{"id":7235,"date":"2020-12-30T14:21:23","date_gmt":"2020-12-30T13:21:23","guid":{"rendered":"https:\/\/www.gemitaly.it\/?page_id=7235"},"modified":"2020-12-30T14:21:23","modified_gmt":"2020-12-30T13:21:23","slug":"portal-vein-embolization","status":"publish","type":"page","link":"https:\/\/www.gemitaly.it\/en\/glubran-2-in-interventional-radiology-2-session\/portal-vein-embolization\/","title":{"rendered":"Portal Vein Embolization"},"content":{"rendered":"

Portal Vein Embolization – PVE<\/h3>\n

Felice D\u2019Antuono MD<\/p>\n

Over the past decades, perioperative care and surgical techniques improvement have led to an increased number of candidates for major liver resection. One of the limiting factors for surgery is the share of residual parenchyma, FLR (future liver remnant); in particular, high-risk patients for perioperative liver failure are those whose liver is removed:<\/p>\n

>80% (HEALTHY LIVER)<\/p>\n

>60% (CHRONIC HEPATOPATHY).<\/p>\n

In literature, post-surgical liver failure reaches 30% and is still the leading cause of death after major liver resections. It appears directly related to FLR (future liver remnant).<\/p>\n

Most surgical teams consider the minimum share of FLR \/ TLV as = 20%<\/p>\n

However, FLR \/ TLV = 40% in case of chronic liver disease<\/p>\n

FLR \/ TLV = 30% when CT is present in high doses<\/p>\n

Preoperative Portal Embolization (PVE) <\/span>is a technique developed to compensate for insufficient FLR volume by embolizing the portal branches of the parenchyma to be resected and direct the flow to the FLR branches.<\/p>\n<\/div>

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Preoperative Portal Embolization (PVE) <\/span><\/strong>is a technique developed to compensate for insufficient FLR volume by embolizing the portal branches of the parenchyma to be resected and direct the flow to the FLR branches.<\/p>\n

As an example, here is a successful case from literature: a patient with intrahepatic cholangiocarcinoma in the right lobe, who underwent extended right hepatectomy. sFLR\/TLV starts at just 27% but a CT scan 2 weeks after right PVE shows hypertrophy with sFLR\/TELV at 35%. PVE can be also used as a STRESS TEST: <\/span>it is shown that a modest hypertrophic response to PVE is strongly correlated with postsurgical liver failure. In other words, an insufficient hypertrophic response can be considered an indicator of reduced regenerative capacity, and surgery should be avoided.<\/p>\n

Liver regeneration properties have been well known since ancient Greece. In the 1920s, two French surgeons studying rabbit liver demonstrated that the ligation of the right lobe induced its atrophy while causing hypertrophy of the left one.<\/p>\n

Today we know why that is: PVE triggers a membrane-and-cytoplasmic signaling cascade and the production of growth factors and cytokines, which increase the mitotic activity of the liver, thus causing its hyperplasia.<\/p>\n

This answer is generally very rapid: the graph on the left shows a fast-growing hypertrophy rate over the first two weeks and the subsequent plateau phase. During this phase, CT scans are performed to evaluate liver volume in order to assess patient fitness for surgery.<\/p>\n<\/div>

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PVE PROCEDURE<\/strong><\/span><\/h4>\n

Percutaneous transhepatic approach <\/span>has become the standard choice (a trans-ileocolic approach is also an option)<\/p>\n