What is vascular embolization? Uterine artery embolization (UAE): essence, indications, how it is performed, results and rehabilitation

Minimally invasive manipulation - embolization is a surgical procedure to mechanically close the lumen of a blood vessel feeding a cancerous tumor. During the intervention, the surgeon inserts a special catheter into the femoral artery.

This treatment technique is widely used in many areas of medicine. It gained particular popularity in oncological practice in the 21st century due to its low-traumatic, painless nature and relative simplicity of the technique.

The essence and goals of embolization

The procedure for mechanically stopping blood flow in a malignant neoplasm has the following goals:

The development of ischemia (impaired blood supply) of mutated tissues, which leads to persistent remission or disintegration of the tumor. In some cases, this scenario can protect the patient from radical intervention.
Prevention of spontaneous bleeding during tumor excision surgery.
Reducing the size of tumor formation, which in the future makes it possible to more accurately remove oncology.
Palliative care for seriously ill patients by reducing the growth of pathology and, as a consequence,. The improvement in the well-being of the cancer patient is short-term.

The essence of the manipulation is as follows:

Preliminary treatment is carried out for the cancer patient. X-ray examination of the structure of the circulatory system using a contrast agent is necessary to clarify the method of bringing the embolus to the site of mutation.
For the patient, the puncture site is treated with an anesthetic solution.
Femoral artery puncture.
Inserting a catheter into an arterial vessel and moving it towards the previously selected cancer artery.
Transporting emboli through a catheter and cutting off the blood supply to the pathological area of the body.

Types of embolization

In oncological practice, it is customary to distinguish the following types of embolization:

Preoperative – it is also considered the initial stage of radical intervention.
An independent method of anti-cancer treatment - this type is most often used for liver and kidney tumors.
Palliative care, which is based on stopping bleeding, eliminating pain and stabilizing malignant growth.

Benefits of tumor embolization for cancer patients

The procedure does not cause mechanical damage to tissues adjacent to the tumor.
Rapid rehabilitation and recovery of a cancer patient.
Ease of manipulation.
Minimal number of postoperative complications.
Point effect on malignant neoplasm.
No seams or soft tissue incisions.

How is embolization performed in oncology?

Doctors do not recommend eating food or carbonated drinks 4-5 hours before surgery. Also, the patient uses sedatives.

After examining the contrast X-ray data, the surgeon inserts a catheter into the femoral artery. The embolus gradually penetrates into a large cancer vessel, completely blocking its lumen.

Contraindications

The presence of a chronic or acute infectious process.
An allergic reaction of an immediate type in the form of anaphylactic shock or Quincke's edema.
Respiratory and renal failure.
Patient intolerance to contrast agent or other components of this technology.

Disadvantages of embolization in the treatment of cancer patients

The positive outcome of therapy largely depends on the experience and qualifications of the oncologist.
There is a high probability of emboli implanting into nearby physiologically healthy tissues.
Often the clinical picture of cancer excludes tumor embolization.
After successful treatment, symptoms may often occur.
Presence of postoperative pain in the tumor growth area.

Is embolization safe for cancer patients?

This technique is aimed at stopping the blood flow to the malignant growth site. In this case, neighboring healthy tissues, as a rule, remain undamaged and retain their function. Modern medical technologies use ultra-precise catheters that deliver the embolus directly to the problem area of the body.

To ensure safe manipulation, before radical intervention, the cancer patient undergoes additional diagnostics using contrast radiography, ultrasound, computed tomography and magnetic resonance imaging. These examinations are aimed at clarifying the location of the tumor, the structure of the vascular network and the point of overlap of the artery lumen.

The specialist pays special attention to the patient’s existing contraindications to this measure. Despite this, most prohibition factors are relative. For example, pathology of the renal system causes a chronic increase in blood pressure. In such conditions embolization is an extremely dangerous procedure. To carry out this manipulation, it is enough to normalize hypertension. In most clinical cases, an individual selection of research method and treatment tactics is carried out for each patient.

