PROCEDURE:
1. Direct portogram
2. Right Portal Vein Embolization
3. Post embolization portogram
CLINICAL HISTORY:
CONTRAST: 75 ml Omnipaque
FLUOROSCOPY TIME: 40.9 minutes
COMPLICATIONS: None
PROCEDURE:
Following written informed consent, the patient was placed supine on the procedure table. After induction of general anesthesia, the right abdomen was prepped and draped in standard sterile fashion.
The abdomen was evaluated with ultrasound. An appropriate skin entry site was chosen and anesthetized with local. Under ultrasound guidance, a micropuncture needle and 0.018′ wire was advanced into a ______ branch of the right portal vein and down into the main portal vein. The needle was removed and transitional catheter was advanced into the portal vein. Digital subtraction portography was then performed. Subsequently the wire was upsized and a 10 cm 5 French sheath was placed into the portal vein.
Over the wire a similar one catheter was advanced into the main portal vein. Digital subtraction angiography in AP and oblique views was obtained to delineate the portal vein anatomy. Subsequently the anterior posterior branches of the right portal vein were cannulated utilizing the Simmons catheter. A microcatheter was advanced into the subsegmental right anterior and posterior portal venous branches. These were embolized with progressively enlarging microspheres including: _________________. In order to avoid manipulation after embolization the microcatheter was removed and Simmons 1 catheter advanced in the portal vein and subtraction angiography again performed demonstrating near stasis to the right portal vein. At this point numerous detachable coils including _________ were utilized to embolize the right anterior and posterior portal venous branches. Digital subtraction angiography was again performed. The catheter was removed. The access tract was then embolized utilizing Gelfoam pledgets through the existing sheath along with coils. Post tract embolization sonography demonstrated no significant bleed. The patient tolerated the procedure and sedation well and there were no immediate complications.
FINDINGS:
1. Direct portogram demonstrates patency of the main as well as the right and left portal vein branches.
2. Post microsphere and coil embolization of the right anterior and posterior portal vein there is stasis of vascular flow.
IMPRESSION:
Successful microsphere and coil embolization of the anterior and posterior divisions of the right portal vein.
PLAN: The patient will be admitted for post-procedure monitoring.
Frequently Asked Questions
Portal vein embolization (PVE) is a procedure used to redirect blood flow within the liver by blocking selected branches of the portal vein with materials like microspheres or coils. It's typically performed to prepare the liver for surgery, especially if a significant portion of the liver is to be removed. By embolizing the right portal vein, the left side of the liver can enlarge, ensuring the patient retains enough healthy liver tissue post-surgery.
Portal vein embolization is performed under general anesthesia. The procedure involves using imaging guidance to insert a needle into a branch of the portal vein. A catheter is then advanced, and digital subtraction angiography is used to map the vein's anatomy. Once the target branches are identified, embolizing agents such as microspheres and coils are introduced to block blood flow. The process is monitored with angiography to ensure successful embolization.
What are the potential complications of portal vein embolization?
Portal vein embolization is generally safe, but as with any medical procedure, there are potential risks. Complications may include bleeding, infection, or injury to surrounding structures. However, in the described case, there were no immediate complications, and the procedure was well-tolerated. Patients are typically monitored post-procedure to manage any delayed complications.
What is the recovery process like after portal vein embolization?
After portal vein embolization, patients are usually admitted for monitoring to ensure there are no immediate complications. Recovery involves managing any pain or discomfort, monitoring liver function, and ensuring no significant bleeding occurs. Patients can typically resume normal activities gradually, but follow-up appointments are necessary to assess the liver's response and growth in preparation for any planned surgery.
Why is digital subtraction portography used in portal vein embolization?
Digital subtraction portography is an imaging technique used to visualize the portal vein's anatomy during embolization. It involves taking X-ray images before and after the introduction of contrast media, allowing physicians to see blood flow patterns and ensure the correct branches are targeted for embolization. This technique helps in precise catheter placement and confirms successful embolization.
What is the role of microspheres and coils in portal vein embolization?
Microspheres and coils are embolizing agents used to occlude blood vessels in the portal vein during embolization. Microspheres are tiny spherical particles that can block small vessels, while coils are used for larger vessels. Together, they create a blockage that redirects blood flow and induces liver growth on the non-embolized side. This is crucial for patients needing liver surgery, as it ensures sufficient hepatic function post-operation.