🎯 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.
📋 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
Portal access — percutaneous ultrasound-guided puncture of the right portal branch (ipsilateral approach)
Portal venography — mapping of the portal branches to be embolised
Embolization — cyanoacrylate glue + coils for permanent occlusion; right portal branches (D5, D6, D7, D8) ± segment IV if extended PVE
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
⚡ At a glance — key figures
Portal vein embolization blocks the portal branches supplying the liver segments due for surgical removal, stimulating growth of the remaining liver over several weeks before major liver surgery.
| Criterion | Data |
|---|---|
| Purpose | Increase the future liver remnant volume to make major hepatectomy safer |
| Timing before surgery | Usually 4–6 weeks, with imaging to confirm adequate growth |
| Anaesthesia | Local, as a day case or short admission |
| Cost | Covered by French national health insurance at Cochin AP-HP — no out-of-pocket fees. |
Data validated by the team of Prof. Anthony Dohan, Department of Interventional Radiology, Cochin Hospital AP-HP, Université Paris Cité.
✅ Covered by French health insurance (Assurance Maladie). No extra fees at Cochin Hospital AP-HP.
❓ Frequently asked questions
✓ Why this page is trustworthy
Written by the Interventional Radiology team at Cochin Hospital AP-HP, Université Paris Cité. Medically reviewed by an interventional radiologist of the department. Last updated: August 2026.