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Portal Vein Embolization, Liver Venous Deprivation, and DRAGON Trial Data

Portal Vein Embolization, Liver Venous Deprivation, and the DRAGON Trial Data

This episode synthesizes the latest CIRSE standards and DRAGON trial findings to guide Interventional Radiologists in maximizing the Future Liver Remnant (FLR) and minimizing Post-Hepatectomy Liver Failure (PHLF).

  • The Limitation of Standard PVE: We discuss why Portal Vein Embolization (PVE) alone often isn't enough, with a sobering 15-20% failure rate where patients never reach resection due to insufficient hypertrophy or tumor progression.

  • The "Combined" Solution (DVE/LVD): The discussion explores why adding Hepatic Vein Embolization (HVE) to block outflow prevents collateral formation ("the enemy of hypertrophy"), creating a faster, more robust regenerative signal.

  • DRAGON 0 Results: The retrospective data is a game-changer: combined embolization achieved a 92% resectability rate (compared to just 68% for PVE alone) and significantly better long-term survival.

  • The Paradox of Speed: While the prospective DRAGON 1 trial showed massive growth speed (Kinetic Growth Rate of 8.3% per week), it revealed a critical warning: 22% of patients still developed liver failure despite hitting volume targets.

  • The New Standard: The takeaway is clear—Volume does not equal Function. To prevent failure in these rapidly regenerated livers, we must move beyond simple volume ratios and demand functional assessments like KGR and mebrofenin scintigraphy before surgery.

Tune in to understand why "making volume" isn't enough and how functional assessment is the new safety frontier.

 

Based on comments from experts, content on Wysdom, and the articles cited below.

Bilhim T, et al. CIRSE Standards of Practice on Portal Vein Embolization and Double Vein Embolization/Liver Venous Deprivation. Cardiovasc Intervent Radiol. 2024 Aug;47(8):1025-1036. doi: 10.1007/s00270-024-03743-8. Epub 2024 Jun 17. PMID: 38884781; PMCID: PMC11303578.

Korenblik R, et al., DRAGON collaborative study group. Safety and efficacy of combined portal and hepatic vein embolisation in patients with colorectal liver metastases (DRAGON1): a multicentre, single-arm clinical trial. Lancet Reg Health Eur. 2025 Apr 10;53:101284. doi: 10.1016/j.lanepe.2025.101284. PMID: 40255933; PMCID: PMC12008670.

 Korenblik R, et al., DRAGON trials collaborative. Liver regeneration after portal and hepatic vein embolization improves overall survival compared with portal vein embolization alone: mid-term survival analysis of the multicentre DRAGON 0 cohort. Br J Surg. 2024 Apr 3;111(4):znae087. doi: 10.1093/bjs/znae087. PMID: 38662462; PMCID: PMC11044894.