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.