# Portal Vein Embolization - please help



## Lisa Bledsoe (Oct 2, 2013)

Hello All - Looking for some guidance on this procedure please.  Are we on the right path?  Are we missing anything?  Codes chosen are in in parenthesis below each section.  Thank you in advance!!!

Neff 21-guage needle access to the portal branch was achieved with ultrasound gudance.  Image was saved to PACS.  0.018 inches guidewire was advanced into the branch using fluoroscopy guidance.  The tract was dilated to acommodate standard wires over a 4-French vascular sheath.  A 5-French vascular sheath was then placed
*(76937-26)* 

4-French and 5-French Kumpe catheters wer used to negotiate the left portal pathway to the main portal vein.  Omniflush catheter was placed in the main portal and a portogram was obtained.  Selective catheterization of the branches of the right portal was performed with 5-French Kumpe catheters and 3-French microcatheter.
*(36481-lt, 75887-26-59)*

N-butyl-cyano-acrylate/Lipiodol was placed via the 3-French/5-French coaxial system.  Selective glue embolization was performed of the right portal branch and additional branches extending superiorly.  Microcatheter was removed.  Selective catheterization of the portal branch extending inferiorly to segments 5 and 6 was performed with the Kumpe catheter.  A 3-French microcatheter was placed into the right portal branches extending inferiorly.  The glue embolization was completed until ther was completed until there was sluggish, near stasis of the portal inflow.  One small branch of the portal vein extending to segment 5 remained partially open.  
*(37204, 75894-26)*

Kumpe catheter was employed for portography from the main portal branch.  The left portal branches remained patent.
*(75898-26)*


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