Portal vein embolization (PVE) is an image-guided procedure done 3 to 4 weeks before a major liver operation when the part of the liver that will remain after surgery is too small. Blocking the portal vein branches that feed the part to be removed sends blood to the part that will stay, which then grows and makes the operation safer. In a review of 44 studies and 1,791 patients, technical success was 99.3% and the future liver remnant grew by an average of 37.9%.
This guide draws on patient information from Memorial Sloan Kettering Cancer Center (MSK) and Northwestern Medicine in the US, the Royal Free Hospital in the UK and the Netherlands Cancer Institute (AVL), together with a systematic review in a European journal and the multinational DRAGON1 trial. It covers who needs PVE, how it is done, recovery time, side effects, and availability in Japan and other countries.
Treatment status · PVE was reported as a pre-resection procedure by Japanese surgeons in 1990 and is now a standard step at liver surgery centers in the US, Europe and Japan. All figures below come from studies of real patients and from hospital patient guides. This article is general information, not a treatment recommendation.
The size of the remaining liver decides surgery
The liver can regrow after part of it is removed. Right after surgery, however, the remaining liver must do all the work, and if too little is left, liver failure with jaundice or fluid build-up can follow. Liver surgeons therefore measure liver volume on CT before surgery and check whether the future liver remnant will be large enough.
The AVL guide explains that PVE is needed when only about 30 to 40% of liver tissue would remain after surgery. The exact threshold depends on whether the liver is healthy, whether the patient has had long chemotherapy, and whether there is cirrhosis. Tests used to assess liver function before procedures are summarised in liver cancer tests before treatment.
The aim of PVE is not to treat the tumor directly but to prepare the body for surgery. Patients first told that surgery is not possible may become candidates once the future remnant has grown enough.
Why blocking the portal vein makes the liver grow
Blood reaches the liver through two vessels: the hepatic artery, which brings oxygen, and the portal vein, which brings nutrients absorbed from the gut. Portal blood carries growth signals for liver cells, so the part of the liver that receives more of it grows.
In PVE, the portal branches to the part that will be removed are closed with medical glue, small particles or metal coils. That side gradually shrinks while the side that will stay grows over several weeks. Because the hepatic artery is left open, the embolized side stays alive until surgery. This differs in purpose and vessel from arterial embolization that starves a tumor, which you can compare in our TACE guide.
| Item | Portal vein embolization (PVE) | Combined portal and hepatic vein embolization (PVE/HVE) |
|---|---|---|
| Vessels closed | Portal branches to the side to be removed | Portal branches plus the hepatic vein on the same side |
| Purpose | Grow the remnant so major resection is safer | Grow the remnant faster and more |
| Evidence | Review of 44 studies, 1,791 patients | DRAGON1 trial, 102 patients at 43 European centers |
| Current role | Standard procedure at many centers worldwide | Offered at specialist centers; comparative trials under way |
Based on van Lienden KP, et al. CVIR 2013 and DRAGON1 (Lancet Regional Health Europe 2025).
Who receives PVE
PVE is used for patients facing an operation that removes a large part of the liver. Northwestern Medicine lists both primary liver cancer and cancer that has spread to the liver from elsewhere.
- Colorectal liver metastases: when metastases are concentrated in one side and a wide resection is needed. Smaller metastases that can be treated with heat are covered in colorectal liver metastases ablation.
- Hepatocellular carcinoma: when a large tumor requires removal of a wide area, such as the whole right liver.
- Perihilar bile duct cancer: when the bile duct and a large part of the liver must be removed together. Jaundice is relieved first with drainage, described in biopsy and drainage.
- A liver after long chemotherapy: when more liver needs to be preserved.
The review found that cirrhosis can reduce liver growth, while chemotherapy and cholestasis had no clear effect (platinum drugs were an exception). In patients with cirrhosis, plans therefore consider both the volume and the function of the remnant.
The procedure, from preparation to discharge
PVE is performed by an interventional radiologist using a needle and a thin tube (catheter), with no surgical incision. Patient guides from three countries describe the same overall flow.
| Item | MSK (US) | Royal Free (UK) | AVL (Netherlands) |
|---|---|---|---|
| Anesthesia | General plus local | General plus local | Put to sleep by an anesthesiologist |
| Fasting | No food from midnight; clear liquids until 2 hours before arrival | Morning list: nothing from midnight; water until 2 hours before | No food for 8 hours, no drinks for 4 hours |
| Duration | About 2 to 3 hours | Usually about 2 hours | Not stated |
| Embolic material | Tiny particles | Medical glue | Particles, glue, coils or a plug |
| Hospital stay | Recovery unit, then the team decides on discharge | Usually home the next day | Usually one night |
| Next CT | 3 to 4 weeks later | About 4 weeks later | CT and MRI at 3 to 4 weeks |
Summarised from each hospital's patient guide. Instructions differ between hospitals, so follow the guide you receive.
- Preparation: if you take blood thinners such as warfarin or aspirin, agree in advance when to stop them. Mention any past reaction to contrast dye.
- Procedure: the radiologist finds the portal vein with ultrasound, passes a needle through the side or upper abdomen, guides a catheter under X-ray, and maps the vessels with contrast. After confirming the branches, they are closed, and the puncture site is sealed with glue or a small plug.
- Going home: sedation lingers, so a companion should drive you home, and someone should stay with you the first night.
