Portal Vein Embolization: Complications and Alternative Approaches

Learning Objectives: 1. Understand the role of portal vein embolization (PVE) in cancer management
2. Provide an overview of complications associated with portal vein embolization
3. Offer alternative approaches to PVE in patients with high risk or highly vascular liver tumors

Background: Preoperative PVE is indicated in patients undergoing liver mass resection. Embolization of the portal vein redirects blood flow to remaining portions of the liver not removed by surgery, resulting in hypertrophy in future liver remnants (FLR). PVE is generally well-tolerated, with a major complication rate of approximately 2-3%, mostly involving portal vein thrombosis, infection, or hemobilia. Although PVE is generally an effective procedure, there may be certain complications in patients with hypervascular or exophytic tumors. In these patients, portal vein embolization may pose certain risks.

Clinical Findings/Procedure Details: Through a case-based discussion, this exhibit will outline complications, procedural details, and alternative approaches in patients undergoing preoperative portal vein embolization for high-risk liver tumors. In this exhibit, we will describe a rare case at our institution: a patient with spindle cell mass of the liver was referred to interventional radiology by hepatobiliary surgery for portal vein embolization prior to planned resection. Two weeks following PVE, the patient presented with severe RUQ pain. Imaging studies revealed rupture of the spindle cell mass.

Conclusion and/or Teaching Points: This clinical case describes the second ever tumor rupture status post portal vein embolization that has been established in medical literature. Although uncommon, tumor ruptures must be considered as a potential complication when performing PVE. Interventional radiologists should consider alternative approaches such as Y90 radiation lobectomy instead of PVE in patients with hypervascular tumors located in a subscapular or exophytic position. In our exhibit, we hope to use a case-based approach to demonstrate PVE indications, complications, and alternative approaches that interventional radiologists may utilize in patients with high-risk tumors.