Portal Vein Embolization

Surgery is an option for people with an early stage of liver cancer. The surgeon may remove the whole liver or only the part that has cancer.

Portal vein embolization is a preoperative procedure for large volume liver resection in patients with liver cancer. The Portal Vein is blocked (embolized) to decrease the size of diseased liver to be removed and increase the size of the liver that will remain. It is generally recommended by your surgeon.

How do I prepare for the procedure?

You will be scheduled for a consultation with the Interventional Radiology Team. Bring a list of questions to ask your doctor. It is important that you understand exactly what procedure is planned, the risks, benefits and other options before your procedure.

What happens during the procedure?

Conscious sedation is provided prior to and throughout the procedure. You will lie flat on the x-ray table and will be connected to several types of monitoring equipment.  The technologist will prepare the skin over your abdomen by cleaning it with an antiseptic solution and place sterile drapes and towels over you to create a sterile work place. Ultrasound of the liver is performed to determine the best access route into the portal venous system. Under sterile conditions, access into the portal venous system is gained with US or fluoroscopic guidance or both. The procedure is performed with fluoroscopy.

Lidocaine local anesthetic is injected into the skin overlying the right internal jugular vein in the neck and the right femoral artery in the groin.  Contrast dye is injected to allow visualization of the arteries which supply the pancreas.  The contrast causes a brief mild warm feeling as it enters your bloodstream.  During the test the Interventional Radiologist may ask you to hold your breath for five to fifteen seconds.  In addition, you may be asked to lie perfectly still to prevent sudden movement from blurring the x-ray pictures.

The Interventional Radiologist then injects particles into the Portal Vein ramifications to cause its blockage (embolization). When the procedure is completed, the catheter is removed and pressure is applied over puncture site until there is no bleeding (approximately 15 minutes).The procedure takes about one to two hours.
                               
What happens after the procedure?

You will be required to stay to recover for two to four hours after the end of the procedure. While in recovery, you will be monitored closely for signs of bleeding and to ensure that the effects of the sedation have worn off.  You must have a responsible adult to drive/escort them home from the hospital.

Going home:

Patients should refrain from lifting more than ten pounds, refrain from strenuous activity or anything which causes abdominal distension for the following 48-72 hours.  Any straining such as vomiting, coughing, or forced bowel movements could dislodge the clot that forms to seal the site and cause bleeding.  If you notice any signs of bleeding such as bulging under the skin the size of a golf ball, put direct pressure to the area and go to the nearest emergency room or call 911 for assistance.  Do not take a tub bath, go in a hot tub or submerge in water for five days.  Report any signs of infection (redness swelling, discharge and fever) to your doctor.  At home you can eat normally but you should drink extra fluids for one to two days following the procedure.  The results of your hepatic venous sampling will be sent to your primary care physician who will then contact you.

If you need to reschedule your appointment please call the Interventional Radiology Department directly at (802) 847 3663.

If you have any questions or need to reschedule an appointment please feel free to contact the Interventional Radiology Office at 802- 847-8359. Our business hours are Monday – Friday 8:30 a.m. to 5 p.m. Someone is available to take your call after hours for emergencies.

This information is provided by the Fletcher Allen Health Care, Department of Radiology, Division of Interventional Radiology and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact your health care provider.