Indications and Contraindications for Portal Vein Embolization

Abstract

Multiple factors are considered when determining whether or not a particular patient will benefit from portal vein embolization (PVE). First, an evaluation for underlying liver disease must be made to ascertain the necessary future liver remnant (sFLR) volume following resection – those patients with an otherwise healthy liver will not require as large an FLR mass as those with cirrhosis. Next, the patient’s body size must be taken into account. Then, the planned surgical intervention must be considered (i.e., the size and complexity of the surgical resection as well as the possibility of any other nonhepatic surgery to be performed concomitantly). These three factors are considered in the setting of the patient’s age and comorbidities (e.g., diabetes mellitus) that may affect hypertrophy and ultimately, the perioperative outcome. Thus, after all of these factors have been evaluated and the patient remains a surgical candidate, appropriate liver CT volumetry is performed so that the standardized FLR volume expressed as a percentage of the estimated total liver volume (TLV) can be used to determine the need for PVE. In addition, contraindications with regards to the use of PVE are also discussed.