Kondratiuk V. Endovascular support for expanded liver resections

Thesis is devoted to surgical treatment of patients with liver tumors with the use of preoperative embolization of the portal vein branches. The work is based on the principles of an individualized choice of embolization tactics, depending on the inherited and acquired features of the portal system and the volume of the planned extensive liver resection. On the basis of the study of the features of portal anatomy in patients with liver tumors, the portal catheter access technique was developed and introduced, and an individualized algorithm for its selection was proposed, which made it possible to increase the technical efficiency of the portal vein branches embolization by 6,5 %. The method of distal-stem segmental embolization of the portal vein branches was developed and implemented in clinical practice, which allowed to increase the clinical efficacy of the procedure by 21,2 %. The application of the proposed algorithm for endovascular preparation allowed expanding the range of resectability of patients with liver tumors by 21,8 % due to the inclusion in the group of operable patients who were considered inoperable due to the extremely small future liver remnant and reduced postoperative lethality by 4,2 % (from 8,8 % to 4,6 %) due to the reduction of the incidence of fatal postoperative liver failure