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Preoperative Percutaneous Portal Vein Embolization: Evaluation of Adverse Events in 188 Patients¹

¹ From the Institut Paoli Calmettes, Marseille, France (D.R.D.S., J.R.D.); Department of Interventional Radiology, Institut Gustave Roussy, 39 Rue Camilles Desmoulins, 94805 Villejuif, France (T.d.B., A.H., D.E.); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (A.D., M.G.); Hôpital Saint André, Bordeaux, France (G.G., J.S., H.T.); and Centre Hospitalier Universitaire La Timone, Marseille, France (P.P., J.M.B.). Received December 9, 2003; revision requested February 16, 2004; revision received April 5; accepted April 22. Address correspondence to T.d.B. (e-mail: debaere@igr.fr).

View larger version (144K): [in a new window]   Figure 1a. Images obtained in 64-year-old man with a large right liver metastasis discovered 2 years after resection of primary colorectal cancer. (a) Transverse CT scan obtained before PPVE shows large liver metastasis (arrow) in right lobe and small left lobe (arrowhead), the volume of which was estimated to be 30% of total liver volume. (b) Frontal portogram obtained before embolization shows patent portal vein and its intrahepatic branches. (c) Frontal portogram obtained after embolization of right portal vein shows redistribution of portal flow toward future remnant liver. (d) Transverse CT scan obtained 4 weeks after PPVE shows future remnant liver, which accounted for 56% of complete liver volume.

View larger version (156K): [in a new window]   Figure 1b. Images obtained in 64-year-old man with a large right liver metastasis discovered 2 years after resection of primary colorectal cancer. (a) Transverse CT scan obtained before PPVE shows large liver metastasis (arrow) in right lobe and small left lobe (arrowhead), the volume of which was estimated to be 30% of total liver volume. (b) Frontal portogram obtained before embolization shows patent portal vein and its intrahepatic branches. (c) Frontal portogram obtained after embolization of right portal vein shows redistribution of portal flow toward future remnant liver. (d) Transverse CT scan obtained 4 weeks after PPVE shows future remnant liver, which accounted for 56% of complete liver volume.

View larger version (184K): [in a new window]   Figure 1c. Images obtained in 64-year-old man with a large right liver metastasis discovered 2 years after resection of primary colorectal cancer. (a) Transverse CT scan obtained before PPVE shows large liver metastasis (arrow) in right lobe and small left lobe (arrowhead), the volume of which was estimated to be 30% of total liver volume. (b) Frontal portogram obtained before embolization shows patent portal vein and its intrahepatic branches. (c) Frontal portogram obtained after embolization of right portal vein shows redistribution of portal flow toward future remnant liver. (d) Transverse CT scan obtained 4 weeks after PPVE shows future remnant liver, which accounted for 56% of complete liver volume.

View larger version (136K): [in a new window]   Figure 1d. Images obtained in 64-year-old man with a large right liver metastasis discovered 2 years after resection of primary colorectal cancer. (a) Transverse CT scan obtained before PPVE shows large liver metastasis (arrow) in right lobe and small left lobe (arrowhead), the volume of which was estimated to be 30% of total liver volume. (b) Frontal portogram obtained before embolization shows patent portal vein and its intrahepatic branches. (c) Frontal portogram obtained after embolization of right portal vein shows redistribution of portal flow toward future remnant liver. (d) Transverse CT scan obtained 4 weeks after PPVE shows future remnant liver, which accounted for 56% of complete liver volume.

View larger version (154K): [in a new window]   Figure 2a. Images obtained in 65-year-old man who had previously undergone metastasectomy for colon cancer. (a) Frontal portogram obtained toward end of PPVE shows large NBCA embolus (black arrow) at the origin of anterior branch of right portal vein. There is proximal narrowing (white arrow) of the left portal vein. (b) Transverse CT scan obtained 24 hours later shows thrombosis of the left portal branch (arrow) and NBCA in right portal branches (arrowheads).

