Original CommunicationPreoperative contralateral portal vein embolization before major hepatic resection is a safe and efficient procedure: A large single institution experience
Section snippets
Patients
Between January 1997 and March 2006, a total of 146 patients underwent a right, percutaneous PVE with or without embolization of the portal branches of segment IV through a contralateral approach before right hepatectomy or extended right hepatectomy. Among these patients, the predicted FRL was <30% (for normal parenchyma) and 40% (for cirrhotic or injured parenchyma) of the total functional liver volume. All PVE were performed in our institution by a single interventional radiologist (M.G.).
Success of PVE
Contralateral PVE was performed successfully in 145 of 146 patients (99%). In 1 patient, the left portal vein was not accessible for catheterization after repeated attempts probably because the diameter was too small. This patient underwent operative ligation of the right portal vein followed by liver resection 2 months later. In 122 patients (84%), a right PVE was conducted, whereas 23 patients (16%) had right PVE with embolization of the portal branches of segment IV.
Morbidity and mortality after PVE
The post-PVE course was
Discussion
The current study suggests that percutaneous, contralateral PVE can be performed with a high rate of success (99%) and with a low mortality and morbidity. When PVE is used the planned hepatectomy is then performed in most patients (79%). Cirrhosis, chemotherapy, and diabetes mellitus did not appear to affect the volume of the FRL hypertrophy in our series. A mild and transitory but not clinically relevant decrease of prothrombin time and platelet count was observed after PVE.
Liver resection is
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