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Why do some patients need portal vein embolization? It has amazing therapeutic potential!
Hepatic portal vein embolization (PVE) is a preoperative procedure performed in interventional radiology to promote proliferation of the anticipated future liver remnant, usually performed several weeks before major liver resection surgery. This procedure involves injecting embolic material into the right or left portal vein to block portal venous flow. By blocking blood flow to the part of the liver that is to be removed, blood is redirected to healthy liver areas, which then causes hypertrophy and proliferation of the liver.
This procedure may allow for a more extensive resection in certain patients, address conditions that might otherwise be contraindicated, and improve oncological outcomes.
Medical Uses
The indication for PVE depends on the ratio of future liver remnant (FLR) to total estimated liver volume (TELV) and liver status. Although there is no consensus on the minimum liver capacity, in patients with normal liver function, the FLR/TELV ratio should be at least 25%. In patients with chronic liver disease, such as cirrhosis, the FLR/TELV ratio is recommended to be at least 40%. In these patients, PVE may be an indicator of increased FLR and FLR/TELV ratio.
Surgery Results
Hepatic portal vein embolization is an extremely well tolerated procedure with a very low mortality rate (0.1%) and a very low rate of technical failure (0.4%). The incidence of surgical complications is also low (2-3%), including portal vein thrombosis, liver ischemia, infection, etc. The success rate of PVE depends on the extent of the regenerative response.
A study found that patients who underwent PVE had a 29% improvement in five-year survival for patients whose tumors were initially unresectable.
Contraindications
Portal hypertension is an absolute contraindication as these patients are not surgical candidates and are at higher risk of complications after PVE. Furthermore, complete embolization of the bilateral hepatic portal veins would not predictably increase FLR, thus precluding PVE. Recently, some scholars have begun to explore the possibility of performing PVE in patients with bilateral tumors, but it still needs to be evaluated with caution.
Risks and Benefits
PVE has some risks, including portal vein thrombosis, liver ischemia and hypoxia. Nevertheless, PVE can significantly reduce postoperative complications and hospital stay.
The advantage of PVE is that it can enable patients with tumors that are otherwise unresectable to obtain the right to have their tumors resected, thereby reducing mortality and increasing the success rate of surgery.
Development prospects
In current research, some new technologies have been discovered, such as transarterial PVE, which can promote the enhancement of FLR and has better safety than traditional PVE. In the future, reversible PVE technology may be used. When patients cannot undergo resection, embolization of absorbable materials can be used to promote liver regeneration.
ConclusionOverall, portal vein embolization is an important technique that provides patients with an inadequate FLR/TELV ratio with the opportunity to undergo resection and potential treatment. In the face of the potential of this technology, should we rethink its value in the treatment of liver disease?
