Portal Vein Embolization: Predicting Outcomes and Comparing Techniques

Introduction: Portal vein embolization (PVE) is a well-established technique utilized prior to hepatic resection to redirect blood flow and induce hypertrophy of nonembolized sections, thereby increasing future liver remnant (FLR). Low standardized FLR (sFLR) is a strong predictor of increased postoperative complications; therefore, it is important to carefully assess candidates and attempt to accurately predict FLR hypertrophy. With numerous recent surgical advances, many patients who were previously considered ineligible are now undergoing partial hepatectomies, with increasing use of PVE to improve clinical outcomes. This exhibit will review the indications and factors to consider when assessing patient candidacy and predicting response, as well as evaluating the benefits of adjuvant therapies and comparison of different PVE techniques.

Content Organization:

1. Indications for PVE, and factors taken into consideration when evaluating patient (baseline liver function, liver volumetry, and planned surgery).

2. Calculation of FLR/sFLR volume and kinetic growth rate.

3. Proposed predictors of FLR hypertrophy after PVE.

4. Comparison of PVE techniques (i.e., percutaneous transhepatic versus trans-splenic approach, extent of embolization, efficacy of different embolic materials).

5. Adjunct therapies (i.e., systemic chemotherapy, stem cell transplantation, transarterial embolization).

6. Institutional experience with case presentation.

Learning Points: PVE is an important procedure with increasing clinical usage, which improves surgical outlook for many patients and provides the option for surgical treatment to many patients who would have previously been deemed ineligible. There are numerous factors to consider prior to performing PVE which can help predict clinical outcome, and understanding variations in technique and adjuvant therapies is crucial to optimize FLR hypertrophy.