Indications for<unk>  depend on the ratio of future liver remnant (FLR) to total estimated liver volume (TELV) and liver condition. Although there is no consensus to the absolute minimum liver volume required for adequate post-resection liver function, a FLR/TELV ratio of at least 25% is recommended in patients with otherwise normal livers. The recommendation for those with chronic liver disease such as cirrhosis is a FLR/TELV ratio of at least 40%. In these patients a<unk>  may be indicated to increase the FLR and the FLR/TELV ratio. Preoperative patients receiving extensive chemotherapy with a FLR/TELV less than 30% should also receive<unk>  prior to resection; conversely, chemotherapy does not preclude subsequent<unk> . Other important considerations before a<unk>  include co-morbidities such as diabetes, procedure type and the extent of planned resection. Insulin resistance has been associated with slower rates of regeneration and higher likelihood of inadequate FLR growth after<unk> . Additionally, if the resection requires more extensive surgery such as a resections of the pancreas or small bowel, a greater FLR/TELV ratio may be needed for safe recovery. Outcomes Preoperative<unk>  is a very well tolerated procedure with extremely low<unk> ity rates (0.1 percent) and technical failure rates (0.4 percent). Complication rates from the procedure are low as well (2 – 3 percent) and include<unk>  vein thrombosis, liver infarction, necrosis, infection, pneumothorax, and other risks as listed above. Success of<unk>  is determined by degree of regenerative response, which again depends on factors such as baseline liver condition, technical approach and pre-existing co-morbidities. 5-year survival in patients with originally unresectable tumors as a result of inadequate future liver remnant and received<unk>  with subsequent resection was found in one study to be 29%. Originally, there was concern that<unk>  could promote tumor growth and increase recurrence rates, however a systematic review has found that there was no significant difference observed in postoperative hepatic recurrence or 3 and 5 year overall survival rates. This suggests that<unk>  does not have any significant adverse effects on the risk of oncogenesis. Overall,<unk>  is an important technique that can allow for patients with inadequate predicted FLR/TELV ratios an opportunity for resection and potential cure of their liver conditions.
Portal vein embolization
Hepatic artery embolization
Hepatic artery thrombosis
Portal vein thrombosis
Thrombectomy
Fibrinolysis syndrome
Percutaneous hepatic perfusion
Embolization