Iodized oil in the portal vein after arterial chemoembolization of liver metastases--a caution regarding hepatic necrosis.

Of 20 patients with hepatic metastases from colorectal cancer treated by arterial chemoembolization, 4 showed iodized oil in peripheral branches of the portal vein. Aseptic necrosis of both the tumor and normal parenchyma in corresponding liver segments developed in 2 of these patients. They were successfully treated with antibiotics and percutaneous drainage. In the 2 remaining patients, the procedure was interrupted before complete arterial occlusion when oil was detected in the portal vein on fluoroscopy, and there was no complication. Appearance of iodized oil in the portal vein during arterial chemoembolization of colorectal liver metastases is an unfavorable event signaling the risk of liver necrosis.