title: Assessment of percutaneous transhepatic portal vein embolization with portal vein stenting for perihilar cholangiocarcinoma with severe portal vein stenosis.
abstract: BACKGROUND
  The aim of the present study was to assess the clinical efficiency of portal vein (PV) stenting when performed with preoperative percutaneous transhepatic portal vein embolization (PTPVE) in patients with severe PV stenosis due to tumor invasion.
  
  
  METHODS
  Between 2007 and 2013, four consecutive patients (one male, three females; mean age, 52 years; age range, 25-73 years) with perihilar cholangiocarcinoma and PV stenosis underwent PTPVE and PV stenting. Patients were analyzed with regard to the procedure, hypertrophy of the future remnant liver (FRL), and plasma clearance rate of indocyanine green by the FRL (ICGK-F). Further, the %FRL volume increase in PTPVE was compared between the stenting group and the usual PTPVE group who have perihilar cholangiocarcinomas without PV stenosis.
  
  
  RESULTS
  Preoperative PTPVE with PV stenting was successfully performed and portal flow to the FRL improved after stenting in all four patients. The %FRL volume increase was 18-60% (mean, 34%) in the stenting group and was 12-51% (mean, 21%) in the usual PTPVE group. The ICGK-F value after PTPVE exceeded 0.05 in all four patients. All patients achieved R0 resection.
  
  
  CONCLUSIONS
  Preoperative PTPVE with PV stenting appears to be feasible in cases of severe PV tumor invasion and stenosis. This procedure may allow a broader indication for surgery.
authors.affiliation: Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. ryouta771@med.nagoya-u.ac.jp.
authors.forename: Ryota
authors.initials: R
authors.lastname: Hyodo
authors.forename: Kojiro
authors.initials: K
authors.lastname: Suzuki
authors.forename: Tomoki
authors.initials: T
authors.lastname: Ebata
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Komada
authors.forename: Yoshine
authors.initials: Y
authors.lastname: Mori
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Yokoyama
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Igami
authors.forename: Gen
authors.initials: G
authors.lastname: Sugawara
authors.forename: Shinji
authors.initials: S
authors.lastname: Naganawa
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic; D002405:Catheterization, Central Venous / Q000379:methods; D018281:Cholangiocarcinoma / Q000150:complications / Q000628:therapy*; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: Percutaneous transhepatic portal vein embolization; Perihilar cholangiocarcinoma; Portal vein stenosis; Stent