604 - LAVA in the Portovenous System: Preliminary Assessment of EVOH Efficacy and Safety During Portal Embolization

Monday, April 13, 2026

12:10 PM - 1:10 PM ET

Poster Presenter(s)

AW

Alexander O. Weinstein, BS

Medical Student
UT Health San Antonio, United States

Author/Co-author(s)

CS

Cadfael Soulard, BA

Medical Student
UT Health San Antonio, United States
NH

Nathan Hendrickson, DO

Integrated Interventional Radiology Resident
UT Health San Antonio, United States
JW

John A. Walker, MD

Associate Professor of Radiology
UT Health SA - Radiology MC7800, United States
Jorge Lopera, MD, FSIR (he/him/his)

Faculty
UT Health Science Center in San Antonio, United States
Carlos B. Ortiz, MD

Resident Physician
UT Health San Antonio, United States

Purpose: EVOH is an effective embolic agent for the closure of intracranial and extracranial arteries. Limited literature is available for EVOH use in the portovenous system. We aim to assess the efficacy and safety of LAVA EVOH embolization in the portal system at a single tertiary referral center.

Materials and Methods: A retrospective analysis was performed to identify all cases performed between 7/26/2024–6/3/2025 using portal EVOH embolization. Inclusion criteria included variceal embolization for bleeding varices (with or without TIPS) or portosystemic shunt embolization for hepatic encephalopathy (HE). Technical success was defined as successful intraprocedural occlusion of the targeted shunt or varix. Clinical success was defined as freedom from same site re-intervention in the event repeat procedures were required to address new variceal bleeding or refractory hepatic encephalopathy. Complications were reviewed and stratified by SIR classification guidelines.

Results: A total of 30 patients met inclusion criteria (15 male, median age 61, range 2–75 yrs) with 22 variceal (73.3%) and 8 shunt (26.7%) embolization procedures performed. Of the cases, 30 (100%) were technically successful and 29 (96.7%) achieved clinical success. TIPS was performed in conjunction with 13 variceal embolizations (59.1%). Average pre-procedural MELD was 16.6 ± 8.4 (n = 28, excluding 2 PELD) and post-procedural MELD was 17.1 ± 8.2 (p = 0.76). Both LAVA 34 (n = 26) and LAVA 18 (n = 4) (SIRTEX Medical) were utilized with adjunctive embolic materials as follows: coils (n = 20), plugs (n = 5), and histoacryl (n = 1). Three episodes of nontarget embolization were observed (10%)—2 related to catheter technique and 1 late visualization of distal varix to portal communication. A total of 7 procedural AEs (3 related to EVOH) were recorded including 5 mild AEs (3 nontarget embolizations, 1 access site hematoma, and 1 TIPS related portal vein infarct) and 2 severe AEs. Both severe AEs occurred due to severe hepatic encephalopathy after TIPS and were successfully treated with TIPS reduction or increased lactulose. Four patients died within a year of embolization, though no deaths were related to embolization complications.

Conclusion: EVOH embolization in the portal system demonstrates technical and clinical success for portal venous occlusion. Further clinical studies are needed to evaluate portal EVOH embolization for long term outcomes.