Embolization therapy is a method used to resolve certain health problems. It is especially preferred for tumors, vascular abnormalities, and bleeding that is difficult to control. During this procedure, a small embolic material is placed in a specific blood vessel. Thus, the blood flow is cut off, and by reducing the amount of blood going to the problematic area, treatment is achieved. For patients, this method offers a less invasive option compared to surgical intervention. Moreover, the recovery process is generally faster. The procedure can take about 30 minutes.
Things to Know About Embolization
| Definition | A minimally invasive procedure used to block blood vessels and stop blood flow. |
| Indications | Aneurysm, AVM, hemangioma, emergency bleeding, goiter, myoma, prostate, hemorrhoid, varicocele, pelvic congestion syndrome, liver, kidney, bone tumors, etc. |
| Fields of Application | Interventional radiology, oncology, gynecology. |
| Procedure | Injection of embolic agents (microspheres, coils, particles) into the vessel via a thin catheter. |
| Preparation | Blood tests, imaging tests (MRI, CT, ultrasound), fasting (usually 6-8 hours). |
| Advantages | Minimally invasive, short recovery time, tissue-specific treatment. |
| Risks and Complications | Infection, bleeding, vascular injury, embolic agents migrating to the wrong location. |
| Recovery Process | Usually rapid; normal activities can be resumed within a few days. |
| Contraindications | Severe coagulopathy, active infection, certain anatomical challenges. |
| Alternative Treatments | Surgical intervention, radiotherapy, medication therapy. |
Interventional Radiology / Interventional Neuroradiology
Prof. Dr. Özgür KILIÇKESMEZ
What is Embolization Therapy?
Embolization, as a medical procedure, ensures the blockage of blood vessels. This procedure is performed with minimally invasive methods and is suitable for various conditions. It provides a quick solution for emergencies while maintaining its effectiveness for planned treatments.
The procedure is carried out by entering a vein with a needle and reaching other vessels through very thin tubes. In angiography, it is a method that is performed under sedation and pain relief while the patient is awake, and it can last around 30-60 minutes.
During the procedure, various materials are placed into the vessel:
- Special mechanical devices (coil, glue, onyx, particles, vascular plug, etc.)
- The patient’s own clotted blood
These materials disrupt blood flow and contribute to solving the issue in the relevant area. This method is preferred in both emergency and elective cases, promising patients a quick and effective recovery period.
What Are the Benefits of Embolization Therapy?
It plays a major role, especially in treating vascular abnormalities. Through this treatment method:
- Atypical vascular connections are successfully eliminated.
- The vessels that feed tumors and similar pathological growths are effectively closed.
- Severe bleeding is prevented or stopped.
Thus, patients achieve both immediate and long-term relief. The application of the treatment varies depending on the patient’s condition but is generally a fast and safe process.
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Which Diseases Are Treated with Embolization?
In particular, conditions that cause bleeding fall within the scope of this treatment. Bleeding and tumors that can occur in different organs of the body can be controlled with embolization. Among the serious ailments patients experience are conditions that carry a vital risk, such as brain aneurysms and arteriovenous malformations.
- Arteriovenous malformations
- Brain aneurysms
- Cancers and bleeding tumors
- Frequent nosebleeds
- Gastrointestinal bleeding due to peptic ulcer and diverticulosis
- Hemorrhoids
- Excessive menstrual bleeding
- Overactive spleen functions
- Retroperitoneal hematoma
- Organs affected by traumatic injuries: spleen, liver, lungs
- Uterine fibroids
- Varicocele in the scrotum
- Prostate enlargement
- Renal aneurysms
- Abnormal connections between arteries and veins
Such conditions necessitate embolization as a treatment method. The procedure is considered an effective way to overcome these health problems. Patients typically observe a quick and safe recovery period with this method.
How Is the Embolization Procedure Performed?
Embolization therapy is specifically designed to intervene in problematic areas within blood vessels. A thin and long catheter is inserted into your vascular system through a small opening in the skin. This catheter is guided by your doctor toward the area to be treated. While advancing the catheter, the vessel pathway is carefully monitored.
- The tip of the catheter carries the embolic agents to the correct point.
- These agents are small particles that disrupt blood flow.
- Once the area requiring treatment is reached, the agents are released.
Thus, blood flow is obstructed, and control is established over the relevant health issue. The embolization procedure is carried out in a sensitive and controlled manner.
Which Doctors Perform Embolization Procedures?
Embolization procedures are conducted by interventional radiology specialists. Doctors in this field are highly knowledgeable about the vascular system inside the body and use this information to implement the treatment. During the procedure, real-time imaging techniques and catheters are actively used. This way, doctors can:
- Easily access the correct vessel,
- Perform the procedure in a precise manner.
Interventional radiology specialists have training in medical imaging and effectively use these skills during the treatment process.
Preparations Before Embolization
Before starting embolization therapy, doctors use various imaging techniques to thoroughly examine the area to be treated. These techniques include:
- Ultrasound,
- Computed tomography (CT) scan,
- Magnetic resonance imaging (MRI)
These imaging methods allow the treatment area to be identified clearly. They are also critical for the accurate placement of the embolic materials the doctor will use during the procedure. Patients may need to take certain precautions before the procedure. For example, blood-thinning medications that could affect the blood clotting process may be stopped under medical supervision. This preparation phase is vital for the success of the embolization procedure.
What Are the Techniques in Embolization Therapy?
