Use of an absorbable embolization material for reversible portal vein embolization in an experimental model

Abstract

Fibrin glue combined with 500 kunits/ml aprotinin resulted in reversible PVE in 80 per cent of animals, with a hypertrophy response comparable to that achieved with permanent embolization material. Surgical relevance Portal vein embolization (PVE) is used to increase future remnant liver volume in patients scheduled for major liver resection who have insufficient future remnant liver size to perform a safe resection. The current standard is PVE with permanent embolization materials, which renders patients found to have unresectable disease prone to complications owing to the permanently deportalized liver segments. Absorbable embolization might prevent the PVE-associated morbidity and lower the threshold for its application. In this study, PVE using fibrin glue and aprotinin resulted in an adequate hypertrophy response with 80 per cent recanalization after 42 days. Considering the minor histological changes following recanalization of embolized segments and potentially preserved function, reversible PVE might also be applied in living donor liver transplantation.

Functional shift with maintained regenerative potential following portal vein ligation

“…However, the utilisation of absorbable embolization materials led to the discovery of reversible PVO. The reversibility of occlusion and subsequent macroscopic changes have been reported 23 , 24 . Our findings significantly add to the cellular background by testifying that in idealised circumstances (cultures), hepatocytes residing in the atrophic LL are not only capable of forming viable cultures, but also express hepatocyte-specific transporters, whose functionality is demonstrated by in vitro organic anion transport.…”

Increased Hepatic Microvascular Density, Oxygenation, and VEGF in the Hypertrophic Lobe following Portal Vein Embolization in Rabbits

“…The rabbit model is unique in that it allows monitoring of microcirculatory changes in a separately regenerating, nonembolized lobe after PVE. Functional and volumetric enhancement of the nonembolized lobe in a rabbit model of PVE was found to be comparable with the hypertrophy response in humans after PVE [13,14].…”

“…Previous studies have shown that the rabbit is a suitable animal for selective PVE, as the cranial lobes are anatomically separated from the caudal lobe and can be easily distinguished [13,14,21,22]. The rabbits were divided into 2 groups (n = 6 rabbits per group) in which the cranial liver lobes underwent permanent (P-PVE) or reversible PVE (R-PVE).…”

Liver related complications in unresectable disease after portal vein embolization

“…van den Esschert et al (11) compared the hypertrophy response after PVE in rabbits using two absorbable embolization materials. A recent study published by Olthof et al (12) found an adequate hypertrophy response using a combination of fibrin glue and aprotinin as embolization material showing 80% recanalization after 42 days in a rabbit model of PVE. The use of absorbable embolization materials therefore seems a promising approach in preventing the long-term complications of permanent embolization.…”