Portal Vein Embolization
Portal Vein Embolization (PVE) is an advanced medical procedure in the field of interventional radiology aimed at increasing the volume and function of the healthy liver remnant that will remain following a hepatic resection (Hepatectomy).
The procedure is essential for patients suffering from primary tumors such as Hepatocellular Carcinoma or Intra-hepatic Cholangiocarcinoma and liver metastases, which require surgical removal of a large portion of the organ, when the remaining tissue is not large enough to sustain life functions and prevent post-operative liver failure. The central concept is to utilize the liver's unique ability to regenerate by diverting blood flow and nutrients toward the healthy section, which triggers an accelerated growth process known as hypertrophy. Thanks to this technique, many patients previously considered unresectable become suitable candidates for life-saving surgery.
Before a decision is made regarding the feasibility of the procedure, the patient undergoes a medical evaluation and imaging tests such as CT or MRI to plan the procedure and verify the condition of the liver and blood vessels.
The treatment process begins with a meticulous evaluation including advanced imaging tests such as CT or MRI for the precise calculation of the various liver volumes and the performance of volumetry. On the day of the procedure, the interventional radiologist inserts a thin catheter under ultrasound and X-ray fluoroscopy guidance into the portal venous system of the liver. Access is typically achieved through a small skin puncture under local anesthesia and mild sedation; the physician navigates the catheter to the portal vein branches supplying the areas intended for resection and injects embolic agents including alcohol, embolic particles, and micro-coils. This blockage causes blood flow to be diverted to the healthy part, leading to its rapid growth within a period of four to six weeks; in some cases, liver venous deprivation (LVD) can also be performed to further accelerate the growth rate and achieve better results in a shorter timeframe. The treatment is particularly suitable for patients with colorectal cancer that has metastasized to the liver or for patients with primary biliary tract tumors.
Among the advantages are
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The procedure allows for more healthy liver tissue to grow and strengthen before an extensive resection surgery.
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The treatment significantly improves liver function post-surgery and reduces the risk of dangerous liver failure.
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Provides hope and a surgical opportunity for patients considered unresectable due to insufficient liver volume.
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Performed using a minimally invasive approach without the need for open surgery or general anesthesia.
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Advanced real-time imaging technologies ensures maximum precision and minimal damage to healthy tissues.
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Recovery time from the procedure is very fast, and most patients are discharged home shortly after the treatment.
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Serves as a tolerance test predicting the liver's ability to recover after the planned surgical resection.
Disadvantages and risks
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The patient may experience temporary side effects including pain, nausea, mild fever, and general discomfort.
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Small risk of infection/internal bleeding resulting from the insertion of the catheter into the liver's venous system.
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An allergic reaction to the embolic materials or the contrast agent injected during the procedure may occur.
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In rare cases, blockage of blood vessels in the healthy area may occur, which could impair the surgical plan.
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Sometimes, sufficient liver growth is not achieved within the planned timeframe, which may delay the surgery.
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The tumor may continue to grow during the waiting period for liver regeneration.