title: Use of double-occlusion balloon catheter: preoperative portal vein embolization for induction of future remnant liver hypertrophy.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of using double-occlusion balloon catheters in preoperative portal vein embolization (PVE) to induce future remnant liver hypertrophy.
  
  
  METHODS
  PVE was achieved with gelatin sponges by using double-occlusion balloon catheter in seventeen patients with hepatobiliary malignant tumors. The ipsilateral approach was used in thirteen patients and the contralateral approach in four patients due to large size of tumor in the right hepatic lobe. Surgery was performed in 15 patients, 14-27 days (mean, 21.9 days) after PVE. Computed tomographic liver volumetric studies were performed before embolization and before surgery. The changes in aspartate aminotransferase (AST), alanine aminotransferase (ALT), prothrombin time (PT), and total bilirubin levels before and after the PVE were evaluated. Complications were evaluated after PVE.
  
  
  RESULTS
  PVE using double-occlusion balloon catheter was successful in all cases, irrespective of approach technique. The future remnant liver (FRL) volumes were 251-920 cm3 (mean, 437 cm3) before PVE and 281-1042 cm3 (mean, 555 cm3) after PVE. The mean increase in the volume of the FRL was 28.6%; this represented 37% of the preresection volume of the liver. Clinical and biologic tolerance of PVE was mandatory. There were no complications.
  
  
  CONCLUSIONS
  PVE using the double-occlusion balloon catheter is safe and well-tolerated and can be performed technically with ease. This hypertrophy allows hepatectomy to be performed safely when the FRL volume is initially insufficient in patients with hepatobiliary tumors.
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul, 135-710, Korea.
authors.forename: Min Joo
authors.initials: MJ
authors.lastname: Kim
authors.forename: Sung Wook
authors.initials: SW
authors.lastname: Choo
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Do
authors.forename: Kwang Bo
authors.initials: KB
authors.lastname: Park
authors.forename: Yoon Hee
authors.initials: YH
authors.lastname: Han
authors.forename: In Wook
authors.initials: IW
authors.lastname: Choo
authors.forename: Jae Min
authors.initials: JM
authors.lastname: Cho
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Cho
authors.forename: Sung Joo
authors.initials: SJ
authors.lastname: Kim
authors.forename: Tae Sung
authors.initials: TS
authors.lastname: Sohn
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D021721:Balloon Occlusion / Q000295:instrumentation*; D001650:Bile Duct Neoplasms / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000628:therapy; D002408:Catheters, Indwelling; D018281:Cholangiocarcinoma / Q000628:therapy; D004867:Equipment Design; D005260:Female; D006500:Hepatic Duct, Common / Q000473:pathology; D006801:Humans; D006984:Hypertrophy / Q000628:therapy; D018285:Klatskin Tumor / Q000628:therapy; D008099:Liver / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery; D011517:Prothrombin Time; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase