Medical Oncologist
CION Cancer Clinics
Portal vein embolisation: growing the remaining liver before surgery | CION Cancer Clinics
Portal vein embolisation blocks the blood supply to the side of the liver holding the tumour, so the healthy side grows before surgery. It is offered when a tumour could be removed but too little liver would be left. This page explains who it suits, who it does not, what happens on the day and during the wait, and what the alternatives are. At CION Cancer Clinics, a multidisciplinary tumour board weighs your liver function and your scans before recommending any treatment.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed October 2026, next review due October 2027
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On this page
- What is portal vein embolisation, and who is it for?
- What does the team check before suggesting PVE?
- What happens during portal vein embolisation?
- How does PVE compare with the other ways forward?
- Who is portal vein embolisation not right for?
- What this page cannot tell you
- Common questions about portal vein embolisation
The short answer
What is portal vein embolisation, and who is it for?
Portal vein embolisation, often shortened to PVE, is a procedure that makes the healthy part of your liver grow before surgery. It is for people whose tumour could be removed, but whose surgeon worries that too little liver would be left behind afterwards.
The portal vein carries blood from the gut to the liver. In PVE, a radiologist blocks the branch of this vein that feeds the side of the liver holding the tumour. Blood is then sent to the other side, which responds by growing. When enough growth has happened, the operation removes the blocked side.
Why it is needed at all
Before any liver operation, the surgeon measures the future liver remnant, the part that will stay. If it is too small, the liver can fail after surgery. PVE is the usual way to make that remnant safer without giving up on the operation.
PVE is used for primary liver cancer and for cancer that has spread to the liver from elsewhere, most often the bowel. If your liver tumours came from bowel cancer, the colon cancer page on liver surgery eligibility covers that path. For bile duct cancer there is a separate page on embolisation before bile duct surgery.
Before it is offered
What does the team check before suggesting PVE?
PVE only makes sense if surgery is the right goal and the liver can still grow. The tumour board looks at all of this together.
The tumour
The cancer must be confined to the part of the liver that will be removed, with no spread elsewhere that would make surgery pointless. Scans are reviewed to be sure the side that stays is free of tumour.
The liver itself
A healthy or mildly fatty liver grows well after PVE. A liver with cirrhosis grows slowly and less, and may not grow enough at all. Your Child-Pugh grade, a score of how well the liver works, guides this.
Also looked at
- Signs of portal hypertension, raised pressure in the portal vein
- Bilirubin, the yellow pigment that causes jaundice
- A blocked bile duct, which may need draining first
The size of the planned remnant
The remnant is measured from your CT or MRI scan. PVE is considered when that remnant is borderline or too small for the health of your liver.
You
Your fitness for a major operation, your other illnesses and your own wishes all count. PVE is a first step toward surgery, so it is only worth doing if you would go ahead with the operation.
Not sure whether this applies to you?
Ask an oncologistFrom start to surgery
What happens during portal vein embolisation?
Planning scans and blood tests
A recent contrast CT or MRI measures the liver, and blood tests check clotting and liver function. CION arranges these through its diagnostic partners.
The procedure itself
An interventional radiologist passes a thin tube through the skin into the portal vein, guided by ultrasound and X-ray. Tiny particles or glue block the chosen branch. CION coordinates PVE through accredited partner hospitals.
A short hospital stay
Most people have sedation and local anaesthetic, and go home within a day or two. Mild pain on the right side and a low fever are common and settle.
Waiting for the liver to grow
Growth usually takes a few weeks. A repeat scan measures the new remnant. If it has grown enough, surgery is planned. Your team will tell you where the operation takes place.
The radiology technique is described in more detail on the embolisation page for portal vein embolisation.
Side by side
How does PVE compare with the other ways forward?
Option
When the team may consider it
PVE, then surgery
The tumour can be removed but the remnant is too small, and the liver can still grow
Two-stage surgery or ALPPS
Tumours on both sides, or a need for faster growth, in carefully chosen people
Ablation or TACE
Small tumours, or a liver too damaged for a large operation
Transplant
Cirrhosis with cancer within strict size and number limits
Medicines
Cancer too widespread for any local treatment
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Not for everyone
Who is portal vein embolisation not right for?
