Transhepatic Portal Vein Embolization: Anatomy, Indications, and Technical Considerations
David C. Madoff, MD ; Marshall E. Hicks, MD ; Jean-Nicolas Vauthey, MD ; Chusilp Charnsangavej, MD ; Frank A. Morello, Jr, MD ; Kamran Ahrar, MD ; Michael J. Wallace, MD ; Sanjay Gupta, MD
1 From the Departments of Diagnostic Imaging (D.C.M., M.E.H., C.C., F.A.M., K.A., M.J.W., S.G.) and Surgical Oncology (J.N.V.), University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 57, Houston, TX 77030-4009. Recipient of a Cum Laude award for an education exhibit at the 2001 RSNA scientific assembly. Received February 14, 2002; revision requested March 12 and received March 22; accepted March 22.
Portal vein embolization (PVE) is increasingly being accepted as a useful procedure in the preoperative treatment of patients selected for major hepatic resection. PVE is performed via either the percutaneous transhepatic or the transileocolic route and is usually reserved for patients whose future liver remnants are too small to allow resection. It is a safe and effective method for inducing selective hepatic hypertrophy of the nondiseased portion of the liver and may thereby reduce complications and shorten hospital stays after resection. A thorough knowledge of hepatic segmentation and portal venous anatomy is essential before performing PVE. In addition, the indications and contraindications for PVE, the methods for assessing hepatic lobar hypertrophy, the means of determining optimal timing of resection, and the possible complications of PVE need to be fully understood before undertaking the procedure. Technique may vary among operators, and further research is necessary to determine the best embolic agents available and the expected rates of liver regeneration for PVE. Nevertheless, as hepatobiliary surgeons become more experienced at performing extended hepatic resections, PVE may be requested more frequently.