In 1920, Rous first observed ligated lobe atrophy and un-ligated lobe regeneration after ligation of one branch of the portal vein in rabbit. In 1975, Honjo reported on portal vein ligation in HCC patients. In 1986, Kinoshita first utilized PVE to control tumor progression in HCC patients who failed TACE and accidently discovered that the non-embolized lobe regenerated. In 1987, a preoperative selective PVE of the right PV was applied in an extended right hemihepatectomy of a liver tumor metastasis. In 1990, Mukuuchi first used PVE in a major hepatectomy for hilar cholangiocarcinoma. Preoperative PVEs were infrequently performed in Japan and France in the 1990s, with global adoption of the technique being a recent event. This method extends the indications of liver resection, increases the safety of surgery, and reduces complications, which explains why PVE has been widely adopted [1, 4–7].

The ideal embolic agents for PVE should be economical, nontoxic, permanent, complete, non-recanalizing, and radiopaque. There are many current options, such as gelatin sponges, dehydrated alcohol, polyvinyl alcohol (PVA), and steel bands. Recanalization is guaranteed with the use of a gelatin sponge with fibrin sealant. Periportal fibrosis, which can make the following surgery difficult, is frequently impermanent, and various degrees of stomachache can occur following the use of dehydrated alcohol. PVA for distant branches and springs for the proximal portal vein are stable and permanent and also contribute to the regeneration of the FLR after PVE and preventing PVA contraflow; however, these methods can result in peripylephlebitis.

There are two main procedures for PVE: percutaneous transhepatic portal vein embolization (PTPE) by ultrasound and transileocolic portal embolization (TIPE) [11, 12].