Preoperative Portal Vein Embolization Strategy for Complex Liver Resection
Portal vein embolization (PVE) is part of the standard of care to prepare extended liver resections when the future remnant liver is too small and induces the risk of postoperative liver insufficiency. PVE is most often reported before right or right extended hepatectomy but can be used in the preparation of any type of liver surgery including the most atypical ones. Such atypical PVE requires excellent collaboration between surgeons and interventional radiologists to precisely determine the segment that will be resected and consequently which will require embolization. Excellent quality pre-PVE imaging, namely CTAP 3D reconstruction, will greatly help in better defining the access route to the portal system and facilitate catheterization of all target segments for embolization. Due to the usual complexity of catheterization, oblique view and at best 3D rotational angiography will greatly help the completion of atypical PVE. When complex liver resections include preoperative radiofrequency ablation (RFA) in the future remnant liver (FRL), RFA zone including safety margins must be taken into account during preoperative volumetry to avoid an overestimation of the FRL volume. RFA can be used at the time of PVE to treat tumor located in the FRL and thus avoid potential growth in the waiting period between PVE and surgery.
KeywordsPortal vein embolization Liver resection Imaging in preoperative portal vein embolization Radiofrequency ablation
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