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During a 5-year period, 54 patients underwent emergency percutaneous transhepatic protography for embolization of varices to control gastrointestinal bleeding. The portal vein could not be entered in six patients: five died and one survived a gastric devascularization procedure. In the 48 patients who had successful embolization, 19 went on to elective surgery with 12 survivors. Of the 29 patients who were not surgical candidates, 21 died. Categorizing these 48 patients according to the direction of flow in the portal vein showed that 36 had hepatopetal flow and three partial hepatopetal flow. Twenty patients survived. The remaining nine had hepatofugal flow. None of these patients survived the hospitalization. Criteria are described for selecting patients in whom embolization of varices through the percutaneous transhepatic route will be of maximum therapeutic benefit.
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