Cardiologist

Higher education:

Cardiologist

Saratov State Medical University named after. IN AND. Razumovsky (SSMU, media)

Level of education - Specialist

Additional education:

"Emergency Cardiology"

1990 - Ryazan Medical Institute named after Academician I.P. Pavlova

Endovascular embolization is one of the methods of treating blood vessels, when a catheter and other materials are inserted inside to change the movement of blood flow and supply a medicinal substance into the damaged vessel. The technique is minimally invasive and is performed under the supervision of a physician using X-rays or CT. Most often, the endovascular embolization method is used to stop internal bleeding and stop the blood supply to tumor formations of various etiologies (to stop their growth).

What is this method?

The endovascular method of therapy is designed to perform the necessary interventions on the blood vessels of the brain to prevent the development of dangerous diseases. Thus, blocking blood access to a malignant tumor in time can stop its growth. This is extremely important if surgical removal is impossible due to certain circumstances.

There are other blood vessel abnormalities that can be corrected by embolization:

Elimination of aneurysms.
Correction of abnormal structure and dilation of blood vessels that disrupts normal blood flow in the brain.
All types of strokes.
Relieving vasospasm.
Restricting blood access to pathological formations such as tumors and fistulas.

Endovascular treatment procedures

The endovascular technique includes several different procedures that achieve a certain effect. Let's look at what embolization is and how it is carried out. Embolization is a procedure during which a special material (liquid or solid) is injected into a vessel to prevent normal blood flow. Most often, doctors use materials such as polyvinyl alcohol, adhesives, gels, foams and microspheres.

If the goal is to deliver a drug to a specific area of the brain, then special catheters are used to specifically deliver the drug, blocking other vessels. In this way, chemotherapy drugs for the treatment of cancer, antispasmodics, drugs for dissolving blood clots and hematomas are delivered.

Through embolization, medical devices and instruments are delivered to the vessels: stents, coils, balloons. Stents are small tubes that help open the lumen of a vessel. Balloons are used to treat blood vessels during angioplasty. Coils help regulate blood flow and are most often used in the treatment of aneurysms. Thanks to mechanical catheters, blood clots, medical devices and other foreign bodies are removed from blood vessels.

Preparatory activities

Before prescribing embolization, the doctor is obliged to conduct a complete clinical examination of the patient. During the diagnostic process, blood and urine are donated for biochemical analysis, the functional capacity of the kidneys and liver is assessed, and the presence of infectious diseases is determined. In addition, the level of blood clotting and the Rh factor are determined.

Consultations with an anesthesiologist are carried out. If the patient is taking certain medications, he must notify the attending physician about this. If there is an allergy to medications, this is discussed before the operation. A week before the operation, the patient must stop taking anticoagulants and NSAIDs. If there is diabetic pathology and insulin dependence, the patient discusses with the doctor the regimen for using the necessary glucose-lowering drugs.

During the conversation, all previous diseases and surgical interventions are discussed. If a woman is pregnant at the time of illness, she is obliged to warn about this, since the procedure is carried out using x-ray equipment. This will help minimize your baby's exposure to radiation. It is important to tell your doctor about any pacemakers, implants, neurostimulators, chemotherapy ports, prosthetics, or other medical devices inside the body.

The patient is fully instructed in preparation for the operation, and an individual plan for postoperative treatment with the help of medications is developed. Stop eating and drinking a few hours before the start. Procedures are carried out to cleanse the intestines and empty the bladder. The patient is dressed in special hospital clothes. Immediately before the procedure, an ultrasound examination of the patient, computed tomography of the brain and MRI are performed.

Equipment for endovascular embolization

Despite the fact that endovascular embolization is considered a minimally invasive procedure, it is still a surgical intervention in the human body. Therefore, it requires both special professional training of doctors and special equipment. During the procedure, an X-ray machine, catheters, synthetic materials, medications, medical instruments (spirals, tubes, balloons, etc.) are used.

The operating room is equipped with a special table with built-in X-ray equipment. Tubes and detectors move along the table so that, using radiation, the operation process can be monitored in real time on a computer monitor. Anesthesia equipment is also located here: a heartbeat monitoring device, an intravenous infusion system, an artificial respiration machine, blood pressure measurements, etc.

A catheter is a long, thin plastic tube; may vary in diameter. It is used to deliver medications and medical instruments to blood vessels. The selection of medications is carried out by the doctor based on the chosen method of treatment and the purpose of the procedure. The most often used is gel foam, consisting of concentrated gelatin, shaped like a sponge. Small pieces of it are introduced into the vessel. When the blood flow reaches the place where the blood clot has formed, it stops there. The material remains inside the blood vessel for 2-3 weeks, after which it dissolves on its own.

