In Reply to: Case 0498_08 -- Chemoembolization in a patient with left portal vein occlusion posted by Editor on March 31, 1998 at 14:50:16:
The crucial questions when doing CE in patients with portal occlusion are how selective were you and how much gelfoam went in?? In a patient with partial PV occlusion I would go very selectively and in this case do the two left hepatic artery branches separately with a reduced (half-2/3) volume of CE. With complete occlusion as in this case I would also consider giving no gelfoam or no more than 1 ml of gelfoam slurry for the left hepatic artery CE (I would probably have given none). Doing the right is less of a problem with the patent right portal vein. We have 5 or 6 patients who had CE with superselective injection and reduced CE volumes without any problems.
We also use a CE mix of Adriamycin (60mg), optiray (10ml) and ethiodol (20ml).
Why did you change from gelfoam to Ivalon knowing he is at increased risk for liver infarction?? Gelfoam is at least sort of temporary and allows you to go back to treat recurrence through the same vessels - Ivalon is permanent and may commit you to embolizing recurrence via phrenics etc in the future.