Embolization
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Embolization is a non-specific term often used to describe a procedure where blood vessel treatments are performed.
Historically, embolization procedures were developed to treat certain conditions in which blockage of blood vessels was necessary to prevent bleeding from an injury or to block the growth or rupture of an aneurysm, an arteriovenous malformation, or a tumor.
With today’s technology, many more types of treatment can now be performed. Rather than simply blocking blood vessels, for example, embolization procedures can reconstruct vessels to cure large and giant cerebral aneurysms. Therefore, the term embolization has historical meaning, the actual meaning, and sometimes misapplied meaning.
Embolization procedures may be stand-alone procedures or they may be performed in combination with conventional surgery or radiation treatments.
When is Embolization performed?
In its basic form, embolization is performed when shutting down blood flow will be helpful—for example, to prevent hemorrhage, to reduce the size of a lesion, or to make a lesion more straightforward to remove.
Embolization can be applied with one of several goals in mind. The embolization treatment may be palliative in cases where no surgery is contemplated, protecting the patient from hemorrhage or other symptoms. Embolization can be curative, as in many cases of brain aneurysms and dural arteriovenous fistulas. Sometimes, doctors use embolization to amplify the benefits of radiation therapy, since an embolized lesion receives limited blood flow and nutrients—and is, therefore, more vulnerable to radiation’s effects. Sometimes, embolization is adjunctive to surgery, such as with cerebral arteriovenous malformations. Using embolization in conjunction with surgical resection, we have demonstrated among the lowest, if not the lowest, risk of brain AVM treatment in the medical literature.
Lesions that we treat with embolization include:
- Tumor, especially those with robust blood supplies
- Aneurysm
- Vascular malformation; Common types of vascular malformation include arteriovenous malformation (AVM) and dural arteriovenous fistula (DAVF)
How should I prepare for Embolization?
Embolization can be performed under local anesthesia with light sedation, with deeper sedation with monitored anesthesia care or with general anesthesia when necessary or advantageous. Discuss with your doctor the types of anesthesia that are most useful for your procedure, and you can express your thoughts and wishes at that time.
Access to the blood vessel system for an embolization procedure is most often obtained via the common femoral artery or vein- the large blood vessels near the skin surface that travel down the leg. Other blood vessels in the wrist, upper arm, or even the neck could be used, depending on the particular need. Local anesthetic medication is used to prevent pain at the skin. There are no touch-sensitive nerves inside the blood vessels, so there is usually no pain associated with passage of the tube to the blood vessels leading to the brain.
Since the procedure is minimally invasive, there is no need for an incision that exposes the treatment site. Instead, the procedure is usually performed through tubes no more than 2mm to 3mm in diameter—at a maximum, about the width of two pennies. The physician uses image guidance to “see” inside from outside the body, most commonly X-ray fluoroscopy or ultrasound.
Many types of implantable materials are available for embolization procedures. In fact, the number of devices keeps growing every year as new and better technology becomes available. The choice of device depends on the purpose of the procedure and the condition being treated. Some embolic materials are permanent; some are not. Some are metallic; some are plastic or made from other polymers. You can discuss with your physician the embolic materials that are right for you and the procedure under consideration.
How is Embolization performed?
Embolization procedures can be performed in an emergency or electively. In an emergency, our physicians are available 24 hours per day, seven days per week, 365 days per year to perform embolization and other stroke emergency procedures.
For procedures in which the patient decides when to come into the hospital for treatment, it is important to meet with your physician and to understand the risks and benefits, goals and alternatives to your procedure. It may help to keep a list of your questions and to bring the list to your appointments.
Bring a complete list of your medications and their schedule of administration. It is possible that your physician may need to make some changes prior to your procedure.
What can I expect after Embolization?
After the procedure, most patients will be monitored in the Recovery Room (Post Anesthesia Care Unit or PACU) or the Neurological Intensive Care Unit (NICU). Nurses and other care specialists in these areas are specifically trained to monitor patients after procedures. Following removal of the treatment catheter, manual compression of the small access site usually takes 15 to 20 minutes to prevent any further bleeding. Sometimes, a closure device is used to prevent bruising at the access site too.
How long will I stay in the hospital?
For a treatment procedure performed at the time of an emergency, the amount of time a patient spends in the hospital is mostly determined by the condition requiring treatment.
For scheduled procedures, most patients are observed overnight and discharged home in the morning after breakfast. If the embolization procedure is performed as an adjunct to another surgical procedure, then these procedures can sometimes be arranged on successive days (one day after the other) for your convenience.
Will I need to take any special medications?
Additional medication may be required, but this depends on the condition and the type of embolization procedure planned. Speak with your surgeon to find out if you will require any additional medications.
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