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Controversies in the Use of Portal Vein Embolization

van Gulik T.M.a · van den Esschert J.W.a · de Graaf W.a · van Lienden K.P.b · Busch O.R.C.a · Heger M.a · van Delden O.M.b · Laméris J.S.b · Gouma D.J.a

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Departments of aSurgery and bRadiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

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Dig Surg 2008;25:436–444

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Article / Publication Details

First-Page Preview
Abstract of Paper

Published online: February 12, 2009
Issue release date: February 2009

Number of Print Pages: 9
Number of Figures: 5
Number of Tables: 0

ISSN: 0253-4886 (Print)
eISSN: 1421-9883 (Online)

For additional information: https://www.karger.com/DSU

Abstract

Background/Aims: Portal vein embolization (PVE) has reached worldwide acceptance to increase future remnant liver (FRL) volume before undertaking major liver resection. The aim of this overview is to point out and discuss current controversies in the application of PVE. Methods: Review of literature pertaining to techniques of PVE, complications, tumor proliferation, timing of resection, and hypertrophy response after PVE. Results: Procedure-related complications after PVE include hematoma, hemobilia, overflow of embolization material, and thrombosis of portal vein branch(es) of the non-embolized lobe. Persistence of the embolized, atrophic lobe is usually not harmful. Embolization of the portal branches to segment 4 in addition to embolization of the right portal trunk is controversial and is advised only in selected cases. It remains undecided whether embolization of the portal venous system is more effective in inducing hypertrophy of the FRL than ligation of the portal vein. Accelerated tumor growth after PVE is a major concern and requires consideration of post-PVE chemotherapy. A waiting time of 3 weeks between PVE and liver resection is advised. Post-hepatectomy regeneration is not hampered after preoperative PVE. Conclusion: PVE is a useful preoperative intervention to increase volume and function of the FRL. Further progress awaits clarification of the mechanisms of the hypertrophy response induced by PVE in conjunction with new embolization materials and protective chemotherapy.

© 2009 S. Karger AG, Basel


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Article / Publication Details

First-Page Preview
Abstract of Paper

Published online: February 12, 2009
Issue release date: February 2009

Number of Print Pages: 9
Number of Figures: 5
Number of Tables: 0

ISSN: 0253-4886 (Print)
eISSN: 1421-9883 (Online)

For additional information: https://www.karger.com/DSU


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