In order to permanently block blood vessels, polyvinyl alcohol and gelatin-coated plastic microspheres are used. Using embolic coils, the lumens of large vessels are closed. Such spirals are made from stainless steel and platinum. Each spiral is twisted from the finest metal wires; the diameter of each of them is much thinner than a human hair.

Sometimes spirals can be coated with special polymer materials. The width and diameter of the spiral differ. The choice of the size and material of the spirals is made by the doctor, based on the specific situation of the development of the disease. There are also biologically active spirals that, after a certain period of time, dissolve on their own and do not require additional surgery to remove them.

With the help of special liquid preparations, it is possible to provoke the formation of a blood clot in a certain place in the vessel. Such a thrombus will close the lumen of the abnormal blood vessel and block blood access to the pathology. This effect is achieved with the help of alcohols and other sclerosing drugs.

Liquid substances similar to glue, when they enter the lumen of the vessel, quickly harden, which makes it possible to effectively embolize the damaged area and achieve a certain result. The use of such drugs and devices during surgery is completely safe for the life and health of the patient. This is confirmed by numerous clinical studies.

Phased implementation

Endovascular embolization of cerebral blood vessels is performed under general anesthesia. The patient, being asleep, does not feel anything during the procedure. Using small pinpoint incisions or punctures, special thin tubes called catheters are inserted. They are sent to pathologically altered arteries, observing the process using x-rays. The exact location of the pathology is determined using contrast materials. Once the location is located and confirmed by a series of x-rays, embolic agents are injected through the catheters.

The procedure is completed with a series of photographs confirming that the blood flow has stopped in the required area. The catheters are removed, bleeding stops (if any), and a sterile bandage is applied to the incision sites. The drugs that control the patient’s condition are turned off, and the anesthesia supply system is removed.

Sometimes your doctor may apply a special patch to the open artery wall. This will allow the tissues to heal and recover faster. On average, vascular embolization takes several hours. In mild cases it may last only 30 minutes. After the operation, the patient must spend at least 8 hours in bed.

After the anesthesia wears off completely, the patient may experience pain. In this case, the doctor prescribes painkillers. If the pain intensifies, it is eliminated with special injections. The patient remains in the hospital under medical supervision for several more days. Next begins the period of recovery and rehabilitation, which takes an average of 2-3 weeks.

What benefits does this technique give to patients?

The procedure is minimally invasive, which prevents injury to large amounts of tissue. Punctures or cuts do not even require stitching. This helps to avoid cosmetic defects on the skin. The rehabilitation period is significantly reduced, meaning the patient returns to his normal lifestyle faster. There are practically no complications or side effects. Compared to open surgery, the risk of bleeding during embolization is minimized.

It has been clinically proven and confirmed by medical experience that catheter embolization helps to cope with bleeding quickly and effectively. This is especially true in emergency cases.

The procedure has proven to be a good way to treat tumors and modified vessels that have limited access. If, due to the severe course of the patient’s disease, open surgery is not possible, then vascular embolization can achieve stabilization of the condition. Thus, timely closed aneurysms and anastomoses not only help control the symptoms of the disease, but also significantly increase the patient’s life expectancy.

Possible risks

Sometimes an allergic reaction to drugs introduced into the vessels is possible. This happens extremely rarely, since preliminary preparation can eliminate all possible negative consequences of the operation and complications.

When inserting a catheter into the walls of a blood vessel, there is always a risk of injury, bleeding or hematoma formation. But since the procedure is performed under the close supervision of a specialist, all necessary actions are taken for the safety of the patient. The risk of death is very low and reduced to almost zero. Less than 10% of cases require additional surgery and treatment after the procedure.

The effectiveness of the embolization procedure is confirmed by monitoring patients during the postoperative and rehabilitation periods. The combination of endovascular technology with other methods of vascular treatment (balloon catheters, stenting, bypass surgery) can significantly increase positive results. The only problem today is the treatment of very large aneurysms, the neck of which is too wide. In such situations, it is not possible to perform endovascular embolization.