PVE does not suit people whose cancer has spread outside the liver, or who have tumours in the side of the liver that is meant to grow. It also does not suit anyone who would not be fit for, or would not want, the major operation that follows. Growing the liver serves no purpose without the surgery.
Cirrhosis and portal hypertension
In advanced cirrhosis, or with clear signs of portal hypertension, the liver may not grow enough. Blocking part of the portal vein can also raise the pressure further. For these people, ablation, TACE or a liver transplant is often the more realistic discussion.
When the cancer grows during the wait
The weeks of waiting carry a small risk. In some people the tumour grows, or new spots appear, before the liver has grown enough. The repeat scan checks for this. If it happens, the plan changes. Some teams combine PVE with TACE to try to hold the tumour back while the liver grows.
PVE is a step toward surgery. It does not treat the cancer on its own.Being straight with you
What this page cannot tell you
It cannot tell you whether PVE is right for you. That depends on your scans, the health of your liver and the operation your surgeon is planning. It also cannot tell you how much your liver will grow, because that varies from person to person and is hard to predict in advance.
Who to ask
Ask your liver surgeon why PVE is being suggested, what remnant they are aiming for, and what the plan is if the liver does not grow. If you have been told surgery is impossible and PVE was never mentioned, ask whether it was considered. CION's tumour board can review your scans and give you a clear answer.
Questions we are asked
Common questions about portal vein embolisation
Is portal vein embolisation an operation?
No. It is done through a needle and a thin tube, usually under sedation and local anaesthetic, by an interventional radiologist. There is no large cut. It prepares the liver for the real operation that follows, which removes the tumour.
Is it painful?
Most people feel some pain on the right side of the abdomen for a day or two, and some have a mild fever or feel sick. Pain relief usually controls this. Tell the team at once if pain is severe, or if you notice yellow eyes or a high fever.
How long do I wait before surgery?
Usually a few weeks, while the healthy side of the liver grows. A repeat scan measures the growth. The exact wait depends on how quickly your liver responds and on your surgeon's plan. It is shorter in a healthy liver and longer if the liver is damaged.
What if my liver does not grow enough?
The team will look at other options. These may include a second procedure to block a vein draining the liver, a smaller operation, ablation, TACE or medicines. Poor growth is itself useful information, because it warns that the liver might not have coped with surgery.
Can the cancer spread during the wait?
In some people the tumour grows during the waiting weeks. The repeat scan checks for this before surgery goes ahead. Some teams give TACE as well to slow the tumour. Your team will weigh this risk against the risk of operating on too small a remnant.
Can PVE be done if I have cirrhosis?
Sometimes, in mild cirrhosis with good liver function. The scarred liver grows less, and the team must be sure the pressure in the portal vein is not already raised. In more advanced cirrhosis, other treatments are usually discussed instead.
What does it cost?
PVE is quoted separately from the operation and varies by hospital and by the plan. Ask for a written, itemised estimate covering the procedure, the scans, the stay and the later surgery. Check with your insurer or scheme whether both steps are covered.
Where can I get my case reviewed?
Call the CION helpline and send your scans and reports. The tumour board, including surgical oncologists, will look at whether surgery is possible and whether PVE would help. If it is the right step, CION coordinates it through an accredited partner hospital.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- American Cancer Society — Surgery for Liver Cancer
- American Cancer Society — Embolization Therapy for Liver Cancer
- Cancer Research UK — Surgery for liver cancer
- EASL — EASL Clinical Practice Guidelines: management of hepatocellular carcinoma
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Future liver remnant: the number surgeons calculateThe measurement that decides whether PVE is neededTwo-stage liver surgery and ALPPSThe other way to operate when too little liver would remainWho is suitable for liver surgery?Every check before an operation is offeredPortal vein embolisation: the procedureHow the radiologist does it, step by step
Talk to us
Told there is not enough liver left for surgery?
Send us your scans and reports and the CION tumour board will look at whether preparing the liver could make surgery possible. One helpline serves every CION centre.