Therapeutic embolization

Overview
Embolization is a non-surgical, minimally-invasive procedure performed by an interventional cardiologist or interventional radiologist and interventional neuroradiologists. It involves the selective occlusion of blood vessels, by purposely introducing emboli.

Therapeutic Applications
Embolization is used to treat a wide variety of conditions affecting different organs of the human body.

Hemorrhage
The treatment is used to occlude:


 * AVMs
 * Cerebral aneurysm
 * Gastrointestinal bleeding
 * Epistaxis

Growths

 * In the liver, typically HCC lesions. Either by infarction or TACE (Transcatheter arterial chemoembolization).
 * Kidney lesions
 * Uterine fibroids

The Procedure
The procedure is a minimally-invasive alternative to surgery. The purpose of therapeutic embolization is to prevent blood flow to an area of the body, which effectively can shrink a tumor or block an aneurysm.

The procedure is carried out as an endovascular procedure, by an Interventional Cardiologist or a Consultant Radiologist in an Interventional Suite. It is common for most patients to have the treatment carried out with little or no sedation, although this depends largely on the organ to be embolized. Patients who undergo Cerebral Embolization or Portal Vein Embolization are usually given a general anesthetic.

Access to the organ in question is acquired by means of a guide wire and catheter(s). Depending on the organ this can be very difficult and time consuming. The position of the correct artery or vein supplying the pathology in question is located by Digital subtraction angiography or DSA. These images are then used as a map for the radiologist to gain access to the correct vessel by selecting an appropriate catheter and or wire, depending on the 'shape' of the surrounding anatomy.

Once in place, the treatment can begin. The artificial embolus used is usually one of three things:


 * Coils: Guglielmi Detachable Coil or Hydrocoil
 * Particles
 * Foam

Once the artificial emboli have been successfully introduced, another set of DSA images are taken to confirm a successful deployment.

Advantages

 * Minimally invasive
 * No scarring
 * Minimal risk of infection
 * No or rare use of general anaesthetic
 * Faster recovery time

Disadvantages

 * User dependent success rate
 * Risk of emboli reaching healthy tissue
 * Not suitable for everyone