Cochin Hospital – Port-Royal · AP-HP · Paris Cité University
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Interventional Radiology Cochin
Cochin Hospital AP-HP AP-HP

Portal Vein Embolization (PVE)

Interventional Radiology · Cochin Hospital AP-HP · Paris

✉️ ri.cch@aphp.fr📞 +33 1 58 41 46 12
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🌿 Portal vein embolization — Pre-operative liver preparation

Portal Vein Embolization (PVE)

Future liver remnant hypertrophy · Before major hepatectomy · Expert hepatobiliary centre

🎯 Principle and objective

Pre-operative portal vein embolization (PVE) is performed before major hepatic resection. It involves selectively occluding the portal branch on the side to be resected, depriving that lobe of its portal blood supply. In response, the future liver remnant (FLR) receives increased compensatory portal flow and undergoes progressive hypertrophy.

This hypertrophy — assessed by CT volumetry 4–6 weeks after PVE — allows safe surgical resection by ensuring a sufficient functional hepatocyte mass.

Clinical context: A major hepatectomy leaving an insufficient FLR carries the risk of post-operative liver failure, a potentially fatal complication. PVE is a key step in the multidisciplinary management of resectable hepatic tumours.

📋 Indications

PVE is indicated when the FLR volume is insufficient to sustain adequate hepatic function after resection:

  • Normal liver: FLR < 25–30% of total liver volume
  • Compromised liver: FLR < 40% in patients with cirrhosis, steatosis, or prior chemotherapy

CT volumetry must be performed before any decision on PVE, and the decision is always validated in a hepatobiliary multidisciplinary team meeting (MDT).

🔬 Technique

1

Portal access — percutaneous ultrasound-guided puncture of the right portal branch (ipsilateral approach)

2

Portal venography — mapping of the portal branches to be embolised

3

Embolization — cyanoacrylate glue + coils for permanent occlusion; right portal branches (D5, D6, D7, D8) ± segment IV if extended PVE

4

CT volumetry at 1, 3 and 5 weeks — surgical decision based on achieved FLR hypertrophy (>30–50% increase expected)

📊 Expected results

  • FLR hypertrophy of 30–50% at 4–6 weeks
  • Rate of adequate FLR gain allowing surgery: approximately 85%
  • If hypertrophy is insufficient: consider hepatic vein deprivation (HVD) as a complementary procedure
Note for referring surgeons: Our interventional radiology team works in close collaboration with the hepatobiliary surgery department at Cochin Hospital. All PVE cases are discussed at the weekly hepatobiliary MDT meeting. Please send your referrals to ri.cch@aphp.fr.

✅ Covered by French health insurance (Assurance Maladie). No extra fees at Cochin Hospital AP-HP.