendocrine tumour liver metastases in 1 patient. A right PVE was performed in 16 of the cases, with additional embolisation in segments 4a and 4b in 6 patients, and segment 4b in 3 patients. No case of left PVE was performed. Post procedural CT volumetry was performed at an average of 29.9 days (range from 14 to 53 days) after the initial embolization. There was a 33% increase in the mean volume of the left lobe from 598.1 ml to 886.5 ml for patients underwent histoacryl glue/lipodol PVE. Whereas, in the patients who underwent PVE using PVA/coils, the mean increase was 22% from 561.1 ml to 719.8 ml. There was inadequate liver hypertrophy in 1 patient which required a second PVE to be performed with repeat liver volumetry. Another patient had spasm of the branches of portal vein during the procedure, requiring a repeat embolisation. The initial post PVE CT was performed at a mean of 30 days, followed by another 28.5 days. Of these two patients, the mean left lobe volume increased from 356.6 ml to 561.9 ml on the subsequent CT volumetry, with a 37% further increased in liver volume. Seventeen patients subsequently underwent liver resection, whereas 8 patients did not undergo planned surgery due to various reasons such as inadequate liver hypertrophy and disease progression. Conclusion(s): Right sided portal vein embolization was effective in inducing left lobe hypertrophy with a mean increase in volume of the left lobe of 26% over an average of 29.9 days.