Portal Vein Embolization in Preparation for Major Hepatic Resection: Evolution of a New Standard of Care

Portal vein (PV) embolization (PVE) is gaining acceptance in the preoperative management of patients selected for major hepatic resection. PVE redirects portal blood flow to the intended liver remnant to induce hypertrophy of the nondiseased portion of the liver and thereby reduce complications and shorten hospital stays after resection. This article reviews the rationale and existing literature on PVE, including the mechanisms of liver regeneration, the pathophysiology of PVE, the imaging techniques used to measure liver volumes and estimate functional hepatic reserve, and the technical aspects of PVE, including approaches and embolic agents used. In addition, the indications and contraindications for performing PVE in patients with and without chronic liver disease and the multidisciplinary approach required for the treatment of these complex cases are emphasized.