Portal Vein Embolization: Rationale, Techniques, and Outcomes to Maximize Remnant Liver Hypertrophy with a Focus on Contemporary Strategies

Abstract

Hepatectomy remains the gold standard for curative therapy for patients with limited primary or metastatic hepatic tumors as it offers the best survival rates. In recent years, the indication for partial hepatectomy has evolved away from what will be removed from the patient to the volume and function of the future liver remnant (FLR), i.e., what will remain. With this regard, liver regeneration strategies have become paramount in transforming patients who previously had poor prognoses into ones who, after major hepatic resection with negative margins, have had their risk of post-hepatectomy liver failure minimized. Preoperative portal vein embolization (PVE) via the purposeful occlusion of select portal vein branches to promote contralateral hepatic lobar hypertrophy has become the accepted standard for liver regeneration. Advances in embolic materials, selection of treatment approaches, and PVE with hepatic venous deprivation or concurrent transcatheter arterial embolization/radioembolization are all active areas of research. To date, the optimal combination of embolic material to maximize FLR growth is not yet known. Knowledge of hepatic segmentation and portal venous anatomy is essential before performing PVE. In addition, the indications for PVE, the methods for assessing hepatic lobar hypertrophy, and the possible complications of PVE need to be fully understood before undertaking the procedure. The goal of this article is to discuss the rationale, indications, techniques, and outcomes of PVE before major hepatectomy.

Metodologías de Medición de Volumetría Hepática

“…Entre ellas, surge un procedimiento llamado embolización de la vena porta, utilizado especialmente en pacientes con metástasis hepáticas. Consiste en la administración de material embólico de manera dirigida a venas portales intrahepáticas que presenten compromiso tumoral, redirigiendo el flujo sanguíneo y generando hipertrofia de hasta 40 % del volumen de los segmentos no comprometidos en respuesta (Charles et al, 2023;Calderon Novoa et al, 2023).…”

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“…Subsequently, elucidating the definition reveals that varicose veins are enlarged and twisted veins commonly observed in the legs [6]. Legs are the most frequent location for varicose veins, which are twisted, swollen veins that can cause pain and cosmetic issues [7], [8].…”

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“…Для профилактики развития пострезекционной печеночной недостаточности, или так называемого синдрома малой доли, применяют различные методы, направленные на гипертрофию FLR: портовенозную эмболизацию (ПВЭ), перевязку воротной вены (ПВВ), ALPPS, PRALPPS и др. [8][9][10][11][12]. Каждый из представленных методов имеет преимущества и очевидные недостатки, поэтому поиск наиболее эффективного и безопасного метода продолжается.…”