Having a portal vein embolisation (PVE)

What is portal vein embolisation?

Portal vein embolisation (PVE) is a procedure performed under general anaesthetic in which part of the blood supply to the liver is deliberately blocked (embolised). This is usually done prior to surgery to remove a tumour in your liver. This procedure is carried out in some patients to increase the likelihood that surgery can take place.

How is PVE done?

A specially trained doctor called an interventional radiologist will perform the procedure.

They have special expertise in using imaging for diagnosis, to perform procedures and administer treatment.

The procedure involves passing a small tube (catheter) through the skin in the abdomen into the liver. Medical glue is used to block the blood supply to the side of the liver containing the tumour.

The benefits of having a PVE

PVE is usually done because your surgeon is planning to remove a tumour from your liver.

Often a significant amount of normal liver must be removed along with the tumour. The body requires a certain amount of liver to carry out important functions and sometimes people cannot have surgery to remove the tumour as there would not be enough liver remaining afterwards.

PVE takes advantage of the fact that the liver regrows under certain circumstances. Deliberately blocking the blood supply to the side of the liver which contains the tumour causes the remaining liver to grow. This increases the amount of liver that will be left following the surgery and means that the tumour can be removed.

Risks and side effects

PVE is a safe medical procedure with a risk of serious complications of less than 1%, but some risks and complications can arise.

It is normal to feel tired, weak and to have a low fever following the procedure. This is due to the body’s response to the blockage of blood supply to the liver and tumour. This should settle and requires no treatment except drinking fluids and taking over the counter painkillers if you need these.

Very rarely, the material used to block the blood vessel can travel to the part of the liver which would not be removed by the surgeon. This could potentially prevent the liver from growing adequately. Great care is taken to minimise this risk.

Before your procedure

You will be contacted regarding a pre-operative assessment (POA) as this is required in work-up for any procedures that require a general anaesthetic. If you haven’t heard regarding your POA appointment the week before your procedure, please contact the number below.

If you are taking warfarin or any other blood thinning medication

Please call the interventional radiology department at the Royal Free Hospital on 020 7433 8772 for further advice.

If you have any allergies or have previously had a reaction to the x-ray dye (contrast)

You must tell the radiology staff before you have the test.

Morning admissions

Please do not eat or drink anything from midnight – you can drink water for up to two hours before the procedure.

Afternoon admissions

You may eat a light breakfast but please do not eat or drink anything after 6am. You can drink water for up to two hours before the procedure.

Take your medicines as normal, with a sip of water, unless your doctor or nurse tells you not to.

On the day of the procedure

The procedure will take place in the interventional radiology department at the Royal Free Hospital.

You will be asked to give written consent before the procedure. We want to involve you in decisions about your care and treatment – please do not hesitate to ask the doctor if you have any questions at all. It is your decision to have the procedure.

You will be shown to a private cubicle and asked to change into a hospital gown. A small plastic tube (cannula) will be placed into a vein in your arm. PVE is always carried out under general anaesthetic – this will be injected through the cannula, and you will remain asleep throughout the procedure.

You will also receive an injection of local anaesthetic in the skin on the abdomen. Once numb, a different, small plastic tube is inserted into the portal vein through a tiny incision in the skin. X-ray dye will be injected to obtain pictures of the portal vein and plan the procedure.

Medical glue is then injected into the branches of the vein that supply the tumour and surrounding liver area that the surgeon plans to remove. At the end of the procedure this tube is removed.

You should expect the procedure to take about two hours, but timing varies as every patient is different.

After your portal vein embolisation

You will be taken back to a ward where you will stay in bed as instructed by the nursing staff. They will monitor you at regular intervals.

Once you have been observed for a satisfactory length of time you will be discharged home. This is usually the next day. Someone will need to take you home by car or taxi, especially if you have received sedatives, as the effect of these can last for 24 hours. Public transport is not recommended as it is not safe should you feel unwell.

What you should do when you get home

When you get home, you should:

• Rest for a minimum of 24 hours and if possible do not go to work on the day after the procedure.
• It is recommended that someone stays with you overnight.
• You can eat and drink as normal.
• Take your usual pain relief, as prescribed, if necessary.
• Continue with your normal medication as prescribed. If you take anticoagulants, restarting these will be discussed with you before you are discharged.

When will you receive your results?

You will be given an appointment for a follow up scan in about four weeks. Following this scan you will have an appointment with the surgeons to discuss whether surgery is possible.

What to do if you have a problem at home

There may be some bruising at the puncture site (the site at which the catheter is inserted) – this is usually not serious. You will feel tired and might have a low fever for three to five days. If you have any concerns, contact the radiology department on 020 7433 8772.

If you have a fever or increasing pain, go to your nearest emergency department.

Parking

Please be aware that a very limited number of parking spaces are available at the hospital.