Preoperative Interventions: Portal Vein Embolization

Preoperative portal vein embolization (PVE) is a well-known minimally invasive interventional radiological procedure to increase the future liver remnant (FLR) volume. PVE is performed in patients having inadequate FLR preceding extensive hepatectomy for curative treatment of hepatobiliary malignancies to reduce postoperative liver failure. PVE is recommended when the FLR is observed to be of small size prior to hepatic resection to provide necessary hepatic function following hepatic resection. When properly implemented, PVE increases the number of suitable patients for therapeutic liver resection and reduces the postoperative morbidity and mortality. Different techniques may be used to access the portal vein branches for portal vein embolization, also different embolic agents may be used to achieve technical and clinical success ensuring a low complication rate. PVE additionally has been combined with other procedures to enhance patient’s therapeutic success; similarly few new novel strategies have been developed to maximize the rate of FLR hypertrophy.