Understanding Embolization Treatment

What is embolization?

Embolization is a minimally invasive procedure used to cut off blood supply to a certain part of your body. This is often an important step in treating abnormal or excessive bleeding caused by illnesses or sudden injuries.

During the procedure (which is also known as catheter embolization and endovascular embolization), a doctor guides a thin, flexible tube called a catheter through your main arteries until it reaches the blood vessel that needs to be closed off.

The doctor then inserts one of several synthetic materials, called embolic agents, through the catheter and into the blood vessel. These materials, which include glue, foam, small plastic particles or tiny metal coils, block the blood vessel so blood can no longer flow through it.

Throughout the procedure, your doctor will use X-ray imaging and a special dye (called contrast solution) to better visualize the treatment site and take pictures that show the blood vessel before and after embolization.

Embolization is used to treat several conditions that affect the brain. Examples include:

• sealing blood vessels that are feeding a brain tumor
• blocking blood flow to an arteriovenous malformation or a dural arteriovenous fistula
• cutting off blood supply to a bulging or ruptured artery called an aneurysm

Embolization can be used alone or in combination with other treatments, including open surgery or radiation therapy. Because it is much less invasive than traditional surgery, embolization is associated with minimal blood loss, a shorter hospital stay and fewer complications.

How to prepare for your embolization procedure

The following general guidelines apply to most people who are preparing for an embolization procedure. Your doctor or another clinician from Lyerly Neurosurgery may give you additional instructions.

• The night before your procedure, you should not eat or drink anything after midnight.
• The morning of your procedure, do not take any prescription or over-the-counter medications that can increase bleeding risk. These include blood thinners and nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen and naproxen). However, if you are taking Plavix or aspirin under Dr. Hanel's or Dr. Sauvageau's direction, please continue taking your daily dose unless a member of our team tells you otherwise.
• If you use other daily prescription medications, you may be able to take them as usual the morning of your procedure — your doctor will let you know what is safe to use.
• Unless instructed otherwise, your embolization procedure will take place at Baptist Medical Center Jacksonville. Please check in at the registration area located on the first floor of the J. Wayne and Delores Barr Weaver Tower. You will be given detailed instructions on what time to arrive and where to park.
• Bring your prescription or over-the-counter medications with you to the hospital, in their original containers.
• Don't forget to notify our team if you have a history of bleeding disorders, or if you are allergic (or have a sensitivity) to any medications, anesthesia, latex or adhesive tape.

What to expect during your embolization procedure

The length of time it takes to perform embolization varies from one to several hours, depending on the specific condition being treated.

The procedure can be performed under general anesthesia (meaning you will be asleep) or using a sedative that keeps you awake, but in a relaxed state.

When it's time to begin, a member of the interventional team will help you lie down on your back on a special adjustable table called an X-ray table. For your safety, and to keep your head still during the exam, the interventional team member will place straps across your head, chest and legs. He or she will also place a needle in your arm, so you can receive fluids or a sedative intravenously.

When it's time to place the catheter in your artery, a member of the health care team will wash, disinfect and numb the area of your body (typically the groin) where the catheter will be inserted. He or she also may need to shave away a small amount of hair.

Once the catheter has been placed, your doctor will carefully guide it up through the main blood vessels in your abdomen, chest and neck. You will not be able to feel the catheter moving through your arteries.

You'll receive an injection of contrast dye once the catheter has reached its final destination. You may feel a temporary warm or flushing sensation as the dye enters your bloodstream.

Using X-ray technology, your doctor will monitor the dye as it moves through the blood vessels in your brain and highlights the area needing treatment. He will take a series of pictures before and after embolization to document that the procedure worked.

Your doctor will then insert the embolic agent through the catheter and into the target blood vessel. The embolic agent used during your surgery will depend on the type of condition you're being treated for.

Once in place, the embolic agent will block or seal off the blood vessel, preventing blood from flowing through it.

Upon completion of your embolization procedure, your doctor will remove the catheter and bandage the insertion site. From there, you will be taken to a recovery area for observation.

What to expect after your embolization procedure

The average length of stay in the hospital following embolization is 24 hours.

Immediately after surgery, you will be monitored closely by your doctor and his health care team. First you'll be taken to a recovery area for short-term observation, and then you will be transferred to an inpatient room for continued surveillance.

During the first couple of hours following your procedure, you will need to remain lying down.

Drinking plenty of fluid after your exam will help flush the contrast dye from your body.

Before you are discharged from the hospital, members of your health care team will help guide you through your transition to home. They will make sure you understand what medications to take, and when you may resume bathing, driving and physical activity.

Your doctor or another member of the Lyerly Neurosurgery team will give you detailed instructions for taking care of yourself once you're home. However, the following general guidelines apply to most people:

• It is normal for your catheter insertion site to remain tender or bruised for several days. During this time you should avoid heavy lifting and other strenuous activities.
• You may experience mild headaches for the first few days following your procedure, especially if you were treated for a brain AVM. Your doctor will talk to you about pain medications that are safe to use.

Once you are home, pay attention to any unusual symptoms. Call our office at 904.861.0316 if you experience any of the following:

• excessive bleeding, swelling, new bruising or drainage from the insertion site
• pain or discomfort at the insertion site that gets worse over time, or cannot be controlled with pain medication
• fever
• sudden shortness of breath

Are there any risks I should be aware of?

As with any medical procedure, embolization is associated with rare but serious risks. These include:

• allergic reaction to the contrast dye (please let your doctor know if you are allergic to iodine)
• prolonged exposure to X-ray radiation
• infection
• excessive bleeding
• a torn or damaged blood vessel
• the embolic agent lodges in the wrong place, and restricts blood flow through a healthy artery
• a blood clot that forms around the tip of the catheter, then remains in the blood vessel
• stroke, which can occur if the catheter dislodges plaque from an artery wall, and the plaque becomes lodged in a blood vessel

If you have any questions or concerns about the safety of this procedure, please do not hesitate to discuss them with your doctor.

The region's trusted embolization experts

Since Lyerly Neurosurgery was founded in 1934, our physicians have cared for thousands of people who need treatment for a brain or spine condition.

Today our practice continues to build upon a legacy that blends compassion, safety and innovation. Our neurosurgeons provide the full spectrum of evidence-based care, including the latest minimally invasive procedures that can only be offered by neurosurgeons with advanced training and experience.

Together with Baptist Medical Center Jacksonville, our team performs emergency and preventive neurosurgery services including new embolization treatments by specialists who are fellowship trained in endovascular neurosurgery.