J Korean Soc Radiol.  2015 May;72(5):335-343. 10.3348/jksr.2015.72.5.335.

Comparison of the Effectiveness of Preoperative Portal Vein Embolization in Patients with Chronic Liver Disease: Gelfoam versus Gelfoam-Coil Combination

• Shin SW
• Chang IS
• Choo SW
• Do YS
• Park HS
• Park KB
• Cho SK
• Choo IW

• KMID: 1793890
• DOI: http://doi.org/10.3348/jksr.2015.72.5.335

Abstract

PURPOSE
To compare the effectiveness of portal vein embolization (PVE) performed using gelfoam or a gelfoam-coil combination before major hepatic resection in patients with chronic liver disease.
MATERIALS AND METHODS
PVE using gelfoam or a gelfoam-coil combination was performed in 37 patients. From April 2003 to September 2007, PVE was performed using gelfoam (n = 17) and a gelfoam-coil combination (n = 20) to induce hypertrophy. Computed tomography volumetry was performed 2-4 weeks after PVE to assess the changes in liver volume.
RESULTS
The mean percentage increase in future liver remnant volume was 23.7 +/- 23.7% in the gelfoam group and 36.7 +/- 18.5% in the gelfoam-coil group (p = 0.02). Recanalization was found in 15 gelfoam group patients and 8 gelfoam-coil group patients (p = 0.003). The mean tumor size increased from 4.5 +/- 2.9 cm before PVE to 5.0 +/- 3.5 cm after PVE in the gelfoam group and from 4.3 +/- 2.2 cm before PVE to 4.7 +/- 2.5 cm after PVE in the gelfoam-coil group (p = 0.80).
CONCLUSION
The gelfoam-coil combination was more effective than gelfoam alone for induction of compensatory hypertrophy by PVE in patients with chronic liver disease.

MeSH Terms

Carcinoma, Hepatocellular
Gelatin Sponge, Absorbable*
Humans
Hypertrophy
Liver
Liver Diseases*
Portal Vein*

Figure

• 

  Fig. 1 A 45-year-old man with a hepatocellular carcinoma underwent preoperative portal vein embolization using only gelfoam. A. Frontal portography before embolization shows intact right portal vein. B. Frontal portography after embolization using gelfoam only shows occlusion of right portal vein and redirection of portal blood flow to left portal vein. C. Abdominal CT scan obtained 4 weeks after portal vein embolization shows recanalization of right portal vein.

• 

  Fig. 2 A 46-year-old man with a hepatocellular carcinoma underwent preoperative portal vein embolization using gelfoam-coil combination. A. Frontal portography before embolization shows patent right portal vein. B. Frontal portography after embolization using gelfoam-coil combination shows complete occlusion of right portal vein. C, D. Abdominal CT scan obtained before PVE (C) and 3 weeks after PVE (D) at the level of celiac trunk shows hypertophic change of left lobe and hepatic attenuation difference and hypotrphic change of right lobe (arrows) suggesting embolized state of right lobe of the liver. The FLRbefore PVE was 431.7 cm3 and the FLRafter PVE was 714 cm3. The % increase of FLR volume after PVE was 65.4%. FLR = future liver remnant, PVE = portal vein embolization

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