Liver Venous Deprivation for Rapid Liver Hypertrophy before major Hepatectomy: A Case Report

Liver Venous Deprivation (LVD) is an emerging minimally invasive strategy to induce rapid liver hypertrophy of the Future Liver Remnant (FLR) before a major hepatectomy. LVD (aka “double vein embolization”) entails same-session percutaneous embolization of the portal and hepatic veins of the planned liver resection. This report discusses the utilization and technical challenges of LVD in managing of a 49-year-old male with recurrent multifocal Colorectal Liver Metastases (CRLM). The patient initially underwent neoadjuvant FOLFOX chemotherapy followed by a simultaneous laparoscopic sigmoid colectomy and liver surgery (microwave ablation of segment 5^th, and wedge resections of segment 1^st and 4^thb), followed by completion of chemotherapy. The patient had a R0 resection with clear colon and liver surgical margins. Nine months after the initial surgery, the patient had a rise in tumor markers, and surveillance imaging demonstrated recurrence of liver metastases in segments 1^st and 5^th. LVD was performed by interventional radiology, which led to 28% increase in FLR (segments 2^nd, 3^rd, and 4^th); initially measuring 464 cm3 prior to LVD and measuring 594 cm3 by post-procedure day 21. The patient underwent right hemi-hepatectomy and caudate resection on post-procedure day 29. The patient did not have any complication and discharged on postoperative day six. The patient remains disease-free with no evidence of recurrence at twelve months follow up.