View larger version (143K): [in a new window]   Figure 2b. Images obtained in 65-year-old man who had previously undergone metastasectomy for colon cancer. (a) Frontal portogram obtained toward end of PPVE shows large NBCA embolus (black arrow) at the origin of anterior branch of right portal vein. There is proximal narrowing (white arrow) of the left portal vein. (b) Transverse CT scan obtained 24 hours later shows thrombosis of the left portal branch (arrow) and NBCA in right portal branches (arrowheads).

View larger version (186K): [in a new window]   Figure 3a. Images obtained in 55-year-old man with metastases from colorectal neoplasm. (a) Frontal portogram shows that right portal vein was occluded (white arrow). Fragment of NBCA partially occluded left portal trunk (black arrow). (b) Frontal portogram obtained after angioplasty of left portal vein demonstrates patency of left portal trunk (arrow). (c) Transverse CT scan obtained before hepatectomy shows voluminous fragment of NBCA in left portal vein (arrow). (d) CT scan obtained 1 year after right hepatectomy and creation of a portoportal graft demonstrates cavernous transformation (arrow) of portal vein.

View larger version (172K): [in a new window]   Figure 3b. Images obtained in 55-year-old man with metastases from colorectal neoplasm. (a) Frontal portogram shows that right portal vein was occluded (white arrow). Fragment of NBCA partially occluded left portal trunk (black arrow). (b) Frontal portogram obtained after angioplasty of left portal vein demonstrates patency of left portal trunk (arrow). (c) Transverse CT scan obtained before hepatectomy shows voluminous fragment of NBCA in left portal vein (arrow). (d) CT scan obtained 1 year after right hepatectomy and creation of a portoportal graft demonstrates cavernous transformation (arrow) of portal vein.

View larger version (133K): [in a new window]   Figure 3c. Images obtained in 55-year-old man with metastases from colorectal neoplasm. (a) Frontal portogram shows that right portal vein was occluded (white arrow). Fragment of NBCA partially occluded left portal trunk (black arrow). (b) Frontal portogram obtained after angioplasty of left portal vein demonstrates patency of left portal trunk (arrow). (c) Transverse CT scan obtained before hepatectomy shows voluminous fragment of NBCA in left portal vein (arrow). (d) CT scan obtained 1 year after right hepatectomy and creation of a portoportal graft demonstrates cavernous transformation (arrow) of portal vein.

View larger version (140K): [in a new window]   Figure 3d. Images obtained in 55-year-old man with metastases from colorectal neoplasm. (a) Frontal portogram shows that right portal vein was occluded (white arrow). Fragment of NBCA partially occluded left portal trunk (black arrow). (b) Frontal portogram obtained after angioplasty of left portal vein demonstrates patency of left portal trunk (arrow). (c) Transverse CT scan obtained before hepatectomy shows voluminous fragment of NBCA in left portal vein (arrow). (d) CT scan obtained 1 year after right hepatectomy and creation of a portoportal graft demonstrates cavernous transformation (arrow) of portal vein.

View larger version (117K): [in a new window]   Figure 4a. Images obtained in 47-year-old man with metastases from rectal neoplasm in right lobe of liver. (a) Transverse CT scan obtained before embolization shows metastasis (arrowhead) located in gallbladder fossa. (b) Transverse CT scan obtained at admission for peritonitis shows gallbladder and metastasis merged in a tumoronecrotic mass (arrowhead).

View larger version (174K): [in a new window]   Figure 4b. Images obtained in 47-year-old man with metastases from rectal neoplasm in right lobe of liver. (a) Transverse CT scan obtained before embolization shows metastasis (arrowhead) located in gallbladder fossa. (b) Transverse CT scan obtained at admission for peritonitis shows gallbladder and metastasis merged in a tumoronecrotic mass (arrowhead).

View larger version (125K): [in a new window]   Figure 5. Transverse CT scan obtained after right portal vein embolization in a 72-year-old woman with metastases from colorectal cancer. Two small NBCA fragments (arrows) are visible in distal portal branch of the left lobe.