Portal Vein Embolisation

Who is Portal Vein Embolisation (PVE) suitable for?​

 

Portal Vein Embolisation (PVE), or Double Vein Embolisation (DVE) or Liver Venous Deprivation (LVD), are offered to patients who require a major liver resection for cancer but whose remaining liver volume or function is not yet sufficient.

These techniques are most commonly used for:

• Colorectal liver metastases (CRLM)

• Hepatocellular carcinoma (HCC)

• Cholangiocarcinoma (bile duct cancers)

They may also be considered before extended or repeat hepatectomies for other liver tumours.

You may be a candidate if:

• Your surgical team recommends a major liver resection but your future liver remnant (FLR) is below safe thresholds.

• You are otherwise fit for surgery, without major infection or portal vein thrombosis.

• Your case has been discussed at a multidisciplinary tumour board (MDT) involving surgeons, oncologists, hepatologists, and interventional radiologists.

Our Specialist IRs regularly attend MDTs and are happy to discuss your case with other specialists.

PVE may not be suitable if:

• There is extensive tumour in both lobes.

• The portal vein is blocked by tumour or clot.

• There is uncontrolled bleeding tendency or severe infection.

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Procedure

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1. Consultation:
   Before the procedure, you will meet your Interventional Radiologist to review scans, discuss the plan, and go through the benefits and potential risks. Your imaging, medical history, and blood results will be reviewed carefully to ensure you are ready for treatment.
    

2. Preparation:
   Routine blood tests are performed to check liver function and blood clotting. If you have jaundice, bile duct drainage may be recommended first to optimise recovery. You may be asked to stop certain medications (such as blood thinners) and will be required to fast for several hours before the procedure.
    

3. Embolisation:
   PVE is performed under sedation or light general anaesthesia in a specialised interventional radiology suite. Using ultrasound and X-ray guidance, a fine needle and catheter are introduced through the skin into the portal vein. Depending on the technique tailored to your particular case, small plugs, particles or medical glue are used to block the vein branches supplying the liver lobe to be removed. Current evidence shows that using medical glue achieves faster and more reliable liver growth compared with other materials, and this is the standard technique used at Specialist IR.
   Once complete, the catheter is removed and a small dressing applied — no stitches are required.
   The procedure typically takes 60–120 minutes, and most patients stay overnight for observation.
    

4. Post-operative care:
   You will be monitored in recovery before returning to the ward. Mild right-sided discomfort, fatigue or low-grade fever for a day or two is common and easily managed with simple pain relief. Most patients resume light activity within a few days. A CT or MRI scan is performed about 4 weeks later to measure liver growth before surgery.

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Benefits

 

• Improves surgical safety: increases the healthy liver portion to prevent post-operative liver failure.

• Minimally invasive: performed through a tiny skin puncture with a short hospital stay.

• Proven success: over 90 % of patients achieve sufficient growth to proceed to surgery.

• Repeatable and adaptable: can be safely repeated or combined with other liver-directed therapies.

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Risks and Side Effects

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Portal Vein Embolisation (PVE), as well as DVE and LVD, are generally very safe, with a low rate of complications.

Common minor effects:

• Mild abdominal discomfort or fatigue

• Low-grade fever (“post-embolisation syndrome”)

Uncommon or rare risks (≈ 2–3 %):

• Bleeding or infection

• Small bruise or haematoma at the puncture site

• Portal vein thrombosis (rare)

• Temporary changes in liver function tests

Serious complications are very uncommon (< 1 %), and almost all patients proceed safely to surgery.

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Outcomes and Results

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Portal Vein Embolisation (PVE) is highly effective in preparing patients for liver resection:

• Over 90–95 % achieve sufficient liver growth.

• Surgery is usually performed 2–4 weeks after embolisation (sometimes longer in cirrhosis).

• These procedures do not negatively affect cancer control or survival compared with patients who did not require embolisation.

Your multidisciplinary team will review your follow-up imaging and coordinate the timing of surgery once liver growth is confirmed.

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Specialist Expertise

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Interventional Radiologists (IRs) are uniquely specialty trained in both the advanced imaging assessment and grading of liver tumours and image-guided "pin-hole" procedures including biopsy, embolisation and ablation. Interventional Radiologists (IRs) are broadly experienced in embolisation procedures as they undergo comprehensive dedicated training in embolisation procedures throughout the body, including the kidney, liver, spleen, uterus and prostate.

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Public eligible patients can typically undergo the treatment with no out-of-pocket expense in the public system. Portal vein embolisation is performed at most of our public and private hospital locations in Melbourne, Victoria, Australia.

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Portal Vein Embolisation content by Dr James Lisik.