Use of double-occlusion balloon catheter: preoperative portal vein embolization for induction of future remnant liver hypertrophy.
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.
Kim
Min Joo
MJ
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul, 135-710, Korea.
Choo
Sung Wook
SW
Do
Young Soo
YS
Park
Kwang Bo
KB
Han
Yoon Hee
YH
Choo
In Wook
IW
Cho
Jae Min
JM
Cho
Jae Won
JW
Kim
Sung Joo
SJ
Sohn
Tae Sung
TS
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
D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase