Background: With rising rates of hepatocellular carcinoma, Egypt has the highest global prevalence of hepatocellular carcinoma (HCC). It has been demonstrated that intra-arterial lipiodol ethanol combination embolization is efficient in the treatment of HCC. Objective: To highlight the efficacy of the intra-arterial ethanol embolization in treatment of hepatocellular carcinoma with malignant portal vein thrombosis (PVT). Patients and Methods: This follow up study was conducted on 46 patients with hepatocellular carcinoma and malignant portal vein thrombosis done in National Liver Institute, Menoufiya University from March 2020 to March 2022. Results: Status and reaction at the conclusion of the research both substantially correlated with PVT (P<0.001). Complete responses were more frequently found in grade II patients (4 patients) than in grade III patients (12 patients), according to data (50.00%). In this trial, 46 patients were involved; 8 patients (17.4%) died, and 38 patients (82.6%) survived; 26.1% of these patients declined follow-up or lost touch, and 17.4% had a full response. Status at the conclusion of the program was revealed to be significantly negatively correlated with PVT grade. However, there was no discernible relationship between study status at the conclusion and gender, ascites, Child score, or number of sessions. Conclusion: Trans arterial ethanol embolization (TAELE) can be used for early-stage HCC, as well as for intermediate-stage disease if other curative modalities are not feasible and can be considered when treating selected patients with segmental portal vein tumor thrombosis (PVTT) (grade I) and preserved liver function.