Preoperative Portal Vein Embolization: Indications and Technical Considerations

Preoperative portal vein embolization (PVE) has become an important tool in the management of select patients before major hepatic resection. PVE redirects portal flow to the intended future remnant liver (FRL) to induce hypertrophy of the nondiseased portion of the liver and thereby may reduce complications and shorten hospital stays after surgery. This article reviews the technical considerations for performing PVE including the use of the ipsilateral or contralateral approaches, how to choose a particular embolic agent for PVE, the importance of liver volumetric measurements to estimate functional hepatic reserve, the pathophysiology of PVE, and some of the results showing the benefit of the procedure. In addition, the indications and contraindications for performing PVE in patients with and without chronic liver disease, the use of combination therapies, and the concern for tumor growth after PVE will be discussed.