Definition & Overview
Arterial embolisation is a minimally invasive surgical procedure used in the treatment of various medical conditions. It involves blocking a part of an artery to stop blood flow to a specific area. Cutting off the blood supply helps doctors treat a particular condition or prevent it from worsening.
Who Should Undergo & Expected Results
Arterial embolisation is recommended for patients diagnosed with:
Aneurysms - An aneurysm forms when a certain area of an artery becomes weakened and begins to bulge. In time, the weakened area will give way resulting in uncontrolled bleeding. To prevent this from happening, doctors have to prevent more blood from entering the aneurysm by performing an embolisation procedure called endovascular coiling. The procedure involves guiding a catheter to the aneurysm and releasing platinum coils to induce a blood clot. This cuts off the blood supply to the aneurysm.
Tumours and fibroid masses - The process of preventing tumours and fibroid masses from getting larger is similar to the treatment of an aneurysm. Arterial embolisation is used to starve the tumour. Without a regular supply of blood, the tumour will eventually die. However, this method is only used if the location of the tumour is difficult to reach through regular surgery.
Bleeding - Arterial embolisation is also an effective method of stopping various types of bleeding caused by trauma or a particular medical condition, such as an ulcer. The method is also used to stop bleeding after childbirth (postpartum bleeding) and excessive bleeding from the nose.
Arteriovenous malformation - An arteriovenous malformation is a condition wherein a part of a vein and artery is abnormally attached to one another. It’s important to note that veins are vessels that contain used blood from an organ back to the heart. Meanwhile, arteries are the vessels that contain enriched blood from the heart back to the various organs. An arteriovenous malformation causes blood to leak from the abnormal attachment. The condition can be corrected by performing an arterial embolisation that prevents blood from passing through that area.
Enlarged spleens - Arterial embolisation reduces the supply of blood to the affected spleen. This causes the spleen to eventually return to its normal size. However, the procedure is mostly used on patients who, for some reasons, are unable to undergo regular surgery.
Patients who undergo arterial embolisation can expect a relatively short recovery period when compared to those who opt for open surgery. But they should also be aware of the complications that may develop.
How is the Procedure Performed?
The concept of arterial embolisation is rather simple as it involves preventing or reducing blood supply to a particular target by blocking the artery. In most cases, this is accomplished by inserting a catheter through the groin and guiding it to the target area. Substances or materials will then be passed through the catheter and implanted at or near the target area to purposely form a blood clot to cut off blood supply.
Prior to the operation, patients are made to undergo a series of examinations to confirm if they qualify for the procedure. In general, arterial embolisation is only recommended when the patient is unable to undergo regular surgery due to the difficult location of the target or the patient’s overall health condition.
These examinations may include kidney and blood clotting tests as well as imaging tests, such as x-ray, magnetic resonance imaging or MRI, and computed tomography or CT scan.
The patient’s current medical condition will also be carefully assessed. If the patient is taking medications, the doctor will inform him or her of which medicines will need to be placed on hold before the procedure is performed.
In most cases, the patient will need to stay in the hospital for a couple of days either before or after the procedure. For some patients, a moderate sedative is sufficient. Others, on the other hand, may require general anaesthesia that will put them to sleep throughout the process.
Once the target has been identified, the surgeon will create an incision, usually in the groin area, where the catheter is inserted. Using an image-guiding device, the surgeon will guide the catheter to the target location and administer a substance that will create a blood clot.
After administering the substance, the catheter is retrieved and the incision is closed using pressure alone. Sutures are not usually required to close the incision. The length of the hospital stay after the procedure depends on the patient’s condition.
Possible Risks and Complications
Arterial embolisation, though minimally invasive, is not risk-free. It is also possible for complications to develop after the procedure.
The common risks associated with the procedure include:
- Adverse reaction to the blood clotting substance
- Damage or bruising of the blood vessel where the catheter was inserted
- Blood clotting substance being placed at the wrong area
- Injury to the organ, such as the uterus when a uterine fibroid embolisation is performed
The procedure also has limitations. It can only be used in certain situations due to the possibility of it creating further complications. For example, if used to stop bleeding, particularly from the nose (epistaxis), the substances used to create a blood clot can result in frequent headaches and death or damage to soft tissue. Therefore, even though the procedure is highly effective, it can only be recommended if the patient cannot undergo a surgical procedure for the condition for one reason or another.
Jose l Bilbao MD, Antonio Martinez-Cuesta MD, Femin Urtasun MD, Octavio Cosin MD;”Complications of Embolization”; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036371/
Aria Health Heart Center;”Embolization – Cutting Off Blood Supply Therapeutically”; https://www.ariahealth.org/programs-and-services/radiology/interventional-radiology/embolization