This information will help you prepare for your portal vein embolization at Memorial Sloan Kettering (MSK).
Your portal vein is a vein that carries blood from your stomach and intestines to your liver. It then splits into the left and right portal veins. These branch into smaller vessels that deliver blood throughout your liver (see Figure 1.)
An embolization is a procedure that blocks the flow of blood to an area. A portal vein embolization will block blood flow to the sections of your liver that your surgeon will resect (remove). This will be done with tiny particles that are injected into your vein (see Figure 2). When the blood flow is blocked, the sections of your liver with the tumor will get smaller. At the same time, the other sections of your liver will get bigger (see Figure 3). This is because more blood is flowing to the unblocked side.
About 3 to 4 weeks after your portal vein embolization you will have surgery to resect the part of your liver that has cancer (see Figure 4). The enlarged side of your liver will make your surgery safer for you.
Before Your Procedure
You may need to stop taking some of your medications before your procedure. Talk with your doctor about which medications are safe for you to stop. We have included some common examples below.
If you take medication that affects the way your blood clots, ask the doctor performing your procedure what to do. The doctor’s contact information is listed at the end of this resource. Some examples of these medications are:
inflammatory drugs (NSAIDs)
Whether he or she recommends you stop taking it will depend on the reason you are taking it. Do not stop taking any of these medications without talking with your doctor.
If you take insulin or other medications for diabetes, you may need to change the dose before your procedure. Ask the doctor who prescribes your diabetes medication what you should do the morning of your procedure.
Please review the information in the resource Common Medications Containing Aspirin and Other Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). It includes important information about medications you’ll need to avoid before your procedure and what medications you can take instead.
If you take any diuretics (medications that make you urinate more often), you may need to stop taking them the day of your procedure. Some examples are furosemide (Lasix®) or hydrochlorothiazide. Speak with your doctor.
If you have an allergy to contrast dye, please tell your doctor.
You must have someone 18 years or older take you home after your procedure. If you don’t have anyone, call one of the agencies below. They will provide someone to accompany you home, however there is usually a charge for this service and you will also need to provide your own transportation.
Most people are discharged the same day as their procedure but some people may need to spend the night at the hospital. We will not know if you will be discharged until after your procedure.
If you develop any illness (fever, cold, sore throat, or flu) before your procedure, please call a nurse in Interventional Radiology at 212-639-2236. A nurse is available Monday through Friday from 9:00 am to 5:00 pm. After 5:00 pm, during the weekend, and on holidays, call 212-639-2000 and ask for the Interventional Radiology fellow on call.
A staff member from Interventional Radiology will call you 2 business days before your procedure. He or she will tell you what time you should arrive at the hospital for your procedure. If your procedure is scheduled on a Monday, you will be called on the Thursday before. If you don’t receive a call by 12:00 pm the business day before your procedure, please call 212-639-5051.
If you need to cancel your procedure for any reason, please call the doctor who scheduled it for you.
- Do not eat anything after midnight the night before your procedure. This includes hard candy and gum.
- Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of water (see figure).
- Starting 2 hours before your scheduled arrival time, do not eat or drink anything. This includes water.
The Day of Your Procedure
- Take the medications you were instructed to take the morning of your procedure with a few sips of water.
- Do not apply cream or petroleum jelly (Vaseline®). You can use deodorant and light moisturizers. Do not wear eye makeup.
- Remove any jewelry, including body piercings.
- Leave all valuables, such as credit cards and jewelry, at home.
- If you wear contact lenses, wear your glasses instead, if possible. If you don’t have glasses, please bring a case for your contacts.
- A list of the medications you take at home
- Medications for breathing problems (such as inhalers), medications for chest pain, or both
- A case for your glasses or contacts
- Your Health Care Proxy form, if you have completed one
- If you use a C-Pap or Bi-pap machine to sleep at night, please bring your machine with you, if possible. If you can’t bring your machine with you, we will give you one to use while you are in the hospital.
Parking at MSK is available in the garage on East 66th Street between First and York Avenues. To reach the garage, enter East 66th Street from York Avenue. The garage is located about a quarter of a block toward First Avenue, on the right (north) side of the street. A pedestrian tunnel connects the garage to the hospital. For questions about pricing, call 212-639-2338. There are also nearby commercial garages on East 69th Street between First and Second Avenues and on East 65th Street between First and Second Avenues.
Please arrive at the main building of MSK at 1275 York Avenue between East 67th and East 68th Streets. Take the M elevator to the 2nd floor. Enter through the glass doors and check in at the desk.
Once you arrive at the hospital, doctors, nurses, and other staff members will ask you to state and spell your name and date of birth many times. This is for your safety. People with the same or similar names may be having procedures on the same day.
You will change into a hospital gown and be seen by a nurse. If you don’t have an intravenous (IV) line, your nurse will put one in.Back to top
During Your Procedure
You will be brought to a procedure room with imaging equipment. You will lie on your back on the procedure table. You will be given medication through the IV to relax you.
Your doctor will numb the area. He or she will insert a needle into the skin by your liver, in the upper right part of your abdomen (belly). Using real time x-rays (fluoroscopy) and contrast (dye), your doctor will place the needle into your portal vein and insert a catheter into it. Once the catheter is where your doctor wants it to be, the particles will be injected.
The catheter will be removed and a small dressing will be placed on the site.
Your procedure will take several hours.Back to top
After Your Procedure
After your procedure, you will be cared for in the recovery room. You will be watched for any symptoms. You may have bleeding, but it is rare.
You should not have much pain after your procedure. If you do feel pain, please tell your doctor or nurse. You can have medication to relieve it.
If you are going home the same day, your nurse will remove your IV and explain your discharge instructions to you and your caregiver.
If you are admitted overnight, you will be discharged the following day.Back to top
- You will have a computed tomography (CT) scan 3 to 4 weeks after your procedure. It will tell your surgeon how your liver has changed. The part of your liver that had the portal vein blocked should be smaller. The other part should be bigger.
- Your liver resection 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 medication
- A temperature of 100.4° F (38.0° C) or higher
- Any unexpected or unexplained side effects
- Any questions or concerns about the portal vein embolization
If you have any questions or concerns, please call Interventional Radiology at 212-639-2236. You can reach a staff member Monday through Friday from 9:00 am to 5:00 pm. After 5:00 pm, during the weekend, and on holidays, please call 212-639-2000 and ask for the fellow on call for Interventional Radiology.Back to top