الفهرس | Only 14 pages are availabe for public view |
Abstract Portal vein embolization is an increasingly common and useful procedure that helps to increase the future liver remnant volume and thereby improve the chances of surgical resection in patients with liver malignancies, who might otherwise not be considered for surgery. Cross-sectional imaging plays an important role in deciding which patients will benefit from portal vein embolization and identifies contraindications for the procedure. PVE not only increases the pool of candidates for hepatectomy, but also decreases significantly the incidence of postoperative complications as well as the intensive care unit stay and total hospital stay. Currently, the percutaneous transhepatic ipsilateral and contralateral PVE approaches are the safest and most commonly used by interventional radiologists worldwide. The complication rates appear to be similar for both approaches. Because PVE is a complex procedure, strict patient selection is critical. Patients with underlying hepatic disease, such as fibrosis or cirrhosis, benefit the most from PVE. In most patients without underlying hepatic disease, PVE should only be performed when the FLR is <20%. Many embolic materials, such as fibrin glue, gelatin sponge, coils, and absolute alcohol, have been used for PVE without significant differences in the degree of hypertrophy. An ideal agent is one that causes permanent embolization without recanalization, is tolerated well by the patient, and is easy to administer. |