Portal vein embolization prior to hepatectomy: Techniques, outcomes and novel therapeutic approaches

Hepatectomy plays a pivotal role in the management of primary and secondary malignancies of the liver, and offers a curative option for the patient. Postoperative liver failure is a severe complication of liver resection, particularly for patients with underlying liver disease. Portal vein embolization (PVE) is a well-established preoperative technique that redirects blood flow to the anticipated remaining liver after resection in an effort to improve the functional hepatic reserve. PVE has improved the safety of hepatectomy and has extended surgical candidacy to patients who previously would have been ineligible for resection because of insufficient remnant liver volume. This article reviews the following aspects of PVE; indications, contra-indications, liver volumetry, approaches, embolization agents, recent outcomes data, and areas of active research including adjunctive therapies and temporary PVE