Portal vein embolization using a Histoacryl/Lipiodol mixture before right liver resection.
OBJECTIVE
The purpose of this retrospective study was to evaluate the efficacy and safety of percutaneous transhepatic portal vein embolization (PVE) of the right liver lobe using Histoacryl/Lipiodol mixture to induce contralateral liver hypertrophy before right-sided (or extended right-sided) hepatectomy in patients with primarily unresectable liver tumors.


METHODS
Twenty-one patients (9 females and 12 males) underwent PVE due to an insufficient future liver remnant; 17 showed liver metastases and 4 suffered from biliary cancer. Imaging was performed prior to and 4 weeks after PVE. Surgery was scheduled for 1 week after a CT or MRI control. The primary study end point was technical success, defined as complete angiographical occlusion of the portal vein. The secondary study end point was evaluation of liver hypertrophy by CT and MRI volumetry and transfer to operability.


RESULTS
In all the patients, PVE could be performed with a Histoacryl/Lipiodol mixture (n = 20) or a Histoacryl/Lipiodol mixture with microcoils (n = 1). No procedure-related complications occurred. The volume of the left liver lobe increased significantly (p < 0.0001) by 28% from a mean of 549 ml to 709 ml. Eighteen of twenty-one patients (85.7%) could be transferred to surgery, and the intended resection could be performed as planned in 13/18 (72.3%) patients.


CONCLUSIONS
Preoperative right-sided PVE using a Histoacryl/Lipiodol mixture is a safe technique and achieves a sufficient hypertrophy of the future liver remnant in the left liver lobe.
Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany. nadine.bellemann@web.de
Nadine
N
Bellemann
Ulrike
U
Stampfl
Christof M
CM
Sommer
Hans-Ulrich
HU
Kauczor
Peter
P
Schemmer
Boris A
BA
Radeleff
D000222:Adaptation, Physiological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D004621:Embolization, Therapeutic; D004659:Enbucrilate / Q000008:administration & dosage; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D015408:Gastrinoma / Q000556:secondary / Q000601:surgery*; D006498:Hepatectomy; D006529:Hepatomegaly / Q000000981:diagnostic imaging; D006801:Humans; D008099:Liver / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000502:physiology; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000556:secondary / Q000601:surgery*; D009929:Organ Size; D011169:Portal Vein / Q000000981:diagnostic imaging; D011300:Preoperative Care; D011859:Radiography; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014014:Tissue Adhesives / Q000008:administration & dosage
D000970:Antineoplastic Agents; D014014:Tissue Adhesives; D004998:Ethiodized Oil; D004659:Enbucrilate