title: Safety and efficacy of preoperative right portal vein embolization in patients at risk for postoperative liver failure following major right hepatectomy.
abstract: BACKGROUND
  Right portal vein embolization (RPVE) has been utilized with or without segment IV (RPVE + IV) prior to hepatectomy to induce hypertrophy and prevent liver insufficiency in patients with a predicted future liver remnant (FLR) of ≤30% or cirrhosis.
  
  
  METHODS
  Records of patients who underwent RPVE during 2006-2010 were retrospectively reviewed. Patient demographics, operative outcomes and complications were analysed. Computed tomography-based volumetrics were performed to determine FLR volume and degree of hypertrophy. Patients were stratified by segment IV embolization. Short-term outcomes following RPVE and liver resection are reported.
  
  
  RESULTS
  A total of 23 patients were identified. Ten patients underwent RPVE and 13 underwent RPVE + IV. The RPVE procedure resulted in a 38% increase in FLR volume. Liver volumes, hypertrophy rates and outcomes were similar in both groups. Rates of operative complications in the RPVE and RPVE + IV groups were similar at 50% and 54%, respectively, and most complications were minor. Complication rates as a result of embolization were 30% in the RPVE group and 31% in the RPVE + IV group. One patient underwent modified operative resection as a result of a complication of RPVE.
  
  
  CONCLUSIONS
  Right portal vein embolization (±segment IV) is a safe and effective modality to increase FLR volume. Post-embolization complications and short-term outcomes after resection are acceptable and are similar in both RPVE and RPVE + IV.
authors.affiliation: Division of General Surgery, Department of Surgery, Oregon Health and Science University, Portland, 97239, USA.
authors.forename: Kristen P
authors.initials: KP
authors.lastname: Massimino
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Kolbeck
authors.forename: C Kristian
authors.initials: CK
authors.lastname: Enestvedt
authors.forename: Susan
authors.initials: S
authors.lastname: Orloff
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Billingsley
mesh_terms: D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008099:Liver / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D017093:Liver Failure / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011183:Postoperative Complications; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology