Liver Diseases pp 611-616 | Cite as

Portal Vein Embolization (PVE) and Partial TIPE ALPPS: Beyond the Limitations of PVE

  • Yutaka Suzuki
  • Yoshihiro SakamotoEmail author


Portal vein embolization (PVE) if often used before major hepatectomy to increase the volume of the future liver remnant (FLR) and thus prevent postsurgical liver failure. In this chapter, the history, methods, efficacy, and limitations of PVE are summarized, and a potential breakthrough in the limitations of PVE is described. PVE was introduced in 1982 in the case of a patient with cholangiocarcinoma. Since its introduction, the indications for preoperative PVE have extended to hepatocellular carcinoma, gallbladder carcinoma, and colorectal liver metastasis, and PVE is now considered an indispensable ancillary procedure performed to ensure the safety of major hepatectomy. There are two main PVE techniques, representing two approaches to PVE: transileocolic portal vein embolization (TIPE) and percutaneous transhepatic portal vein embolization (PTPE). Various embolic materials can be used to occlude the portal branches that will be resected.

However, about 20% of patients who undergo PVE cannot undergo subsequent hepatectomy, often because of tumor progression during the waiting period of 3–8 weeks. To resolve problem, a new two-stage hepatectomy procedure, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), has been applied efficaciously mainly in European countries. The advantage of ALPPS is rapid and significant hypertrophy of the FLR, occurring 7–10 days after the first-stage procedure. The disadvantage of ALPPS is the high associated mortality rate (9% in liver metastasis). To overcome this shortcoming, we developed a modified ALPPS procedure, partial TIPE ALPPS, in which partial liver partition and TIPE are performed as the first-stage procedure. We have applied partial TIPE ALPPS in ten patients so far and found no resulting mortality. In addition, we found that partial TIPE ALPPS, in comparison to conventional PVE, increases volume gain of the FLR.


Portal vein embolization (PVE) Transileocolic portal vein embolization (TIPE) Percutaneous transhepatic portal vein embolization (PTPE) Two-stage hepatectomy (TSH) Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) Partial TIPE ALPPS 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Hepato-Biliary-Pancreatic Surgery DivisionKyorin University HospitalTokyoJapan

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