title: Limits of and Complications after Embolization of the Hepatic Artery and Portal Vein to Induce Segmental Hypertrophy of the Liver: A Large Mini-Pig Study.
abstract: BACKGROUND
  The aim of this study was to compare arterial embolization (AE) with portal vein embolization (PVE) for the induction of segmental hypertrophy regarding procedural efficacy, safety and outcome.
  
  
  METHODS
  A total of 29 mini pigs were subjected to PVE, AE or assigned to the sham (SO) group. Correspondingly, 75% of the hepatic artery or portal vein branches were embolized. Growth and atrophy of the liver lobes, calculating the liver-to-body weight index (LBWI), laboratory data, arteriography, portography, Doppler ultrasound (US) and histopathology were analyzed.
  
  
  RESULTS
  After PVE, 2 animals had to be excluded due to technical problems. After AE, 4 animals had to be excluded because of technical problems and early sacrifice. Postprocedural US demonstrated effective AE and PVE of the respective lobes. Four weeks after PVE, portography showed a slow refilling of the embolized lobe by collateral portal venous vessels. Four weeks after AE, arteriography revealed a slight revascularization of the embolized lobes by arterial neovascularization. Segmental AE led to extensive necrotic and inflammatory alterations in the liver and bile duct parenchyma. Significant hypertrophy of the non-embolized lobe was only noted in the PVE group (LBWI: 0.91 ± 0.28%; p = 0.001). There was no increase in the non-embolized lobe in the AE (LBWI: 0.45 ± 0.087%) and SO group (LBWI: 0.45 ± 0.13%).
  
  
  CONCLUSIONS
  PVE is safe and effective to induce segmental hypertrophy. Portal reperfusion by collateral vessels may limit hypertrophy. AE did not increase the segmental hepatic volume but carries the risk of extensive necrotic inflammatory damage.
authors.affiliation: Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Heits
authors.forename: Lars
authors.initials: L
authors.lastname: Mueller
authors.forename: Andreas
authors.initials: A
authors.lastname: Koops
authors.forename: Susan
authors.initials: S
authors.lastname: Koops
authors.forename: Jochen
authors.initials: J
authors.lastname: Herrmann
authors.forename: Alexander
authors.initials: A
authors.lastname: Hendricks
authors.forename: Iyad
authors.initials: I
authors.lastname: Kabar
authors.forename: Alexander
authors.initials: A
authors.lastname: Arlt
authors.forename: Felix
authors.initials: F
authors.lastname: Braun
authors.forename: Thomas
authors.initials: T
authors.lastname: Becker
authors.forename: Christian
authors.initials: C
authors.lastname: Wilms
mesh_terms: D000818:Animals; D001835:Body Weight; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D006499:Hepatic Artery; D006984:Hypertrophy; D008099:Liver / Q000473:pathology*; D009929:Organ Size; D011169:Portal Vein; D013552:Swine; D013556:Swine, Miniature; D018608:Ultrasonography, Doppler