Thierry De Bačre MD, Presenter: Nothing to Disclose

Antoine Hakime MD, Abstract Co-Author: Nothing to Disclose

Mohamed Abdel Rehim, Abstract Co-Author: Nothing to Disclose

Clarisse Lafont, Abstract Co-Author: Nothing to Disclose

To evaluate safety and efficiency of tailored preoperative portal vein embolization (PPVE) to prepare complex liver resection.

During a ten years period 108 PP were performed to increase the volume of the future remnant liver before liver resection. Most of the liver resections were right (n=43) or right extended (n=58) hepatectomies, and accordingly PPVE occluded right liver lobe branches with or without segment 4 branches. The 7 remaining PPVE were performed in patients bearing metastases in non cirrhotic liver, and tailored according to scheduled complex anatomical liver resections. These resection planed to left in place only segment 4 in 2 patients, segments 4,5 and 6 in 2 patients, segments 6 and 7 in 2 patients, and segments 5 and 6 in one patient taking advantage of a large accessory right hepatic vein in this last patient.

PPVE was performed under general anesthesia with free flow injection of a mixture of cyanoacrylate and Lipiodol using a 5 French catheter. All portal branches feeding the liver segments to be resected were embolized. Coils were used to occlude segmental branches in 2 patients, due to the risk of reflux with cyanoacrylate. PPVE was well tolerated with a mean hospital stay of 2 days. After a mean of 28 days, CT volumetry revealed a mean hypertrophy of the non-embolized liver of 45% (21-88). Liver resections could be performed in 5 patients, and were cancelled in two due to extrahepatic tumor progression in one and insufficient volume increase in the other which demonstrated only a 21% increase.

Despite PPVE is usually used before right or right extended hepatectomy, this technique can be safely used to induce hypertrophy of the future remnant liver before a complex hepatectomy.

De Bačre, T, Hakime, A, Abdel Rehim, M, Lafont, C, Preoperative Portal Vein Embolization to Prepare Complex Liver Resection.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4414848.html