Percutaneous Preoperative Portal Vein Embolization Using a Combination of Gelatin Sponge and Histoacryl Glue

Background: Inadequate remnant liver volume is a major cause of postoperative liver failure. Preoperative portal vein embolization (PVE) is used clinically to prevent postoperative liver insufficiency. Purpose: To evaluate the efficacy and safety of preoperative portal vein embolization, by using a combination of gelatin sponge and histoacryl to induce hypertrophy of future liver remnant (FLR) in patients with a hepatobiliary malignancy. Material and Methods: PVE using a combination of gelatin sponge and histoacryl glue was performed in 11 patients (nine men, two women; mean age 60 years, range 46-70 years). These patients were diagnosed with a hepatobiliary malignancy before surgery and their FLR volumes were judged as insufficient to allow for safe resection (FLR < 25% in patients with a normal liver or FLR < 40% in patients with a chronic liver disease). Liver volume changes, levels of biochemical markers, complications related to PVE, and postoperative complications were retrospectively evaluated. Results: PVE was successful in all patients, and there were no procedural complications. The enlargement of nonembolized liver lobe was 30% (mean 118 cm(3)). A planned hepatectomy was cancelled in four patients due to the presence of a late-detected extrahepatic metastasis. Seven of the 11 patients underwent hepatectomy without complications. Conclusion: Preoperative PVE with a combination of gelatin sponge and histoacryl glue is a safe and effective procedure to induce hypertrophy of nonembolized parts of the liver.