Ep. 660 Techniques & Outcomes of Portal Vein Embolization with Dr. David C. Madoff

How is portal vein embolization (PVE) pushing the boundaries of liver tumor resectability, and what does it take to induce hypertrophy without compromising the remnant liver? In this episode of the BackTable Podcast, interventional radiologist Dr. David Madoff of Yale University joins Dr. Michael Barraza to discuss the pathophysiological rationale, technical considerations, and emerging clinical paradigms of performing PVE to augment the future liver remnant (FLR) prior to resection and reduce the risk of postoperative liver failure. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by RADPAD® Radiation Protectionhttps://www.radpad.com/ --- Timestamps 00:00 - Introduction02:14 - IO Practice and Research07:25 - PVE Indications and Adequate FLR12:55 - Referrals and Patient Selection17:27 - PVE vs. Y90 Radiation Lobectomy22:12 - Liver Venous Deprivation25:31 - Measuring FLR Function30:11 - Procedural Planning and Technique36:36 - Preferred Embolic Agents and Challenges46:58 - Ipsilateral vs. Contralateral Access50:52 - Complications, Medications, and Follow-Up55:45 - Final Thoughts and Closing Remarks --- More about this episode The physicians dissect the anatomic and oncologic benchmarks used to select PVE candidates, including FLR volumetric thresholds for normal, steatotic, and cirrhotic livers. Dr. Madoff walks through his procedural technique, detailing catheter maneuvers and embolic administration, emphasizing the importance of evaluating for anatomic variants, and explaining the benefits of using an ipsilateral approach to protect the FLR. The doctors critique ongoing debates in hepatic augmentation, assess the complementary relationship between PVE and Y90 radioembolization, and discuss the outcomes and risks associated with different embolic agents. They stress the importance of patient selection and assessment protocols that go beyond static volumetric measurements to incorporate functional parameters for better prediction of regenerative kinetics and clinical outcomes. The episode concludes with a review of postprocedural follow-up and potential complications, highlighting the importance of considering pathophysiologic dynamics of both the tumor and the anticipated liver remnant to ensure successful treatment. --- Resources DRAGON Trialhttps://www.dragontrial.com/ Three hundred and one consecutive extended right hepatectomies: Evaluation of outcome based on systematic liver volumetryhttps://doi.org/10.1097/SLA.0b013e3181b674df Portal vein embolization with N-butyl-cyanoacrylate improves liver hypertrophy compared to microparticles – A Swedish multicenter cohort studyhttps://doi.org/10.1016/j.heliyon.2023.e21210 --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app