Single-Center Retrospective Study Comparing Double Vein Embolization via a Trans-Jugular Approach with Liver Venous Deprivation via a Trans-Hepatic Approach: A Comment

Excerpt

I read with interest the recently published study by Della Corte et al. [1] on patients planned for major hepatectomy, either for primary or metastatic tumor disease. The study aims to compare the combination of portal vein embolization (PVE) and liver venous embolization, either by means of trans-hepatic plug and glue embolization (liver venous deprivation—LVD) or trans-jugular plug embolization (double vein embolization—DVE) of the (right) hepatic vein. This comparison is of interest as there is a paucity in data on which technique should be preferred, with arguments existing for both techniques. Two ongoing randomized controlled trials comparing PVE and DVE/LVD utilize either of these techniques; the French HYPER-LIV01 (Clinical trials nr NCT03841305) utilizes LVD, and the multinational Dragon 2 (Clinical trials nr NCT05428735) utilizes DVE. The current study on 36 patients showed no significant differences between the groups in terms of volumetric changes at day 11 or 26. About 80% of the patients also had liver function examination with mebrofenin scintigraphy with similar results in the two groups. Rate of resection was also similar in the two groups, with only one case of posthepatectomy liver failure. Importantly, no patients were discarded from surgery due to insufficient growth of the future liver remnant (FLR). The findings should be viewed with some caution as the study is retrospective from a single center including a limited number of patients with different liver tumors. However, the study indicates that the choice of method and route of liver vein embolization may be left up the operator to decide, and that additional glue embolization of the hepatic veins may not be a necessary adjunct. In a single large right hepatic vein without several veins close to the hepato-caval confluence, it seems pragmatic to do a single trans-hepatic puncture of the (right) hepatic vein and plug this. However, different variants of venous anatomy are common [2]. In a case with several separate veins close to the hepato-caval confluence, it seems more reasonable to access and plug these coming from the vena cava, either through trans-jugular or transfemoral access—whatever suites the anatomical angles best. Planning and thorough review of pre-procedural imaging is of great importance and should guide the choice for access. The current study supports this pragmatic approach. …