Imaging-guided interventions modulating portal venous flow: Evidence and controversiesKey points
Roberto Cannella,
Lambros Tselikas,
Fréderic Douane,
François Cauchy,
Pierre-Emmanuel Rautou,
Rafael Duran,
Maxime Ronot
Affiliations
Roberto Cannella
Université Paris Cité; AP-HP, Hôpital Beaujon, Service de Radiologie, Clichy; Centre de Recherche sur l'inflammation Inserm, UMR 1149, Paris, France; Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90127 Palermo, Italy
Lambros Tselikas
Department of Anesthesiology, Surgery and Interventional Radiology, Gustave Roussy, Villejuif, France; Biotheris, CIC 1428 Inserm, Gustave Roussy, Villejuif, France; Université Paris – Saclay, Saint Aubin, France
Fréderic Douane
Service de Radiologie, CHU Nantes, Nantes, France
François Cauchy
Université Paris Cité; AP-HP, Hôpital Beaujon, Service de Chirurgie HBP, Clichy, France
Pierre-Emmanuel Rautou
Université Paris Cité, AP-HP, Hôpital Beaujon, Service d'Hépatologie, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Centre de Recherche sur l'inflammation Inserm, UMR 1149, Paris, France
Rafael Duran
Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
Maxime Ronot
Université Paris Cité; AP-HP, Hôpital Beaujon, Service de Radiologie, Clichy; Centre de Recherche sur l'inflammation Inserm, UMR 1149, Paris, France; Corresponding author. Address: Hopital Beaujon, 100 boulevard du Général Leclerc, 92119 Clichy, France; Tel.: +33 1 40 87 55 66, fax: +33 1 40 87 05 48.
Summary: Portal hypertension is defined by an increase in the portosystemic venous gradient. In most cases, increased resistance to portal blood flow is the initial cause of elevated portal pressure. More than 90% of cases of portal hypertension are estimated to be due to advanced chronic liver disease or cirrhosis. Transjugular intrahepatic portosystemic shunts, a non-pharmacological treatment for portal hypertension, involve the placement of a stent between the portal vein and the hepatic vein or inferior vena cava which helps bypass hepatic resistance. Portal hypertension may also be a result of extrahepatic portal vein thrombosis or compression. In these cases, percutaneous portal vein recanalisation restores portal trunk patency, thus preventing portal hypertension-related complications. Any portal blood flow impairment leads to progressive parenchymal atrophy and triggers hepatic regeneration in preserved areas. This provides the rationale for using portal vein embolisation to modulate hepatic volume in preparation for extended hepatic resection. The aim of this paper is to provide a comprehensive evidence-based review of the rationale for, and outcomes associated with, the main imaging-guided interventions targeting the portal vein, as well as to discuss the main controversies around such approaches.