Sequential PVE and TAE for Biliary Tract Cancer and Liver Metastases

Abstract

Portal vein embolization (PVE) is a useful tool before major hepatectomy, especially for high-risk patients with chronic liver disease. However, the compensatory hypertrophy of the non-embolized lobe is sometimes insufficient, particularly in patients with severely impaired liver function. In such cases, the addition of transcatheter arterial embolization (TAE) for the segments that underwent PVE could be chosen as one of the options. This procedure induces more atrophy of the embolized lobe and at the same time induces more hypertrophy in the non-embolized lobe, thus extending the indication for liver resection in patients with small remnant liver. However, this technique induces severe parenchymal damage due to hepatic infarction and should be considered a high-risk procedure. Thus, the indication for this technique should be severely restricted, and once it is performed, the patient should be followed up carefully. Further accumulation of data is necessary to determine the indication, the appropriate embolic materials, and the extent of embolization for sequential PVE and TAE.