Comparing Future Liver Remnant Growth Following Double Vein Embolization in Patients who are Surgically Naïve Versus those that have Undergone Prior Partial Left Hepatectomy

Tuesday, March 7, 2023

3:54 PM – 4:03 PM

Location: Phoenix Convention Center, 221C

Presenting Author(s)

Dustin Gulizia, MD (he/him/his)

IR/DR Resident
Rush University Medical Center

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

CV

Chetan Velagapudi, MD

IR/DR resident physician
Rush University Medical Center
JC

Joshua Condon, B.S.

Medical Student
Rush University Medical Center
BK

Bobak Khalili, B.S.

Medical Student
Rush University Medical Center
RR

Rehan Riaz, MD

Assistant Professor of Radiology
Rush University Medical Center
DT

David Tabriz, MD, RPVI

Assistant Professor of Radiology
Rush University
KM

Kumar Madassery, MD

Associate Professor, Vascular and Interventional Radiology
Rush University Medical Center, Rush Oak Park
UT

Ulku C. Turba, MD FSIR

Professor, Vascular and Interventional Radiology
RUSH University Medical Center
Bulent Arslan, MD FSIR

Professor and Chair, Vascular and Interventional Service Line
Rush University Medical Center
Jordan Tasse, MD

Associate Professor, Vascular and Interventional Radiology
Rush University Medical Center

Disclosure(s):

Dustin Gulizia, MD: No financial relationships to disclose

Kumar Madassery, MD: Abbott Vascular: Consultant (Ongoing); Cook Mediical: Consultant (Ongoing); Koninklijke Philips: Consultant (Ongoing); PENUMBRA INC: Consultant (Ongoing)

Ulku C. Turba, MD FSIR: No financial relationships to disclose

Bulent Arslan, MD FSIR: Angiodynamics Inc: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing); BD Bard: Consultant (Ongoing), Speaking and Teaching (Ongoing); Blackswan Vascular Inc: Consultant (Ongoing), Ownership Interest (Ongoing), Speaking and Teaching (Ongoing); Cook Inc: Consultant (Ongoing), Speaking and Teaching (Ongoing); Medtronic Inc: Consultant (Ongoing), Speaking and Teaching (Ongoing); Penumbra: Speaking and Teaching (Ongoing)

Jordan Tasse, MD: No financial relationships to disclose

Purpose: Double vein embolization (DVE) of the liver is an emerging technique that induces hypertrophy of the future liver remnant (FLR) in patients with planned right/extended right hepatectomy for the treatment of primary or metastatic tumors to the liver.

DVE is performed by embolizing both the ipsilateral right portal and hepatic veins prior to planned hepatectomy. In some instances, a smaller 1st stage resection involving resection +/- ablation of the left hepatic lobe tumors prior to DVE, with right/extended right hepatectomy occurring after DVE and appropriate FLR growth. We are investigating whether the staged approach insults the liver parenchyma and hinders future liver remnant (FLR) hypertrophy. We compare the results of DVE on FLR growth in patients with prior partial left hepatectomy versus those that are surgically naïve.

Materials and Methods: All patients who underwent DVE at our institution between 2017 and 2022 were reviewed. Liver volumetry was evaluated by CT or MR prior to and following DVE. Subsequent growth of FLR was calculated and compared between those who underwent liver resection only after DVE, and those who underwent a surgical resection prior to liver embolization.

Results:
A total of 18 patients underwent DVE. Thirteen patients received DVE prior to any liver resection, and five patients underwent a partial left hepatic tumor resection +/- thermal ablation prior to DVE. Mean patient age was 57 years. Median follow up imaging to assess liver growth was 16 days after DVE.
Mean FLR volume increase was 264mL surgical naïve patients and 204mL for patients who underwent resection prior to DVE. The mean percentage of FLR to total liver volume (TLV) rose from 23.1% to 33.9% after embolization for the DVE-first cohort, compared with a rise of 20.5% to 28.6% for the resection-first group. Finally, the kinetic growth rate was 6.0% per week compared with 4.4% per week, respectively.
All 13 DVE-first patients underwent subsequent extensive liver resection at a median of 19 days after embolization. Only 2/5 patients underwent the planned 2nd stage extensive liver resection in the partial hepatectomy-first cohort.

Conclusion: This data suggests a liver resection and/or ablation prior to DVE may decrease the efficacy of the embolization procedure and subsequent FLR hypertrophy. More studies with increased sample sizes are needed for further evaluation.