Objective: Portal vein embolization and hepatic arterial embolization 4-6 weeks before extended hepatic resection have been shown to increase the future remnant liver volume and decrease the risk of hepatic failure after resection. Up to now no comparative studies and animal models exist, in which the regenerative potency of these two procedures is compared.
Material and Methods: The ethical committee of Hamburg University approved this study. 32 pigs were randomised into either portal vein ligation group (n=13), hepatic artery ligation group (n=13) or sham operation group (n=6). In the portal vein ligation group, 75% of the liver volume was excluded from direct portal inflow. In the arterial group, the same segments were excluded from direct arterial inflow. The completeness of the portal or arterial ligation was documented by intraoperative angiography and duplex ultrasound. 4 weeks after ligation, the pigs were sacrified and the weight of the ligated and non-ligated segments were measured. Blood samples were taken 6, 12, 24, 48, 72 h and on day 7, 14, 21 and 28 postoperatively. They include albumin, coagulation factors, AST, ALT, GLDH and platelets.
Results: Arterial ligation was followed by hypertrophy of 9 % (SD 15%) in the non ligated lobe and the ligated segments atrophied not significantly. Portal vein ligation was followed by hypertrophy of 60% (SD 31%) in the non-ligated lobe and atrophy of 12% (SD15 %) in the ligated lobe.
Conclusion: The portal ligation induces more significant hypertrophy in the non-ligated part of the liver comparing to the hypertrophy after arterial ligation. Therefore the method of choice, to increase the future remnant liver volume before extended liver resection, is the portal vein ligation or embolization.
Labarotory results after segmental portal vein ligation, segmental arterial ligation or sham operation
Arterial Ligation (n=12) Portal Ligation (n=12) Sham Operation (n=6)
AST 24h p.o. (U/l (SD)) 1552(550) 239(75) 108(19)
ALT 24h p.o. (U/l (SD)) 295(117) 88(26) 63(8)
GLDH 24h p.o. (U/l (SD)) 882(512) 24(15) 17(13)
Prothrombin time 6h p.o. (%(SD)) 68,5(5) 70{8,6} 80{6}
