title: Simultaneous trans-hepatic portal and hepatic vein embolization before major hepatectomy: the liver venous deprivation technique.
abstract: OBJECTIVE
  To assess technical feasibility, safety, and efficacy of the liver venous deprivation (LVD) technique that combines both portal and hepatic vein embolization during the same procedure for liver preparation before major hepatectomy.
  
  
  METHODS
  Seven patients (mean age:63.6y[42-77y]) underwent trans-hepatic LVD for liver metastases (n = 2), hepatocellular carcinoma (n = 1), intrahepatic cholangiocarcinoma (n = 3) and Klatskin tumour (n = 1). Assessment of future remnant liver (FRL) volume, liver enzymes and histology was performed.
  
  
  RESULTS
  Technical success was 100 %. No complication occurred before surgery. Resection was performed in 6/7 patients. CT-scan revealed hepatic congestion in the venous-deprived area (6/7 patients). A mean of 3 days (range: 1-8 days) after LVD, transaminases increased (AST: from 42 ± 24U/L to 103 ± 118U/L, ALT: from 45 ± 25U/L to 163 ± 205U/L). Twenty-three days (range: 13-30 days) after LVD, FRL increased from 28.2 % (range: 22.4-33.3 %) to 40.9 % (range: 33.6-59.3 %). During the first 7 days, venous-deprived liver volume increased (+13.4 %) probably reflecting vascular congestion, whereas it strongly decreased (-21.3 %) at 3-4 weeks. Histology (embolized lobe) revealed sinusoidal dilatation, hepatocyte necrosis and important atrophy in all patients.
  
  
  CONCLUSIONS
  Trans-hepatic LVD technique is feasible, well tolerated and provides fast and important hypertrophy of the FRL. This new technique needs to be further evaluated and compared to portal vein embolization.
  
  
  CONCLUSIONS
  • Twenty-three days after LVD, FRL increased from 28.2 % (range:22.4-33.3 %) to 40.9 % (range:33.6-59.3 %) • During the first 7 days, venous-deprived liver volume increased (+13.4 %) • Venous-deprived liver volume strongly decreased (mean atrophy:229 cc; -21.3 %) at 3-4 weeks • Histology of venous-deprived liver revealed sinusoidal dilatation, hepatocyte necrosis and important atrophy.
authors.affiliation: Department of Radiology, St-Eloi University Hospital, 80 avenue Augustin Fliche, 34295, Montpellier, France. B-guiu@chu-montpellier.fr.|INSERM U896, Montpellier Cancer Research Institute, 34298, Montpellier, France. B-guiu@chu-montpellier.fr.
authors.forename: Boris
authors.initials: B
authors.lastname: Guiu
authors.affiliation: Department of Radiology, Archet University Hospital, 06000, Nice, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Chevallier
authors.affiliation: Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Alban
authors.initials: A
authors.lastname: Denys
authors.affiliation: Department of Radiology, St-Eloi University Hospital, 80 avenue Augustin Fliche, 34295, Montpellier, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Delhom
authors.affiliation: Department of Radiology, St-Eloi University Hospital, 80 avenue Augustin Fliche, 34295, Montpellier, France.
authors.forename: Marie-Ange
authors.initials: MA
authors.lastname: Pierredon-Foulongne
authors.affiliation: Department of Surgery, Institut du Cancer de Montpellier, 34298, Montpellier, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rouanet
authors.affiliation: Department of Surgery, St-Eloi University Hospital, 34295, Montpellier, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Fabre
authors.affiliation: Department of Surgery, Institut du Cancer de Montpellier, 34298, Montpellier, France.
authors.forename: François
authors.initials: F
authors.lastname: Quenet
authors.affiliation: Department of Surgery, St-Eloi University Hospital, 34295, Montpellier, France.
authors.forename: Astrid
authors.initials: A
authors.lastname: Herrero
authors.affiliation: Department of Surgery, St-Eloi University Hospital, 34295, Montpellier, France.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Panaro
authors.affiliation: Department of Radiology, Archet University Hospital, 06000, Nice, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Baudin
authors.affiliation: Department of Histology, St-Eloi University Hospital, 34980, Montpellier, France.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Ramos
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy; D006503:Hepatic Veins; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011300:Preoperative Care / Q000379:methods*; D016896:Treatment Outcome
keywords: Hepatic Vein; Histology; Liver; Portal Vein Embolization; Surgery