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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


•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. 

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.


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)


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
•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


•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.


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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