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Portal Vein Embolization

This information will help you prepare for your portal vein embolization at Memorial Sloan Kettering Cancer Center (MSKCC). 

Introduction

An embolization is a procedure that blocks the flow of blood to an area. This booklet describes a portal vein embolization. The portal vein carries blood from the stomach and intestines to the liver. It then branches into the left and right portal veins. These branch into smaller vessels that deliver blood throughout the liver. (See Figure 1.)

The procedure blocks the flow of blood to an area of the liver. Tiny particles are injected into the vein. (See Figure 2.) This blockage redirects the blood flow to the side of the liver that is not being embolized. This makes that side grow. This enlarged side will make your surgery safer for you. (See Figure 3.) The sections of the liver that no longer receive a supply of blood get smaller. In about three to four weeks, your surgeon will remove these sections with the tumor. (See Figure 4.)

Figures 2, 3, and 4: These figures show a tumor in the right lobe of the liver. The right lobe will be removed during surgery. During the embolization, the right portal vein is blocked. This causes the lobe to get smaller. The left lobe will grow. That makes recovery after surgery easier.

A doctor in the Department of Radiology will do the embolization. These doctors are interventional radiologists. He or she will work closely with your primary doctor. Your primary doctor will direct your overall care.

Preparation

Please follow these instructions:

  • Review the aspirin card. Your nurse or doctor's office staff will give you this card. It tells you what products have aspirin and anti-inflammatory drugs. It also tells you when to stop taking them and what you can take instead.
  • Ask your primary doctor what to do if you take:
    • Blood thinners such as warfarin (Coumadin®) or clopidogrel (Plavix®), cilostazol (Pletal®), or injectable heparin
    • Medicine for diabetes
    • Aspirin to prevent a stroke or heart attack

If your doctor has any questions, ask him or her to call interventional radiology. The number is listed at the end of this booklet.

  • Call your doctor if you develop any illness within two days of your procedure. This includes a fever, cold, flu, or a sore throat.
  • Do not eat solid food after midnight the night before your procedure.
  • You may eat or drink clear liquids up to 1 hour before your procedure. These include:
    • Water
    • Apple or cranberry juice
    • Coffee or tea without milk
    • Jell-O®

If you are coming in from home for your procedure, you will receive two telephone calls one business day before your procedure. If your procedure is on a Monday, you will be called on Friday. It is important that we have a phone number where we can reach you. It could be your home, office, hotel, or cell phone. If you give us your cell phone number, make sure the phone is charged and turned on.

A nurse will call you between 8:00 am and 7:00 pm to:

  • Review your instructions
  • Confirm information about your procedure
  • Complete a brief assessment
  • Answer your questions
  • Tell you where you should go

If you do not receive a call by 7:00 pm, please call (212) 639-6689.

Someone from the Admissions Center will call you between 3:00 pm and 7:00 pm to:

  • Tell you when to arrive

If you do not receive this call by 7:00 pm, please call (212) 639-7881.

On the day of the procedure, please be aware that many things can impact the start time of your procedure. The procedure before yours may last longer than expected. An emergency may need to be done in the room you are scheduled for. If there is a delay in your start time, we will let you know.

Procedure Day

Enter the hospital through the 1275 York Avenue entrance. Take the escalator to the main floor and turn left to the “C” elevators. Go to the 6th floor and check in with the concierge. You will change into a hospital gown and be seen by a nurse. An intravenous (IV) line will be placed in a vein in your arm. When it is time for your procedure, you will be escorted to the Department of Radiology. You will be admitted to the hospital for one to two days after the procedure.

Procedure

  • The procedure takes several hours.
  • You will be assisted onto an x-ray table and will lie on your back.
  • Your blood pressure, heart rate, and oxygen levels will be checked throughout the procedure.
  • You will be given medicine through the IV to relax you, but you will not be asleep.
  • The doctor will numb the area and insert a needle into the portal vein.
  • A guidewire will be inserted through the needle. A small catheter is then threaded along the guidewire. Once the catheter is where the doctor wants it to be, the particles will be injected.
  • The doctor will use images taken during the procedure to confirm that all blood flow to that area of the liver has stopped.
  • The catheter will be removed and a small dressing will be placed on the site.

Aftercare

  • You will recover in the Pre-Surgical Center.
  • Pain after a portal vein embolization is not very common. If you do feel pain, please tell your doctor or nurse. You can have medicine to relieve it.
  • After several hours, you will be taken to your room. You will be watched overnight for any symptoms. Bleeding could occur, but it is rare.

Follow-Up Care

  • You will see your doctor about two weeks after discharge.
  • Three to four weeks later you will have a computed tomography (CT) scan. It will tell the surgeon how the liver has changed. The part that had the portal vein blocked should be smaller. The other part should be bigger.
  • Surgery will be scheduled around this time.

Call Your Doctor Or Nurse If You Have:

  • Pain that is worse, new, or not relieved by your medicine
  • A fever of 101.4° F (38.3° C) or higher
  • Any unexpected or unexplained side effect
  • Any questions or concerns about the portal vein embolization