Embolization is a technique used to block blood flow in a controlled fashion.
The technique uses a variety of materials to stop bleeding or starve tumors of their nutrient supply.
In some cases, embolization can be used as an alternative treatment when open surgery is undesirable or not recommended.
Embolization is a procedure that blocks the flow of blood through a blood vessel. To do this, the procedure deploys an embolic device into the vessel, commonly a small metal coil, latex balloon, or a liquid or solid chemical agent.
Embolization is well known for controlling postpartum hemorrhage (bleeding after childbirth) but also treats a spectrum of conditions, such as severe internal bleeding, liver cancer, and vascular malformations.
In some situations, embolization offers advantages over traditional surgery. In many cases it can control bleeding more easily than traditional surgery. Also, it is typically less invasive, an important factor when open surgery is risky or inappropriate for a particular patient. Embolization can also be used in conjunction with surgery to reduce blood loss.
WHEN IS THE PROCEDURE INDICATED?
Embolization is indicated in a variety of situations, including:
Bleeding in the liver;
Upper gastrointestinal tract hemorrhage;
Liver cancer; and
Varicoceles, distended veins in the scrotum.
Generally, people who are candidates for embolization first undergo tests that map the blood vessels. These tests, which allow the physician to select the part of the blood vessel for treatment, include:
Computerized tomography (CT) scan; and
Magnetic resonance imaging (MRI).
Other pre-treatment guidelines vary depending on the type of embolization required but may include:
Avoiding solid food for 6 hours;
Drinking plenty of water; and
WHO IS ELIGIBLE?
Patients who have a history of a severe allergic reaction to the dye used in venography and arteriography may be ineligible for embolization.
Uterine fibroid embolization (UFE) is only recommended for women who:
Have completed childbearing;
Have not yet gone through menopause; and
Have a strong desire to avoid a hysterectomy (another treatment for fibroids).
RISK FACTORS FOR POSSIBLE COMPLICATIONS
Risk factors for possible complications include:
Underlying vascular disease;
Multiple vascular injuries;
Previous surgery in the blood vessels or area being treated;
Blood clotting disorders; and
Poor liver function or advanced cirrhosis (scarring in the liver).
WHAT TO EXPECT
Embolization involves making a needle puncture, often in the groin, to insert a catheter into one of the body's main blood vessels. From there, the catheter is threaded under x ray guidance to the location to be treated. The physician deploys the embolic agent through the catheter, effectively stopping the blood flow to that vessel. For certain cases, such as systemic vascular malformations, physicians may puncture the area of the blood vessel directly beyond the lesion.
The duration of the procedure depends on the condition. For example, variocele embolization takes approximately 30 minutes, while chemoembolization takes at least 3 hours.
Success rates for embolization range from approximately 75 to 95 percent, depending on the specific procedure.
POST-TREATMENT GUIDELINES AND CARE
Recovery time depends on the patient's medical condition, but can range from 4 hours of rest and observation to months in the hospital.
Some patients may be prescribed pain medications after the procedure.
The major complication of embolization is damage or loss of tissue or an organ near the blocked blood vessel.
Other complications include:
Recanalization (spontaneous rejoining of the blocked blood vessel);
Migration of a coil;
Infarction (death of the muscle cells in an organ, such as the heart or the bowel); and
Liver failure, tumor rupture, or liver infection (for chemoembolization patients).
Infertility or miscarriage is a possible complication for some patients who receive UFE, but experts do not yet know the long-term outcome of the procedure because it is new and studies are few.
A condition called postembolization syndrome is a common side effect of the procedure. Symptoms include pain, fever, vomiting, nausea, and the inability to eat. These symptoms usually pass within 1 week. Bruising is also a common minor complication of embolization.