title: Trans-Splenic Portal Vein Embolization: A Technique to Avoid Damage to the Future Liver Remnant.
abstract: Portal vein embolization (PVE) induces hypertrophy of the future liver remnant (FLR) in patients undergoing extensive hepatic resection. Portal vein access for PVE via the ipsilateral hepatic lobe (designated for resection) places veins targeted for embolization at acute angles to the access site requiring reverse curve catheters for access. This approach also involves access close to tumors in the ipsilateral lobe and requires care to avoid traversing tumor. Alternatively, a contralateral approach (through the FLR) risks damage to the FLR due to iatrogenic trauma or non-target embolization. Two patients successfully underwent PVE via trans-splenic portal vein access, allowing easy access to the ipsilateral portal veins and eliminating risk of damage to FLR. Technique and advantages of trans-splenic portal vein access to perform PVE are described.
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Road, WCC 308-B, Boston, MA, 02215, USA. asarwar@bidmc.harvard.edu.
authors.forename: Ammar
authors.initials: A
authors.lastname: Sarwar
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Road, WCC 308-B, Boston, MA, 02215, USA.
authors.forename: Olga R
authors.initials: OR
authors.lastname: Brook
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Road, WCC 308-B, Boston, MA, 02215, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Weinstein
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.
authors.forename: Khalid
authors.initials: K
authors.lastname: Khwaja
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Road, WCC 308-B, Boston, MA, 02215, USA.
authors.forename: Muneeb
authors.initials: M
authors.lastname: Ahmed
mesh_terms: D017130:Angioplasty / Q000379:methods*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D006984:Hypertrophy; D008099:Liver / Q000098:blood supply* / Q000473:pathology*; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011183:Postoperative Complications / Q000517:prevention & control*
keywords: Oncology; Portal vein embolization; Trans-splenic access