Embolization

What Is Embolization?

Embolization (em-buh-luh-ZAY-shun) is a procedure done by interventional radiology specialists. In it, they use a long, thin tube called a catheter to put plugging material or a plugging object into a blood vessel to block it.

Why Is Embolization Done?

Doctors use embolization to:

• stop ongoing bleeding, such as from:
  • a nosebleed
  • an injury (trauma)
  • bleeding in the brain (intracranial hemorrhage)
• reduce bleeding during planned surgery on a tumor
• keep a swollen blood vessel (aneurysm ) from leaking or bursting
• shrink a growth that is mostly made of blood vessels, such as a:
  • juvenile nasopharyngeal angiofibroma
• stop the flow of blood through an abnormal connection between arteries and veins (arteriovenous malformation)
• shrink a tumor so a surgeon can cut it out
• make symptoms better by shrinking a cancer that can't be treated with surgery or anti-cancer medicines (called palliation or palliative therapy)

An interventional radiologist might push a chemotherapy drug or radiation source into the cancer during embolization treatment.

Embolization can offer advantages over surgery, including:

• a shorter hospital stay
• fewer infections
• faster recovery
• no significant scar

What Happens Before Embolization?

The interventional radiologist will discuss the risks and benefits of embolization. If you choose embolization treatment for your child, you'll sign a consent (permission) form. The interventional radiology team will schedule the embolization and talk to you about:

• which medicines to give your child, and when to give them
• when your child should stop eating
• when to arrive
• whether your child will stay in the hospital after the embolization

How Is an Embolization Done?

An interventional radiologist does the procedure in a room called an interventional radiology suite (IR suite). The IR suite is like an operating room with extra X-ray and ultrasound equipment. The treatment team typically also includes:

• an anesthesiologist or anesthetist
• nurses and assistants
• technologists (equipment specialists)

Before going into the IR suite, a team member will:

• Ask your child to change into a hospital gown.
• Place an intravenous (IV) line in your child's vein.
• Put medicine into the IV so your child will feel sleepy.

The anesthesiology team will take your sleeping child to the IR suite. For most embolization procedures, the interventional radiologist will then:

• Make a small incision and insert the embolization catheter into your child's femoral artery, a large blood vessel near the crease between the pubic area and hip (the groin).
• Use X-ray images and videos to guide the tip of the catheter to the blood vessel to be embolized.

The interventional radiologist may use one of several methods for the embolization:

• metal coils that are easily seen on an X-ray and have fibers that trigger a blood clot
• a balloon filled with saltwater (saline)
• chemicals that act like glue and plug the vessel
• chemicals that irritate the vessel, so it shrinks (sclerosing agents)
• tiny balls (particles) that may block the vessel and its branches

The interventional radiologist will check the blood flow to be sure the embolization worked before removing the catheter.

Can I Stay with My Child During an Embolization?

Parents can stay in the preparation area until their child goes to the IR suite. Then, you'll move to the waiting area. When the embolization is done, you may go to the recovery room while your child wakes from the anesthesia.

How Long Does an Embolization Take?

Embolization takes from 30 minutes up to several hours depending on:

• how far the embolization site is from the catheter entry site
• how many twists and turns the catheter must pass through to get to the right position
• the number of vessels to be embolized
• the size of the vessels to be embolized

What Happens After Embolization?

Most children go home later the same day. For a few days after the embolization, your child may:

• feel groin pain
• feel pain where the vessel was embolized
• have groin bruises
• not be hungry

If a tumor was embolized, your child may also have these symptoms, which go away after about 3 days:

• mild fever
• pain
• nausea and vomiting

Are There Any Risks From Embolization?

Anything that breaks the skin can lead to an infection. The interventional radiologist will talk to you about that and these other risks before starting the procedure:

• The embolization may not block the right blood vessel.
• The embolizing material may move and block the wrong vessel.
• The catheter may poke a hole in the blood vessel and cause bleeding.
• The catheter may damage blood vessels and cause a blockage.

For embolizations requiring the use of X-rays (as most do), your child's lifetime risk of cancer is increased very slightly.

How Can I Help My Child Feel Better?

To help your child:

• Listen to, read, and follow any instructions the interventional radiology team gives you.
• Give your child pain medicine as needed and as prescribed.
• Ask about any instructions that are not clear.
• Take your child to all follow-up doctor visits.

During recovery, help your child to:

• Rest and get good sleep.
• Avoid strenuous activities.
• Walk daily.
• Avoid soaking the catheter site in a bath or pool.
• Eat and drink liquids as tolerated.

Keep an eye out for:

• swelling
• bleeding
• pain that doesn't go away with pain medicine

What If I Still Have Questions About Embolization?

For non-urgent questions, call the clinic and talk with a staff member.

For urgent questions, use the emergency contact number given for the interventional radiology team.

When Should I Call the Doctor?

The interventional radiology team will tell you when to call or go to an emergency department. These are signs and symptoms of possible problems:

• fresh (bright red) blood on the groin bandage
• more pain, redness, or swelling than you or your child noticed while at the hospital
• fever — a temperature over 100.4°F (38°C)
• unusual sleepiness or unresponsiveness
• pain, a funny feeling, or no feeling in the leg on the side where the catheter was inserted
• a leg that looks blue or feels cold