Portal +/- hepatic vein embolization pre-hepatectomy (PVE +/- LVD)

Background and indications

When major liver surgery is planned, the remaining liver volume after the operation may be insufficient. Portal vein embolization promotes growth of the liver portion that will be preserved, making surgery possible and safer.

Benefits

This technique reduces the risk of post-operative liver failure by increasing the future liver remnant volume by 30-60% within a few weeks. Adding hepatic vein embolization (LVD) further accelerates this growth.

Procedure

Under local anesthesia and sedation, the radiologist punctures a portal vein branch through the liver under ultrasound and fluoroscopic guidance. An embolization agent (glue, particles) is then injected into the portal vein branches supplying the liver portion to be removed. The procedure lasts 1-2 hours.

Risks

Complications are rare but include hepatic puncture site bleeding, extended portal thrombosis or transient portal hypertension. Pain and mild fatigue are common in the following days.

Recovery and follow-up

Discharge is usually possible the next day. A volumetric CT scan is performed 3-6 weeks later to measure liver growth. Surgery is scheduled once volume is sufficient.

Practical information

Local anesthesia. Outpatient procedure (return home the same day).