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Interventional & Vascular Radiology
Liver Intervention

The liver is the largest organ in the body. Weighing approximately 2.5 to 3 pounds, it is roughly the size of a flattened football. Nearly all of the blood that leaves the stomach and intestines must pass through the liver.

As the body’s largest chemical factory, the liver plays a vital role in many important body functions. These include the production of clotting factors, blood proteins, bile and enzymes; the metabolism of cholesterol; the maintenance of normal blood sugar concentration; hormone regulation; and the detoxification of drugs and poisons, including alcohol. Because of its critical role in maintaining health, a diseased liver can cause widespread disruption of body functions.

Millions of Americans suffer from both chronic and acute liver disease. Today, however, new procedures performed by interventional radiologists are successfully treating many conditions that were previously inoperable. These include portal hypertension, bile duct obstruction and liver cancer

Portal Hypertension Treatment—
Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Most of the blood flowing to the liver comes from the portal vein. Blood leaving the liver flows through the hepatic vein which empties into the inferior vena cava—a large blood vessel leading to the heart. Portal hypertension results when a large pressure difference exists between the portal vein and the inferior vena cava.

Portal hypertension is most commonly caused by cirrhosis, a condition where normal liver cells are damaged and replaced by scar tissue. This decrease in normal liver tissue interferes with the flow of blood through the liver. The body responds by diverting this blood through blood vessels surrounding the upper portion of the stomach and the lower portion of the esophagus. The increased blood volume in these veins causes the formation of varices (swollen veins with weakened walls) which often rupture under increased pressure. Esophageal varices may be controlled by several different therapies, including the non-surgical formation of a transjugular intrahepatic portosystemic shunt (TIPS).

During the TIPS procedure, an OIA interventional radiologist will use x-ray guidance to make a tunnel through the liver with a needle to connect the portal vein (the vein that carries blood from the digestive organs to the liver) to one of the hepatic veins (the three veins that carry blood from the liver). A metal stent is placed in this tunnel to keep the track open. The rerouted blood flow in the liver helps reduce pressure in all abnormal veins—not only in the stomach and esophagus, but also in the bowel and the liver.

Before TIPS Procedure
Portal hypertension before the TIPS procedure
—Portal hypertension causes blood flow to be forced backward, causing veins to enlarge and varicies to develop across the esophagus and stomach from the pressure in the portal vein. The pressure backup also causes the spleen to become enlarged.

After TIPS Procedure
After the TIPS procedure
—The shunt allows the blood to flow normally through the liver to the hepatic vein. This reduces portal hypertension, and allows the veins to shrink to normal size, helping to stop variceal bleeding.

Additional Information

Potential complications of the TIPS procedure, include:

  • Shunt narrowing or blockage. Follow-up ultrasounds may be performed frequently after the TIPS procedure to detect these complications. These complications can be treated by an OIA interventional radiologist who can re-expand the shunt(s) with a balloon or repeat the insertion procedure to place a new stent.
  • Mental changes caused by encephalopathy (abnormal functioning of the brain) that occur with severe liver disease. Encephalopathy can worsen when blood flow to the liver is reduced by TIPS which may result in toxic substances reaching the brain without being metabolized first by the liver. This condition can be treated with medications, diet or by revising the shunt.

Bile Duct Obstruction Treatment—
Percutaneous Transhepatic Cholangiogram & Percutaneous Biliary Drainage (PTC/PBD)

Another abnormality of the liver that is treated by OIA’s interventional radiologists is occlusion of the common bile duct. The procedure to alleviate this problem is often called a PTC/PBD, short for Percutaneous Transhepatic Cholangiogram and Percutaneous Biliary Drainage. It is an x-ray procedure in which a small tube is passed through the bile ducts in the liver and into the bowel. It is used to relieve blockages in the bile ducts of the liver that lead to the bowel. 

Inside the Interventional Radiology Procedure Room, your OIA interventional radiologist will inject x-ray dye through your right side and into your liver and bile ducts. After x-ray pictures are taken, the radiologist will place a small tube into one of the larger bile ducts so that blocked bile can drain out of the body.

Liver Cancer Treatment—
Chemoemolization of Liver Tumors

Chemoembolization is an innovative method used to treat certain types of liver cancer. It involves injecting chemotherapy directly into the blood vessels that feed the liver tumor—whether the tumor began in the liver (liver cancer) or spread to it from another organ (metastasized to the liver).

Using x-ray guidance, a small catheter will be inserted through a needle into the femoral artery in the groin. The OIA interventional radiologist will then thread the catheter up through your aorta into the artery in your liver that feeds the tumor.

Chemotherapy mixed with a microsphere is injected directly through the catheter into this artery and into the tumor. When blood flow in the artery stops due to the blockage from the microsphere, the catheter is removed. This procedure provides a high concentration of chemotherapy into the tumor and provides a temporary cut off of the arterial blood supply to the tumor.

Chemoembolization of Liver Tumors

For further information regarding this test, including preparation and what to expect during your exam, please visit the Overlake Hospital Medical Center Interventional Radiology website.

Overlake Imaging Associates applies advanced technology to your care through subspecialty
radiology interpretations and interventional treatments. As the Eastside community’s oldest and
most physician-referred radiology group, we serve patients from Bellevue, Issaquah, Redmond,
Kirkland, Woodinville, Seattle and the surrounding area.

To schedule an appointment or obtain medical records, please call
Overlake Hospital Medical Center Imaging at 425.688.0100

Overlake Imaging Associates P.C., 1417 116th Ave NE, Suite 212, Bellevue, WA 98004, 425.502.8362
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