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Safety and Efficacy of Preoperative Portal Vein Embolization with Polyvinyl Alcohol in 58 Patients with Liver Metastases

Anne M. Covey1, Scott Tuorto2, Lynn A. Brody1, Constantinos T. Sofocleous1, Johanna Schubert1, Hendrik von Tengg-Kobligk1, George I. Getrajdman1, Lawrence H. Schwartz1, Yuman Fong2 and Karen T. Brown1

1 Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.
2 Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.



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  		Fig. 1A —47-year-old man. Portal venogram through multi-side-hole catheter in main portal vein before right portal vein embolization.

 


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  		Fig. 1B —47-year-old man. Portal venogram shows segmental branches of right portal vein that were selected with end-hole catheter and embolized to stasis with 200-µm of polyvinyl alcohol.

 


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  		Fig. 1C —47-year-old man. Portal venogram obtained after successful embolization shows there is no residual flow in right portal vein.

 


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  		Fig. 1D —47-year-old man. CT image obtained after right hepatectomy shows hypertrophied remnant left liver.

 


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  		Fig. 1E —47-year-old man. Contrast-enhanced CT images at level of left portal vein (E) and middle hepatic vein (white line, G) before right portal vein embolization. After right portal vein embolization, CT images obtained at same levels (F and H, respectively) show hypertrophy of left hemi-liver. White line in H points to plane of middle hepatic vein.

 


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  		Fig. 1F —47-year-old man. Contrast-enhanced CT images at level of left portal vein (E) and middle hepatic vein (white line, G) before right portal vein embolization. After right portal vein embolization, CT images obtained at same levels (F and H, respectively) show hypertrophy of left hemi-liver. White line in H points to plane of middle hepatic vein.

 


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  		Fig. 1G —47-year-old man. Contrast-enhanced CT images at level of left portal vein (E) and middle hepatic vein (white line, G) before right portal vein embolization. After right portal vein embolization, CT images obtained at same levels (F and H, respectively) show hypertrophy of left hemi-liver. White line in H points to plane of middle hepatic vein.

 


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  		Fig. 1H —47-year-old man. Contrast-enhanced CT images at level of left portal vein (E) and middle hepatic vein (white line, G) before right portal vein embolization. After right portal vein embolization, CT images obtained at same levels (F and H, respectively) show hypertrophy of left hemi-liver. White line in H points to plane of middle hepatic vein.

 


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  		Fig. 2A —78-year-old man. Contrast-enhanced CT images at level of middle hepatic vein (white line) before (A) and after (B) left portal vein embolization.

 


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  		Fig. 2B —78-year-old man. Contrast-enhanced CT images at level of middle hepatic vein (white line) before (A) and after (B) left portal vein embolization.

 


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  		Fig. 2C —78-year-old man. Postembolization portal venogram obtained with catheter in main portal vein shows good embolization of left portal vein.

 


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  		Fig. 2D —78-year-old man. CT image after left trisegmentectomy shows right posterior sector remnant.

 

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