Recovery time and side effects
The Royal Free advises resting for at least 24 hours and not working the next day. You can eat normally and use ordinary painkillers if needed. Tiredness, a low fever and bruising at the puncture site may last 3 to 5 days and usually settle without treatment.
| Symptom | How common | Management |
|---|---|---|
| Mild pain over the liver | Common | Painkillers; usually better within days |
| Low fever and tiredness | Common, 3 to 5 days | Fluids and ordinary painkillers |
| Nausea or vomiting | Some patients | Medicine; improves with time |
| Bruising or bleeding at the site | Uncommon | Report pain, dizziness or sweating promptly |
| Serious complications | Under 1% (Royal Free), 2.5% (review) | Managed under hospital observation |
Royal Free London, AVL and Northwestern Medicine patient guides; van Lienden 2013 review.
MSK asks patients to call for a fever of 38.0°C or higher, pain not relieved by medicine, shortness of breath or chest pain, or dizziness. These are uncommon, but having the contact number ready brings peace of mind.
After 3 to 4 weeks, CT (and MRI if needed) shows how much the remnant has grown. If growth is sufficient, the surgical team sets a date; if not, the procedure may be repeated or the waiting time extended. Northwestern notes that PVE can be repeated if needed.
Results from research
Researchers at Amsterdam University Medical Center pooled 1,791 patients from 44 studies, publishing in CardioVascular and Interventional Radiology (CVIR) in 2013. In 2025, results of the DRAGON1 trial across 43 European centers were published.
| Study | Patients | Main results |
|---|---|---|
| Systematic review (2013) | 44 studies, 1,791 patients | Technical success 99.3%, clinical success 96.1%, remnant growth 37.9% on average, procedure-related mortality 0.1% |
| DRAGON1 (2025) | 102 patients with initially unresectable colorectal liver metastases, 43 centers | 96 underwent PVE/HVE and 86 of them (90%) had liver resection; no embolization-related deaths |
| Japanese hospital report (2005) | 12 patients with perihilar bile duct cancer, 9 had PVE | No hospital deaths and no liver failure after surgery |
van Lienden KP, et al. CVIR 2013;36:25-34 / DRAGON1, Lancet Regional Health Europe 2025 / Shimada K, et al. World J Surg 2005;29:723-727.
In the review, about 80% of patients went on to planned surgery after PVE. Most who could not had disease spread while waiting, so the authors discussed continuing chemotherapy and careful imaging during the interval. The DRAGON1 investigators concluded that combined portal and hepatic vein embolization was safe with a high resection rate.
Japan and other countries
| Region | Status | Basis |
|---|---|---|
| Japan | Japanese surgeons reported pre-resection PVE for perihilar bile duct cancer in 1990; widely used before major resections for bile duct and liver cancer | Makuuchi M, et al. Surgery 1990; Shimada 2005 |
| United States | Cancer centers such as MSK and Northwestern, usually same-day or one-night stay | Hospital patient guides |
| United Kingdom | Liver surgery centers using glue; usually home the next day | Royal Free London guide |
| Europe (Netherlands, France and others) | Combined portal and hepatic vein embolization in multinational trials; comparative studies ongoing | DRAGON1, 2025 |
International patients are often not covered by the host country's public insurance, so confirm costs and schedules directly with the hospital.
PVE is planned together with surgery. If you are considering treatment abroad, look for a center where liver surgeons and interventional radiologists work as one team, and plan the embolization and the operation at the same hospital. An overview of image-guided procedures is on our IVR (interventional radiology) page.
Questions to ask your doctors
- What percentage of my liver will remain after surgery, and what is needed to be safe?
- Will you block only the portal vein, or the hepatic vein too? Why?
- When will the CT be done after PVE, and when will surgery be scheduled?
- Will I continue chemotherapy while waiting?
- What is the next option if the liver does not grow enough?
For preparing your consultation, see also five questions before an RFA consultation.
Frequently asked questions
Does portal vein embolization treat the cancer?
PVE itself does not remove the tumor. It is a preparatory procedure that grows the remaining liver so a major resection can be done safely; the treatment is the surgery that follows.
How long after PVE is surgery?
MSK, the Royal Free and AVL all check liver growth with CT 3 to 4 weeks later. If growth is sufficient, surgery is planned around then; if not, the wait may be extended or another procedure considered.
Is PVE painful, and how long is the hospital stay?
It is done under general anesthesia. Mild pain over the liver afterward is controlled with painkillers. Stays range from same-day discharge to one night. A low fever and tiredness for a few days are common and usually pass on their own.
What happens to the embolized part of the liver?
It is kept alive by the hepatic artery until surgery, gradually shrinks, and is removed with the tumor. The other side grows as portal blood is redirected to it.
This article summarises overseas official sources and studies as general information and is not medical advice. Discuss treatment choices with a doctor who has examined you.
Sources (checked October 28, 2026)
- van Lienden KP, van den Esschert JW, de Graaf W, et al. Portal Vein Embolization Before Liver Resection: A Systematic Review. CardioVascular and Interventional Radiology. 2013;36:25-34.
- DRAGON1 Collaborative. Safety and efficacy of combined portal and hepatic vein embolisation in patients with colorectal liver metastases (DRAGON1). The Lancet Regional Health – Europe. 2025. NCT04272931.
- Memorial Sloan Kettering Cancer Center. About Your Portal Vein Embolization.
- Royal Free London NHS Foundation Trust. Having portal vein embolisation (PVE).
- Netherlands Cancer Institute (AVL). Portal vein embolization.
- Northwestern Medicine. Portal Vein Embolization.
- Shimada K, Sano T, Sakamoto Y, et al. Safety and Effectiveness of Left Hepatic Trisegmentectomy for Hilar Cholangiocarcinoma. World Journal of Surgery. 2005;29:723-727.