Major Hepatic Resection Following Portal Vein Embolisation: Indications, Technique and Peri-Operative Outcome
2020
Major liver resections are limited by the volume of future liver (FLR) remnant with the risk of subjecting
patient to post surgery liver failure. This increases morbidity and mortality of the patients. However, the
technique of ipsilateral portal vein embolisation (PVE) has given surgeons extra mileage to consider major
liver resections previously thought to be unresectable. Al cases should be discussed in a multidisciplinary
setting. A good knowledge of portal anatomy and variations should be known as part of selection procedure
for PVE. Base liver functional status should be reviewed before consideration given to PVE. CT volumetry
assessment should be made before and after PVE to assess for resectability. Multiple embolic materials are
used in current practice, but none have shown superiority. Several complications are related to application
of PVE, however it is generally regarded a safe procedure. Atleast four weeks are required to assess for FLR
with repeat abdominal cross-sectional imaging. Patients with normal liver function tests achieve maximum
hypertrophy in four weeks versus patients with underlying liver disease. Liver surgery is scheduled upto 2
to 6 weeks following embolisation. The aim of this article is to provide an overview of current indications,
technique, complications and outcomes following PVE.
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