63 - Safety and Outcomes of Combined Portal and Hepatic Vein Embolization (Venous Deprivation)

To evaluate the adverse event (AE) profile of combined portal vein (PV) and hepatic vein (HV) embolization (PVE/HVE, also known as Double Vein Embolization or Liver Venous Deprivation) for patients with primary and secondary hepatic malignancies treated to induce hypertrophy in the future liver remnant (FLR).

Materials and Methods:

A retrospective, single-center analysis was performed in 43 patients (median age 62 years) undergoing single-session PVE/HVE between 2019 and 2024. Malignancies included colorectal liver metastases (N=16), perihilar cholangiocarcinoma (N=11), other liver metastases (N=6), intrahepatic cholangiocarcinoma (N=5), hepatocellular carcinoma (N=4), and benign biliary stricture (N=1). Baseline characteristics included median performance status of 0 (range: 0-2), prior chemotherapy in 29 (67%), biliary stent in 17 (40%), prior cholangitis in 7 (16%), and cirrhosis in 4 (9%). All PVEs were performed via ipsilateral access using nBCA; all HVEs were performed using plugs with or without nBCA. Primary outcomes were intra- and post-procedural AEs graded by the SIR classification. Secondary outcome was surgical resection rates. Logistic regression analysis was performed to identify factors that affect probability of Grade 3+ AEs.

Results:

HVE was performed via transhepatic access (N=28; 65%) or transjugular access (N=15; 35%). Additional accessory right HV branches were embolized in 12 patients (28%). Intra-procedural AEs were limited to Grade 1-2, including glue pulmonary embolism (N=3), perihepatic hematoma (N=2), retrieved inadvertent middle HV plug deployment (N=1), and nontarget glue in the FLR PV (N=1). Grade 3+ post-procedural AEs were observed in 6 patients (14%), all in patients with perihilar cholangiocarcinoma: cholangitis (N=5), peribiliary abscess (N=4), subcapsular biloma (N=2), and peritonitis of unknown origin resulting in death 32 days later (N=1). Performance status, baseline bilirubin, prior cholangitis, and transhepatic HV access did not increase probability of Grade 3+ AEs in patients with perihilar cholangiocarcinoma (p >0.05). Excluding 5 patients pending surgical candidacy evaluation, 26 (68%) completed surgical resection. Reasons for failure to resect were disease progression (N=6), ongoing cholangitis (N=4), and declining performance status (N=2).

Conclusion:

PVE/HVE is generally safe for patients with primary and metastatic hepatic malignancies. However, patients with perihilar cholangiocarcinoma are at increased risk for severe cholangitis-related AEs which jeopardize candidacy for resection.