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SIR 2026

Scientific Session

Interventional Oncology

Session: Portal Hypertension 1

178 - Portal Vein Embolization with Traditional Technique: A Contemporary Report on Success Rate, Predictors of Failure at a High-Volume Center

Monday, April 13, 2026
4:21 PM - 4:30 PM ET
Purpose: Major hepatectomy for liver malignancies can be limited by an inadequate future liver remnant (FLR), increasing the risk of post-hepatectomy liver failure. Portal vein embolization (PVE) is used to induce hypertrophy in patients with small FLR but otherwise resectable tumors. PVE techniques continue to evolve, with recent studies suggesting that N-butyl cyanoacrylate and/or hepatic vein embolization achieve greater hypertrophy than traditional PVE with microspheres and coils. This study evaluated contemporary outcomes of traditional PVE at a high-volume tertiary cancer center.

Materials and Methods: A retrospective review was performed of patients undergoing PVE prior to major hepatectomy between 2015–2023 using microspheres and coils. Patient, tumor, and liver function characteristics were collected. Baseline and post-PVE liver volumetry were measured using 3D software. Successful hypertrophy was defined as achieving delta degree hypertrophy (DDH), the required FLR% increase to meet target FLR volume based on baseline liver function (25% for normal, 30% for preoperative chemotherapy or steatohepatitis, and 35% for cirrhosis).

Results: Eighty-three patients (49 male, 34 female; median age 62) were included. Colorectal liver metastases were most common (51%), followed by primary liver cancers, HCC and ICC (30%). 67% of patients received systemic chemotherapy prior to PVE. At baseline, 81% had normal liver function and 19% had NASH or cirrhosis. Median hypertrophy was 11%, median kinetic growth rate 2.49%/week, and successful hypertrophy occurred in 96%. Liver resection was completed in 75 patients (90%). On univariate analysis, DDH was the only significant predictor of success (p< 0.001). ROC analysis showed that DDH ≤9% predicted 100% success, whereas thresholds above 9% lost predictive reliability.

Conclusion: Traditional PVE with microspheres and coils achieved 96% success at a high-volume center, comparable or slightly better compared to outcomes reported with glue and/or hepatic venous deprivation. Adjunct hypertrophy techniques may be warranted in patients requiring DDH >9%.