Catheter Embolization

What is Catheter Embolization?

Embolization is a minimally invasive treatment that occludes, or blocks, one or more blood vessels or vascular channels of malformations (abnormalities).

Catheter embolization is performed for a number of reasons:

• to control or prevent abnormal bleeding, including bleeding that results from an injury, tumor or gastrointestinal tract lesions such as ulcer or diverticular disease. Embolization is commonly the first line of treatment in gastrointestinal bleeding of any cause. Controlling bleeding into the abdomen or pelvis from injuries caused in a motor vehicle crash is especially suitable for this treatment.

• long menstrual periods or heavy menstrual bleeding that results from fibroid tumors of the uterus. Embolization may prove to be an excellent alternative to a hysterectomy, the surgical removal of the uterus. Because fibroids have a large blood supply, they will tend to shrink and control heavy menstrual bleeding if this blood supply is interrupted.

• occlude or close off the vessels that are supplying blood to a tumor, especially when the tumor is difficult or impossible to remove. After embolization a tumor may shrink or it may continue to grow but more slowly, making chemotherapy or surgery a more effective option.

• eliminate an arteriovenous malformation (AVM) or arteriovenous fistula (AVF) (abnormal connection or connections between arteries and veins). These passageways, which may occur anywhere in the body including the brain or spinal cord, act like a short circuit diverting blood from fully circulating and delivering oxygen where it is needed.

• treat aneurysms (a bulge or sac formed in a weak artery wall) by either blocking an artery supplying the aneurysm or closing the aneusymal sac itself as an alternative to surgery.

• treat varicoceles (enlarged veins) in the scrotum that may be a cause of infertility.

Catheter embolization may be used alone or combined with other treatments such as surgery or radiation.

In a catheter embolization procedure, medications or synthetic materials called embolic agents are placed through a catheter into a blood vessel to prevent blood flow to the area.

What to expect?

Devices to monitor your heart rate and blood pressure will be attached to your body. You will feel a slight pin prick when the needle is inserted into your vein for the intravenous line (IV) and when the local anesthetic is injected.

If the case is done with sedation, the intravenous (IV) sedative will make you feel relaxed and sleepy. You may or may not remain awake, depending on how deeply you are sedated. You may feel slight pressure when the catheter is inserted, but no serious discomfort. As the contrast material passes through your body, you may get a warm feeling.

Most patients experience some side effects after embolization. Pain is the most common and can be controlled by medication given by mouth or through your IV.

Women who have embolization of fibroid tumors may have severe pain or cramps shortly after the procedure and for eight to 12 hours afterward. Pain for as long as three to five days after the procedure is not uncommon and may require appropriate pain medications. Mild headache may follow embolization of an intracranial arteriovenous malformation (AVM).

Most patients leave the hospital within 24 hours of the procedure, but those who have considerable pain may have to stay longer. You should be able to resume your normal activities within a week. About one in five patients treated for fibroids will develop post-embolization syndrome, which consists of fever (up to 102° F) that may be accompanied by loss of appetite and nausea or vomiting. The syndrome may occur after any embolization procedure, but is more prone to develop when a solid tumor is embolized. The symptoms usually clear up within three days, though they sometimes last longer and require medication to improve. These symptoms are the body’s reaction to breakdown products from the tumors and are most common when very large tumors are embolized.

Patient Preparation

Prior to your procedure, your blood may be tested to determine how well your kidneys are functioning and whether your blood clots normally.

You should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to local anesthetic medications, general anesthesia or to contrast materials containing iodine (sometimes referred to as “dye” or “x-ray dye”). Your physician may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners for a specified period of time before your procedure.

You will receive specific instructions on how to prepare, including any changes that need to be made to your regular medication schedule.

You will likely be instructed not to eat or drink anything after midnight before your procedure. Your doctor will tell you which medications you may take in the morning. You will be admitted to the hospital on the morning of your procedure and be assessed by the interventional radiologist before the procedure begins. You should plan to stay overnight at the hospital for one or more days. You will be given a gown to wear during the procedure.