Simultaneous portal vein embolization (PVE) and hepatic vein embolization (HVE) has been shown to be feasible, safe and lead to a faster growth of future liver remnant (FLR) than PVE alone. The objective of this study is to highlight different technical aspects as well as importance of embolization order. Seven patients were treated with simultaneous PVE and HVE. In three cases, HVE was performed first followed by PVE and in four cases the other way around. Portal vein branches were embolized using Glubran-Lipiodol mixture in all cases. Hepatic veins were embolized using Amplatzer II plugs sized 8–20 mm. Specific consideration was given to depth of glue penetration in the portal vein defined by visible branch order on the treated side. Six of seven patients were discharged home the same day. One patient with infected tumor necrosis died of liver failure 40 days later, otherwise there were no periprocedural clinical complications. Median glue penetration was to the 5th order (4th – 5th) when PVE was performed first and 3rd order (2nd - 4th) when PVE was performed after HVE. In one PVE first case, glue spillage was seen due to marked reduced flow in the right portal vein. There was sufficient FLR growth for subsequent surgical resection in the remaining six patients. PVE should be performed prior to HVE because the reduced flow in the portal vein after HVE leads to less deep glue penetration with presumably increased risk of contralateral spillage.

中文翻译：

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门静脉和肝静脉联合同时栓塞（双静脉栓塞）–有关栓塞顺序的技术说明

已证明同时门静脉栓塞（PVE）和肝静脉栓塞（HVE）是可行，安全的，并且比单独的PVE导致未来肝残留物（FLR）的生长更快。这项研究的目的是强调不同的技术方面以及栓塞顺序的重要性。7例患者同时接受了PVE和HVE治疗。在三种情况下，先进行HVE，然后进行PVE，在另外四种情况下进行。在所有情况下，均使用Glubran-Lipiodol混合物栓塞门静脉分支。使用大小为8–20 mm的Amplatzer II栓塞栓塞肝静脉。具体考虑了由治疗侧可见分支顺序定义的门静脉胶粘剂渗透深度。七名患者中有六名当天出院。一名感染肿瘤坏死的患者在40天后死于肝功能衰竭，否则没有围手术期的临床并发症。当首先进行PVE时，中值胶水渗透率达到第5阶（4 – 5th），而当进行HVE后进行PVE时，中值胶水渗透率达到3阶（第2 – 4th）。在第一个PVE病例中，由于右门静脉血流明显减少，可见胶水溢出。其余6例患者的FLR增长足以进行后续的手术切除。PVE应在HVE之前进行，因为HVE后门静脉血流减少会导致较少的深层胶渗透，并可能增加对侧溢漏的风险。当首先进行PVE时，中值胶水渗透率达到第5阶（4 – 5th），而当进行HVE后进行PVE时，中值胶水渗透率达到3阶（第2 – 4th）。在第一个PVE病例中，由于右门静脉血流明显减少，可见胶水溢出。其余6例患者的FLR增长足以进行后续的手术切除。PVE应在HVE之前进行，因为HVE后门静脉血流减少会导致较少的深层胶渗透，并可能增加对侧溢漏的风险。当首先进行PVE时，中值胶水渗透率达到第5阶（4 – 5th），而当进行HVE后进行PVE时，中值胶水渗透率达到3阶（第2 – 4th）。在第一个PVE病例中，由于右门静脉血流明显减少，可见胶水溢出。其余6例患者的FLR增长足以进行后续的手术切除。PVE应在HVE之前进行，因为HVE后门静脉血流减少会导致较少的深层胶渗透，并可能增加对侧溢漏的风险。