Transhepatic Endovascular Portal Vein Embolization Before Hepatectomy

Background and Aims: To evaluate the safety and efficacy of transhepatic portal vein embolization with Embosphere, Gelfoam, and Amplatzer vascular plug II before extended hepatectomy in patients with metastatic liver disease. Materials and Methods: Between January 2008 and October 2014, patients with metastatic liver disease, who were treated with transhepatic endovascular portal vein embolization before extended hepatectomy to increase the future remnant liver volume, were retrospectively evaluated. Multidetector computed tomography was utilized before and after the hepatectomy to calculate the future remnant liver volume. Ipsilateral portal vein embolization was performed in all patients with a microspheric embolic agent (Embosphere, 700–900 μm), gelatin foam (Gelfoam), and Amplatzer vascular plug II. Primary outcome measures are the increase in the percentage of the future remnant liver volume, procedure-related mortality and morbidity, and both technical and clinical success rates. Results: Fourteen (78%) right portal vein and 4 (22%) left portal vein embolizations were performed in a total of 18 patients (12 men and 6 women) with a mean age of 48±10.1 years (range, 32 to 59 years). The mean increase in the future remnant liver volume at 6 weeks was 41.6±6.7% (range, 35% to 45%), which was sufficient for extended hepatectomy, and the clinical success rate was 100%. The technical success rate was 100%, and there was no procedure-related mortality. A self-limited subcapsular hematoma occurred in one patient (5%). There was no recanalization of embolized portal veins during follow-ups. Conclusion: Transhepatic portal vein embolization with Embosphere, Gelfoam, and Amplatzer vascular plug II before extended hepatectomy in patients with metastatic liver disease, is a safe and effective procedure