Portal Vein Embolization Patient Education

Portal Vein Embolization Patient Education

Once your oncologist, surgeon or primary doctor has decided you are a candidate for PVE, Northwestern Medicine interventional oncology radiologists and nurses join your care team.* They review your history, CT scan, MRI or PET scan, and any lab work you have had done. A physician and nurse meet with you and explain the procedure, the benefits and risks and answer any questions you have. They will assist you in scheduling this procedure.

Certain conditions may limit you from being eligible for a PVE procedure, including:

• Severely compromised liver function
• Systemic diseases, such as diabetes, that can limit the growth of the liver after the procedure
• A tumor that grows into the portal vein or an area of the liver that prevents access to your portal vein
• Dilation of the biliary system
• Renal failure

If you have any of these conditions, your care team will discuss other treatment options with you.

Day of procedure

Do not eat solid foods for six hours prior to your scheduled procedure. You may have clear liquids (no milk or dairy products) up until three hours before your scheduled PVE. If you take any routine medications, talk with your physician. These may be taken with sips of water.

Please leave all valuables, such as jewelry, credit cards and money at home. Family members may wish to bring a magazine or book to read while they wait.

After checking in with the reception staff, you will fill out some medical history forms that also ask about any medications you are taking. You’ll wait in the reception area until you are called for the procedure.

A nurse will take you to the prep and recovery area. After you have changed into a surgical gown, the nurse will take your vital signs and start an IV in your arm. A physician will meet with you to discuss the procedure, get your consent and answer any questions you have.

Next, a nurse will take you to the procedure room, where a radiology technologist and the interventional radiologist will be waiting. This skilled care team will remain in the room with you for the length of the procedure.

During the procedure

The nurse will help you lie on an exam table. You will be connected to heart and blood pressure monitors and medication will be given through your IV to help you relax. Your abdomen will be washed with a special soap and covered with sterile sheets. Numbing medicine will be injected into your right upper abdomen. You will feel some burning as the medicine is given. Once it takes effect, the area will be numb. A small needle is then inserted through your skin and into the blood vessels in your liver. The physician will use an ultrasound machine and an X-ray to guide the needle into the portal vein of your liver. A small tube, called a catheter, is then placed through the path of the needle into your portal vein.

Once the catheter is in the correct location, embolizing particles are injected into it. These particles will block the blood flow in the desired portions of your portal vein. This may cause discomfort. Tell the physician or nurse if you are having any pain. Throughout the PVE procedure, medication is given through your IV to keep you comfortable. The procedure typically takes one to two hours. Your blood pressure and pulse are checked closely during, and after, the procedure. After the PVE is complete, the catheter is removed and a bandage is used to cover the surgical site. You will then be moved to prep and recovery.

After the procedure

Once you arrive back in prep and recovery, a nurse will monitor your blood pressure and pulse. Your care team will also check the area where the needle was inserted during the procedure for bleeding or bruising. During this time, tell your nurse if you are experiencing any pain or nausea. Medications can be given to treat these symptoms.

Typically, you will remain in recovery for one to two hours. Your vital signs will be checked one last time, and you will be asked to walk a short distance with a nurse. If you feel well enough to go home, a nurse will remove your IV and you will change and be discharged for home. Before you leave, discharge instructions will be given to you, along with phone numbers of who to contact if you have questions and when to follow up with your physician.

After discharge

Your complete recovery usually takes seven to 10 days. Following discharge:

• Limit your activities and get plenty of rest.
• Do not drive for 24 hours.
• Begin to resume your normal activities the day after you leave the hospital.
• Don't engage in physical exertion or heavy lifting (greater than 10 lbs.) for the next three days.
• You may bathe or shower at any time.
• Slowly increase your physical activity.
• Depending on your job and its demands, you may return to work.
• Check your temperature twice a day for five days.
• If you were prescribed antibiotics or pain medication, be sure to take it as directed. It is normal to have some pain.
• As it heals, your puncture site should remain soft and dry.

When to call your physician

Contact your physician if you have:

• Fever over 101.5 degrees Fahrenheit for more than one day
• Pain or cramping in the abdomen not relieved by pain medication
• Severe, persistent nausea or vomiting
• Redness or red streaks around the skin wound
• Bleeding, pain or drainage at the puncture site

Follow-up care

Your surgeon will closely monitor your recovery. He or she will give you instructions about follow-up appointments, blood tests and scans that will be needed. In most cases, you will have a CT scan or MRI three to four weeks following your procedure to determine the degree of liver hypertrophy.