Portal and Hepatic Vein Embolization versus Portal Venous Embolization Alone in Cirrhotic and Noncirrhotic Swine: A Pilot Study

Abstract

Purpose: To evaluate the effectiveness of combined portal vein embolization (PVE) and hepatic vein embolization (HVE) compared with that of PVE alone in cirrhotic and noncirrhotic swine.

Materials and methods: Sixteen Yorkshire pigs were included in this study. In the cirrhotic group (n = 8) and noncirrhotic group (n = 8), subjects underwent embolization according to established protocols. Computed tomography (CT) scans were acquired before and at 2- and 4-week intervals following the embolization. Liver volumes were segmented in the portal venous phase. Student t test with a significance level at P < .05 was used.

Results: Across all swine, the future liver remnant (FLR) was significantly larger after PVE + HVE than after PVE at 2 weeks (24.12% [95% CI, 15.36%-32.88%] vs 12.75% [95% CI, 7.43%-18.07%]; P = .021) and 4 weeks (23.23% [95% CI, 15.79%-33.47%] vs 15.08% [95% CI, 9.98%-20.87%]; P = .043) after embolization. In the cirrhotic group, the FLR increase was greater following PVE + HVE than after PVE at 2 weeks (20.85% [95% CI, 14.40%-27.30%] vs 8.66% [95% CI, 6.47%-10.86%]; P = .0089) and 4 weeks (19.27% [95% CI, 17.87%-20.67%] vs 13.33% [95% CI, 9.23%-13.33%]; P = .0003) after embolization.

Conclusions: PVE + HVE resulted in greater FLR hypertrophy than PVE alone, indicating that cirrhotic livers may benefit from the addition of HVE.