What is an embolization procedure?
Embolization is a therapeutic procedure to selectively block blood flow in a specific area in the body. Embolization is performed by placing medications or synthetic materials, known as embolic agents, inside a blood vessel. The embolic agents come together to form a block in the blood vessel.
Embolic agents are placed in the targeted spot in the blood vessel by inserting a thin flexible tube (catheter) into the blood vessel. Catheter embolization is minimally invasive and an effective way to control abnormal bleeding or cut off blood supply to abnormal tissue.
What are the uses of an embolization procedure?
Catheter embolization can be performed anywhere in the body. Embolization is used to stop internal or abnormal bleeding in several conditions which include the following:
- Heavy and prolonged menstrual bleeding from uterine fibroids
- Internal bleeding that results from a traumatic injury, particularly in the abdominal region
- Bleeding from lesions or ulcers in the gastrointestinal tract
- Bleeding from abnormal blood vessel connections (fistulas)
- Bleeding from tumors
Other uses of embolization include:
- Blocking blood supply to tumors to starve and shrink them. Embolization can also deliver chemotherapy drugs to kill the tumor in a procedure known as chemoembolization.
- Blocking arteriovenous malformations (AVMs), which are abnormal connections between arteries and veins.
- Blocking blood flow into aneurysms, which are bulges that form because of a weak artery wall. A burst aneurysm leads to internal bleeding (hemorrhage) which can be a life-threatening condition.
- Treatment for enlarged veins (varicoceles) in the scrotum may be causing infertility.
- Treatment for congenital abnormality in the veins (venous malformations).
How is an embolization procedure performed?
A specially trained interventional radiologist performs the embolization procedure in a catheterization laboratory. Typically, embolization is performed with the patient under moderate sedation, but some may require general anesthesia.
Prior to the embolization procedure, the patient must:
- Avoid drinking or anything for a period of time, as advised by the doctor.
- Inform the doctor of any known drug or other allergies.
- Inform the doctor if pregnant.
- Avoid taking any medications or herbal supplements without checking with the doctor first and may have to stop certain medications such as blood thinners.
The patient is usually required to undergo tests such as:
- Blood tests to evaluate kidney function and blood clotting time
- Imaging tests to visualize the blood vessel condition which may include:
- Neurological evaluation in case embolization is performed in the brain
The embolization procedure is performed with the patient lying on a table in an appropriate position depending on the site of the procedure.
- Connects an IV line to the patient’s arm and administers sedation and painkillers.
- Attaches devices to the patient to monitor vital parameters such as:
- Sterilizes the area and injects a local anesthetic where the catheter has to be inserted.
- Makes a tiny incision in the skin.
- Inserts the catheter into the artery and gently advances it to the treatment site with the guidance of continuous X-rays (fluoroscopy).
- Injects a contrast material and determines the exact location of the bleeding or the abnormality, with the use of the fluoroscope.
- Delivers the embolic agent at the treatment site.
- Examines with X-rays, if the embolization is successful.
- Gently withdraws the catheter out of the artery.
- Applies pressure to arrest any bleeding at the insertion site.
- Seals the wound and applies a bandage.
The patient will be under observation for a few hours after embolization. The length of the procedure depends on the underlying condition; for instance, treatment for uterine fibroids is far less complex compared to treating an aneurysm in the brain.
Embolization procedure may require an overnight stay or longer in the hospital depending on the complexity of the condition. Recovery time also depends on the treated condition, but most people can resume normal activities within a week unless there are neurological complications related to the condition.
What are the side effects of embolization?
The side effects of embolization include the following:
- If general anesthesia is used, side effects such as:
- Pain and cramps in the case of embolization for uterine fibroids, which can last up to five days
- Headache in the case of embolization for arteriovenous malformation in the brain
- Post-embolization syndrome, particularly with embolization of solid tumors, because of products from the tumor when it breaks down due to lack of nutrition after blood supply is cut off. Symptoms include:
What are the benefits and risks of embolization?
- Embolization is less invasive than surgery, with fewer risks, less blood loss, and relatively quick recovery.
- Embolization is highly effective in controlling bleeding, especially useful in an emergency.
- Uterine fibroid embolization has a high success rate and can prevent or postpone the need for uterus removal (hysterectomy).
- Embolization is a useful treatment for shrinking inoperable tumors and correcting vascular malformations that are highly risky to operate upon.
- Allergic reaction from the contrast material used
- Bleeding at the catheter site
- Infection at the catheter site
- The wrong deposition of embolic agents can block blood flow to healthy tissue
- Failure of procedure
- Injury to the uterus which may necessitate hysterectomy
- Kidney damage from the contrast material, particularly in people with diabetes or kidney disease
Most of the above risks can be prevented with safe practices and proper precautions by medical professionals.