What is Embolization?

Embolization for bleeding, also known as transcatheter embolization, is a minimally invasive medical procedure that is used to stop bleeding in various parts of the body. This procedure is typically performed by an interventional radiologist, who uses imaging guidance to guide a catheter to the source of the bleeding and then injects embolic agents to block or reduce blood flow to the affected area. In this article, we will explore embolization for bleeding in more detail, including what it is, how it works, and its applications.

What is Embolization for Bleeding?

Embolization for bleeding is a medical procedure that is used to stop bleeding in different parts of the body. It involves the use of embolic agents, which are materials that are injected into a blood vessel or artery to block or reduce blood flow to a specific area. Embolic agents can be made of different materials, such as particles, coils, or glue, depending on the type and location of the bleeding.

Embolization for bleeding is a minimally invasive procedure, meaning that it is performed through a small incision in the skin and typically does not require general anesthesia. This makes it a safer and less invasive alternative to traditional surgery for certain types of bleeding.

How Does Embolization for Bleeding Work?

Embolization for bleeding is typically performed under imaging guidance, such as fluoroscopy or ultrasound, to help the interventional radiologist locate the site of bleeding. Once the site of bleeding is identified, a catheter is inserted through a small incision in the skin and guided to the affected area. The catheter is then used to deliver the embolic agents to the site of bleeding.

The embolic agents work by blocking or reducing blood flow to the affected area, which stops the bleeding. Depending on the location and severity of the bleeding, multiple embolic agents may be used to achieve complete hemostasis (cessation of bleeding).

There are several types of embolization techniques that can be used to treat bleeding, including:

Transcatheter arterial embolization (TAE): This is the most common form of embolization for bleeding. It involves using a catheter to inject small particles or coils into the artery that is bleeding, which block the blood flow and stop the bleeding.

Transcatheter embolization of venous bleeding: This technique is used to treat bleeding from veins. It involves injecting coils or other materials into the veins to stop the bleeding.

Transcatheter embolization of arteriovenous malformations (AVMs): This technique is used to treat abnormal connections between arteries and veins, called AVMs. It involves injecting embolic materials into the AVM to block blood flow and reduce the risk of bleeding.

Balloon occlusion embolization: This technique involves inflating a balloon inside the artery to block blood flow and stop bleeding.

Procoagulant injection embolization: This technique involves injecting a substance that promotes blood clotting into the bleeding vessel, which can help stop the bleeding.

The specific type of embolization used will depend on the location and severity of the bleeding. It is important to consult with a medical professional to determine the best course of treatment for your specific situation.

Applications of Embolization for Bleeding

Embolization for bleeding can be used to treat a variety of bleeding conditions, including:

Gastrointestinal bleeding: Embolization for gastrointestinal bleeding can be used to stop bleeding caused by ulcers, tumors, or other conditions affecting the digestive system.

Trauma-related bleeding: Embolization for trauma-related bleeding can be used to stop bleeding caused by injuries, such as liver or spleen lacerations.

Obstetric and gynecologic bleeding: Embolization for obstetric and gynecologic bleeding can be used to treat bleeding caused by conditions such as fibroids, postpartum hemorrhage, or placenta accreta.

Urologic bleeding: Embolization for urologic bleeding can be used to treat bleeding caused by conditions such as kidney or bladder tumors.

Embolization for bleeding is generally considered safe and effective, with a success rate of over 90% in most cases. However, as with any medical procedure, there are potential risks and complications associated with embolization, including infection, bleeding, and damage to surrounding tissues.

If you are experiencing bleeding and think that embolization may be an appropriate treatment option for you, it is important to talk to your doctor to determine if you are a good candidate for the procedure. Your doctor can help you understand the benefits and risks of embolization and determine whether it is the best course of action for your specific condition.

Why is it done?

It is done to stop bleeding, to treat some congenital or subsequent vascular disorders, to reduce the effects of tumors, and to remove some unwanted diseased tissue pieces.

How is it done?

First, angiography is performed. Vascular structures are shown and the target vessel or vessels to be embolized are determined. A catheter is placed in the target vessels and embolizing substance (vessel occlusive substance) is given. Control angiography is taken. If it is sufficient, the procedure is completed, if not, the necessary vessels are catheterized and the procedure is repeated. Average process takes 1 hour

Risks and Complications of Embolization Procedure:

Depending on your age and current health condition, the following risks and undesirable conditions may occur during the procedure.

1-Pain develops due to the lack of oxygen in the treated area and can usually be controlled with painkillers. The pain may last for days and may require hospitalization.

2- Infection: Abscess, sepsis(%2)

3- Ischemia in the embolization area(4%)

4- Occlusion of the non-target site or organ by unintentional embolization (3%).

5- Bleeding

6- Death(%1)

7-Contrast substance reactions:

a) Anaphylactoid reaction: it is a serious allergy-like reaction, it can lead to death.

b) Spasm and edema in the respiratory tract: it causes respiratory distress.

c) Mild allergic reactions: sneezing, tearing, rash on the body, urticaria (hives).

d) Feeling of warmth at the injection site, pain.

e) Nausea, vomiting.

f) Kidney failure.

g) Cardiac arrhythmias.

h) epilepsy

Required Procedures Before Embolization:

1- Before the procedure, the patient should be fasting for at least 8 hours. Fluid intake should continue until 8 hours before the procedure. After that, fluid intake will be done intravenously. This condition is not required in an emergency.

2- Before the procedure, hemostasis tests (INR, APTT, fibrinogen, platelet count) showing the coagulation properties of the blood and tests for blood-borne diseases (HBs, HIV and HCV) must be performed. If hemostasis tests are not at the desired level, anticoagulant drugs should be discontinued and appropriate treatment should be given. Patients using oral anticoagulant drugs should discontinue their medication 3-4 days before the procedure.

 3- BUN and creatinine tests should also be done, as the contrast agent used may cause kidney damage.

 4- Before the procedure, the patient should continue to take medications such as heart and blood pressure medications that he regularly uses. If the patient takes his medication in the morning, he should drink it with a small amount of water.

5- Those with diabetes should not take diabetes-related blood sugar-lowering drugs because they are hungry. Patients using metformin (glucophage) as a sugar reducer should definitely inform their doctor, this drug should not be used for 48 hours before and after the procedure.

6- Before some embolization procedures, preventive antibiotics can be administered from the vein or hip.

7- Parenteral (intravenously or intramuscularly) sedatives or, if necessary, other drugs are given before the procedure is downloaded to the radiology service or before the procedure. The sedative will relax you, causing drowsiness, but you will probably be awake during the procedure.

Required Actions After Embolization:

 After the procedure is finished, the bleeding will be stopped by manually pressing the entry site. After the bleeding is stopped, a sandbag will be placed on the entry site to prevent bleeding again.

The patient will lie in bed for at least 4 hours after the procedure and lie flat without bending his leg. During this time he will not get up for his needs. Food can be eaten after the procedure unless otherwise stated. In order to avoid some side effects of the contrast agent, it will be beneficial to take plenty of fluids. The patient will be kept under observation in the hospital for a while.