In an embolization procedure, the embolic agents used vary according to the patient’s health condition and the characteristics of the treated vessel. These agents are carefully chosen to block blood flow within the vessel. Each agent has its unique features and may be ideal for specific situations. Here are the main types of embolic agents used in embolization therapy:
- Balloons: Small balloons used to temporarily or permanently block blood vessels.
- Gelatin foam: A sponge-like material based on gelatin, which dissolves on its own in a few days.
- Liquid adhesives: A sticky substance that solidifies quickly to close abnormal vascular structures.
- Liquid sclerosing agents: Alcohol-based substances that damage tissue upon contact and facilitate the closure of abnormal vessels.
- Metal coils: Small devices made of stainless steel or platinum, offering precise placement.
- Particle agents: Various sized spheres used to permanently block small vessels.
What Happens During Embolization?
The embolization procedure typically begins with mild sedation to ensure the patient’s comfort. An interventional radiologist usually makes a 1 mm incision in the wrist, groin, or neck area for easy access to the area to be treated. After this stage, a catheter is advanced toward the targeted site. During the procedure, the interventional radiologist’s movements and the treatment area are monitored through advanced imaging techniques such as fluoroscopy.
- The interventional radiologist injects a special fluid (contrast agent) into the vessel through the catheter to visualize the target vessel clearly.
- After the injection, the embolic agent is administered to the treatment area.
- Once the embolic agent is placed in the treatment area, the blood flow is cut off, thus stopping blood supply to the diseased region.
After the procedure is completed, the catheter is carefully removed and the small incision is covered with a bandage that typically does not require sutures.
Is There Pain or Discomfort During Embolization Therapy?
Patients undergoing embolization therapy usually do not feel discomfort. Any pain or ache is largely prevented by the sedation and local anesthesia used during the procedure. Initially, you may experience a slight pinching sensation from the needle containing the anesthetic substance. However, this feeling is temporary and mild. Later on:
- A sensitivity may occur in the undesired and destroyed tissue,
- There could be a temporary warmth when the contrast agent is administered,
These are normal situations due to the nature of the procedure and typically disappear shortly. Patients can usually return to their normal lives quickly after the procedure.
What Are the Risks and Complications of Embolization Therapy?
The embolization procedure carries certain risks for patients. The likelihood of these risks depends on the area where the procedure is applied and the type of embolic agent used. Possible issues during the procedure include:
- Air embolism: A condition where an air bubble blocks a blood vessel
- Allergic reactions: Sensitivity observed towards the contrast dye
- Bruising or bleeding: Under-the-skin bleeding in the area where the puncture was made
- Movement of the embolic agent: The applied substance relocating or migrating to an incorrect area
- Infections: Sometimes life-threatening infections that can develop post-treatment
- Neuropathy: Known as nerve damage
- Soft tissue necrosis: May occur especially if multiple vessels are treated
- Stroke or blindness: Can occur if the embolic agents used initially migrate
Each risk is evaluated based on factors such as the patient’s overall health status, the area where the procedure is performed, and the characteristics of the chosen embolic agent. The physician performing the treatment informs the patient and their relatives about these risks, allowing them to make informed decisions regarding the treatment process.
What Is the Recovery Process After Embolization?
After the embolization procedure, you will spend the first few days resting at home and limiting physical activities. Depending on where the procedure is performed, you may need to take certain precautions:
If a groin puncture was performed:
- Avoid climbing stairs.
If a wrist puncture was performed:
- Avoid repetitive hand movements such as writing.
Additionally, refrain from lifting heavy objects and avoid strenuous physical activities. You can support your blood circulation by taking short daily walks, thereby preventing complications like constipation. To aid the healing process of the puncture wound, you can apply ice to reduce swelling. Make sure to keep the wound clean and dry.
Post Embolization Syndrome (Flu-Like Syndrome)
After certain embolizations, mild sensitivity, chills, and fatigue similar to flu symptoms may appear for a day or two and usually resolve without treatment. They often improve on their own and only rarely require pain medication.
Frequently Asked Questions
What should be done after embolization?
There are important steps that patients must follow after embolization. On the first day, you should rest completely, and you should gradually return to activities within the next three days. Heavy lifting and strenuous exercises should be avoided until approved by your doctor. A cold pack can be used for bruising at the puncture site. The incision area must be kept clean and dry. It is crucial to stay hydrated and consume plenty of clear fluids. Also, do not drive without your doctor’s approval. If you experience severe pain, excessive bleeding, or a high fever, you should contact your doctor immediately.
Who can undergo embolization?
Embolization is especially recommended for patients with certain health conditions. Severe bleeding is one example. Furthermore, this method is advised for individuals with vascular disorders such as arteriovenous malformations and aneurysms. Patients with tumors can use this procedure to cut off the blood flow feeding the tumor, helping in the treatment process. Women with fibroids can reduce these masses and alleviate painful menstrual periods via embolization. Patients with swollen veins in the scrotum (varicocele) can also benefit from embolization. It is utilized for those with overactive spleen, retroperitoneal hematoma, and certain types of cancer. Good-natured prostate enlargements, hemorrhoids, and goiter are among other examples.
How long does embolization take?
The duration of the embolization procedure varies depending on the complexity of the treatment and the number of vessels that need to be addressed. Typically, the process can be completed in about half an hour to a few hours. In simple cases, it may last around thirty minutes, while more complex situations involving multiple vessels may take longer. After the procedure, patients are encouraged to rest in bed for six to eight hours, allowing the entry site to heal and reducing the likelihood of complications.
Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.
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