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Review
. 2017 Dec;33(6):414-417.
doi: 10.1159/000479474. Epub 2017 Nov 22.

Portal Vein Embolization: History and Current Indications

Hiroji Shinkawa  1 , Shigekazu Takemura  1 , Shogo Tanaka  1 , Shoji Kubo  1
Affiliations
Review

Portal Vein Embolization: History and Current Indications

Hiroji Shinkawa et al. Visc Med. 2017 Dec.

Abstract

Portal vein embolization (PVE) was first adapted for patients undergoing major hepatectomy for hepatocellular carcinoma (HCC). In these patients, PVE caused hypertrophy of the unaffected liver and increased the volumetric ratio of future liver remnant (FLR) to total liver volume. 99mTechnetium-galactosyl human serum albumin (99mTc-GSA) scintigraphy revealed that PVE also induced a shift in hepatic function from the embolized part to the nonembolized part of the liver. Various hepatobiliary malignancies can be treated using PVE, and PVE is increasingly being used to expand the indication for major hepatectomy in patients with initially insufficient FLR volume or function. The indication for PVE is determined by the underlying liver function and standardized FLR volume. In patients with chronic hepatitis, the histologic inflammatory activity was negatively correlated with the increase in FLR volume, and PVE is not suitable for patients with high serum 7s collagen concentrations (>8 ng/ml). This finding may predict the efficacy of PVE. PVE before major hepatectomy can act as a tolerance test to avoid postoperative hepatic failure. PVE also improved long-term survival after liver resection in patients with HCC. Presently, PVE is a safe and useful treatment for patients undergoing major hepatectomy.

Keywords: Future liver remnant; Hepatectomy; Portal vein embolization.

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Figures

Fig. 1
Fig. 1
Embolized portal veins: A right portal vein, B left portal vein, C posterior branch, and D transileocecal embolization of the right portal vein.
Fig. 2
Fig. 2
Histologic finding after portal vein embolization in a patient with portal tumor thrombus. The tumor thrombus is covered by embolic material (arrows).
Fig. 3
Fig. 3
99mTechnetium-galactosyl human serum albumin scintigraphy A before and B after right portal vein embolization.
Fig. 4
Fig. 4
The portal branches perfusing the median and left lateral lobes of the rat liver were embolized.
See this image and copyright information in PMC

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