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Doppler Sonography of Hepatic Arterial Blood Flow Velocity After Percutaneous Transhepatic Portal Vein Embolization

¹ All authors: First Department of Surgey, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.

OBJECTIVE. This study was conducted to elucidate the changes in hepatic arterial blood flow after portal vein embolization.

SUBJECTS AND METHODS. We prospectively measured the flow velocity and resistive index of the common, right, and left hepatic arteries, using Doppler sonography, in 21 patients who underwent embolization of the right portal vein. The measurements were performed before and 1, 3, 5, 7, and 14 days after embolization. We assessed the changes in liver volume with a volumetric study using CT.

RESULTS. After embolization, flow velocity in the common hepatic artery increased significantly (p < 0.0001). Flow velocity in the right hepatic artery also increased significantly (p < 0.0001), with a significant decrease in resistive index (p < 0.0001). The flow velocity and resistive index of the left hepatic artery were unchanged. The increase in flow velocity in the right hepatic artery significantly correlated with that in the common hepatic artery (r = 0.514, p < 0.05). The calculated volume of the embolized right hepatic lobe significantly (p < 0.0001) decreased, from 685 ± 32 cm³ before embolization to 568 ± 28 cm³ after embolization. The atrophy rate of the right hepatic lobe significantly correlated with the increase in flow velocity in the right hepatic artery (r = 0.700, p < 0.0005).

CONCLUSION. Portal vein embolization induces an increase in hepatic arterial blood flow velocity in the embolized hepatic segments, resulting from an increase in common hepatic arterial flow, but not from a steal phenomenon due to decreased hepatic arterial blood flow in the nonembolized hepatic segments. This observation may be explained by the simple mechanical effect of interposing a slower flowing stream (portal flow) in the path of a faster flowing stream (arterial flow).

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