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Semin intervent Radiol 2023; 40(02): 197-211
DOI: 10.1055/s-0043-1768610
How I Do It

Liver Venous Deprivation Using Amplatzer Vascular Plug–Assisted N-Butyl Cyanoacrylate Embolization of the Portal and Hepatic Veins: How Do I Do it?

Emily A. Knott
1   Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
,
Sasan Partovi
2   Section of Vascular and Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
,
Aaron McBride
2   Section of Vascular and Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
,
Abraham Levitin
2   Section of Vascular and Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
,
Sameer Gadani
2   Section of Vascular and Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
› Author Affiliations Funding None.
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Liver resection can be curative in a select group of patients with primary and secondary hepatobiliary malignancies.[1] For these patients, the size and function of the future liver remnant (FLR) must be carefully considered to limit the potential for posthepatectomy liver failure (PHLF), a predominant cause of mortality.[1] [2] [3] [4] Preoperative portal vein embolization (PVE) has been shown to increase the volume of the FLR, allowing more patients to become surgical candidates and improving postoperative outcomes.[1] [2] [5] [6] [7] PVE occludes the portal venous branches supplying the lobe of the liver to be resected and redirects blood flow toward the FLR, leading to compensatory hypertrophy.[2] [8]

There is a risk of disease progression in the time period between PVE and the growth of adequate FLR.[9] Only 60 to 86% of eligible patients eventually undergo resection, with cancellation primarily due to inadequate volume of the FLR and disease progression.[7] [10] [11] [12] [13] [14] This has led to considerable interest in techniques that accelerate hypertrophy of the FLR.[15] [16] [17] [18]

A new technique for achieving hypertrophy of the FLR has recently been proposed: liver venous deprivation (LVD), or concomitant embolization of both portal and hepatic veins.[18] [19] This method is thought to accelerate liver hypertrophy by increasing hepatocellular injury and preventing venous collateralization across the embolized and nonembolized lobes of the liver.[20] Various techniques (e.g., the use of different embolic agents), timelines (subsequent vs. simultaneous), and approaches (transhepatic vs. transjugular) have been proposed to achieve this goal.[17] [19] [21] [22] [23] The technique we use employs vascular plugs and N-butyl cyanoacrylate (NBCA) to simultaneously embolize the hepatic and portal veins (PVs) in a single setting.[18]

In this article, we discuss the anatomical considerations, indications/contraindications, and rationale for LVD. Detailed description of the LVD procedure with supplemental illustrations and images in this article will provide thorough review of this procedure for the physicians performing this procedure.



Publication History

Article published online:
16 June 2023

© 2023. Thieme. All rights reserved.

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