Portal Vein Embolization: A Preoperative Approach to Improve the Safety of Major Hepatic Resection

Portal vein embolization (PVE) has become an important tool in the preoperative management of select patients prior to major hepatic resection. PVE redirects portal flow to the intended remnant liver to induce hypertrophy of the nondiseased portion of the liver and thereby may reduce complications and shorten hospital stays after surgery. This article reviews the rationale and existing literature on PVE, including the mechanisms and rates of liver regeneration, the pathophysiology of PVE, the importance of liver volumetric measurements to best estimate functional hepatic reserve, and the technical aspects of PVE including the use of state-of-the-art imaging techniques to guide the procedure. Also, the indications and contraindications for performing PVE in patients with and without chronic liver disease and the multidisciplinary approach required for the treatment of these complex cases are emphasized.