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CRA05
Portal Vein Embolisation (PVE): A Re-audit & Service Evaluation

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Portal Vein Embolisation (PVE): A Re-audit & Service Evaluation.

S Scullion, T Ali, N Shaida, T C See - Addenbrooke’s Hospital, University of Cambridge

Background:

•PVE with consequent hypertrophy of the unaffected liver is used when predicted remnant liver size following liver resection, or Future Liver Remnant (FLR), is small - i.e. <25 % of the total liver volume.
•Inducing hypertrophy of the FLR reduces the risk of post-operative liver failure.
•Unnecessary delays can result in disease progression and postponement of planned surgery. 

Aims:
1.Assess adherence of our PVE technique to guidelines in ‘CIRSE 2010 quality improvement for PVE’.
2.Ensure no significant delays in performing PVE, which risk disease progression. 

Targets and Methods:

PVEs between 2011-14 retrospectively identified, then re-audited between 2015-16. Electronic medical records then interrogated for key dates (MDT decision for PVE, procedure request, PVE performed, CT f/u) and adherence to CIRSE guidelines.

Results:

35 PVEs:

•97.1% technical success (1 repeat)
•No major and 8.6% minor complications (2non-targetembolisationand1 non-significant PV dissection)
•79.4% had surgery (27/34, 1 awaited)

Delays:

Average time from MDT to performing PvE was 23.4 days – a non-significant difference from previous despite:

•Reducing clinician time to request (9.8 v 13.5 days)
•Appointing a second operator
 
Action:
 
•Feedback to referring clinicians regarding appropriate and timely referrals
•Streamline CT volumetry reporting to ensure timely availability for MDT decision
•Re-audit in 2 years

Conclusion:

•Minimising the delays toperformingPVEpotentiallyincreases the numbers of patients eligible for curative treatment.
•Re-audit has revealed that delay toPVEfromrequestis 23.4 days, not significantly different from the previous audit (24.2 days) despite reducing the times for clinicians to request the procedure (9.8 v 13.5 days) and the appointment of a second operator.
•Increased departmental workload?
•More patients had surgery (79.4% v 70.6%), although this still fails to meet the 85% standard.
 

References:

Madoff DC et al. Transhepatic Portal Vein Embolization: Anatomy, Indications, and technical considerations. Radiographics. 2002 Sep-Oct;22(5):1063-76
CIRSE guidelines (2010): Denys A et al. Quality improvement for portal vein embolization.
CardiovascInterventRadiol. 2010 Jun;33(3):452-6
Avritscher R et al. Percutaneous transhepatic portal vein embolization: rationale, technique, and outcomes. SeminInterventRadiol. 2008 Jun;25(2):132-45.

 

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