Preoperative percutaneous portal vein embolization: evaluation of adverse events in 188 patients.
OBJECTIVE
To retrospectively assess the frequency of adverse events related to percutaneous preoperative portal vein embolization (PPVE).


METHODS
Institutional review board did not require its approval or patient informed consent for this study. The adverse events that occurred during PPVE or until planned hepatic surgery was performed or cancelled were retrospectively obtained from clinical, imaging, and laboratory data files in 188 patients (109 male and 79 female patients; mean age, 60 years; range, 16-78 years). Liver resection was planned for metastases (n = 137), hepatocarcinoma (n = 31), cholangiocarcinoma (n = 15), fibrolamellar hepatoma (n = 1), and benign disease (n = 4). PPVE was performed with a single-lumen 5-F catheter and a contralateral approach with n-butyl cyanoacrylate mixed with iodized oil as the main embolic agent. The rate of complications in patients with cirrhosis was compared with that in patients without cirrhosis by using the chi(2) test.


RESULTS
Adverse events occurred in 24 (12.8%) of 188 patients, including 12 complications and 12 incidental imaging findings. Complications included thrombosis of the portal vein feeding the future remnant liver (n = 1); migration of emboli in the portal vein feeding the future remnant liver, which necessitated angioplasty (n = 2); hemoperitoneum (n = 1); rupture of a metastasis in the gallbladder (n = 1); transitory hemobilia (n = 1); and transient liver failure (n = 6). Incidental findings were migration of small emboli in nontargeted portal branches (n = 10) and subcapsular hematoma (n = 2). Among the 187 patients in whom PPVE was technically successful, there was a significant difference (P < .001) between the occurrence of liver failure after PPVE in patients with cirrhosis (five of 30) and those without (one of 157). Sixteen liver resections were cancelled due to cancer progression (n = 12), insufficient hypertrophy of the nonembolized liver (n = 3), and complete portal thrombosis (n = 1).


CONCLUSIONS
PPVE is a safe adjuvant technique for hypertrophy of the initially insufficient liver reserve. Post-PPVE transient liver failure is more common in patients with cirrhosis than in those without cirrhosis.
Di Stefano
Donatella R
DR
Institut Paoli Calmettes, Marseille, France.
de Baere
Thierry
T
Denys
Alban
A
Hakime
Antoine
A
Gorin
Gilles
G
Gillet
Michel
M
Saric
Jean
J
Trillaud
Hervé
H
Petit
Philippe
P
Bartoli
Jean-Michel
JM
Elias
Dominique
D
Delpero
Jean-Robert
JR
D000179:Acrylates / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D018281:Cholangiocarcinoma / Q000601:surgery; D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006406:Hematoma / Q000209:etiology; D006431:Hemobilia / Q000209:etiology; D006498:Hepatectomy; D006801:Humans; D007459:Iodized Oil / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000150:complications; D008107:Liver Diseases / Q000209:etiology / Q000601:surgery; D017093:Liver Failure / Q000209:etiology; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011300:Preoperative Care / Q000009:adverse effects*; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology
D000179:Acrylates; C032490:n-butyl acrylate; D007459:Iodized Oil