One of the highly effective methods of treating fibroids in the uterine cavity is uterine artery embolization (UAE). The essence of the operation is the selective occlusion of the blood vessels feeding the neoplasm using a liquid intravascular preparation containing biologically inert particles of a certain size (emboli). This method differs from other treatment methods in that it is less invasive and has a small number of complications. The main advantage of UAE is that this operation allows the preservation of the uterus for those women who are indicated for its complete removal.

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Description of the method

Uterine fibroids are one of the most common gynecological diseases among women. The prevalence of this pathology, according to various estimates, ranges from 30 to 80% among patients over 30 years of age. Traditional methods of treatment are the following:

hormone therapy;
removal of fibroids by abdominal surgery (the most traumatic method);
laparoscopy – removal of the formation using an endoscope (through punctures in the abdominal wall);
elimination of fibroids using the hysteroscopic method by introducing a special device through the vagina and cervical canal;
hysterectomy (removal of the entire uterus).

The disadvantages of conservative therapy are the high probability of repeated relapses, the risk of bleeding, the formation of residual scars and adhesions in the abdominal cavity. In the presence of large fibroids, women are most often prescribed a hysterectomy, which leads to a number of side effects - hormonal imbalance, premature aging of the woman’s body, loss of reproductive functions, and metabolic disorders.

Uterine artery embolization (UAE) is a relatively “young” method of treating uterine fibroids. The method has been used to stop postpartum bleeding in women since the 80s. XX century, but its use as a therapy for fibroids in Russia began only in the late 90s. last century.

The essence of the method is that a small diameter catheter is inserted through a puncture in the femoral artery. Through it, small plastic granules measuring 300-700 microns in size are supplied to the area of the fibroids, clogging the blood vessels that feed the tumor. As a result, the formation naturally dies, since there is no blood supply to the muscle cells that form the fibroids. Within a few weeks, fibroid cells are replaced by connective cells, leaving no scars. When fibroids become necrotic, they may be “born” through the vagina. In some cases, additional tumor removal is required.

During the operation, constant monitoring of the condition of the arteries and blood vessels in the uterine basin is carried out. Monitoring is carried out using fluoroscopy - a radiopaque substance is injected into the artery through a catheter, and images are taken with an angiographic apparatus. The procedure is performed under local anesthesia (anesthetic injection into the thigh).

Embolization drug

Bypass surgery of cerebral vessels - how is the operation performed and what may be the consequences?

Indications and contraindications

Indications for UAE are the same as for treating fibroids with other surgical methods:

fibroids growing into the uterine cavity and intermuscular formations larger than 2 cm;
ineffectiveness of conservative treatment;
symptomatic fibroids, accompanied by heavy bleeding (often caused by anemia in women), pain, and compression of neighboring organs;
infertility as a result of the presence of fibroids;
the presence of contraindications for surgery under general anesthesia;
high risk of complications for other methods (cardiovascular or pulmonary insufficiency, adhesions in the abdominal cavity).

UAE avoids hysterectomy in the presence of advanced tumors. In addition to removing myomatous nodes, this technique is also used to treat other diseases - germination of the endometrium into the muscular layer of the uterus, placenta accreta, and the development of a fertilized egg in the cervical canal.

The following factors are contraindications for the operation:

pregnancy;
immunopathological inflammation of blood vessels;
the last phase of the menopause – postmenopause;
impaired patency of arteries;
malignant neoplasms in the uterus and ovaries;
disorders in the hematopoietic system associated with poor blood clotting;
history of previous radiation therapy to the pelvic organs;
infectious and inflammatory diseases of the uterus, appendages (or previous illnesses less than 3 months old);
fibroids, the growth of which is directed into the abdominal cavity, or formations on a thin stalk, since in this case there is a high risk of complications;
atypical location of the tumor;
liver and kidney failure;
tortuosity of the iliac vessels;
autoimmune connective tissue diseases;
allergy to contrast agent.

Advantages and disadvantages

UAE is a minimally invasive method for treating uterine fibroids. Stopping blood circulation in the vessels is carried out only locally, selectively and does not affect healthy endometrial tissue.

Embolization has several advantages over other methods:

no injury to the bladder or ureters (unlike abdominal surgery);
there is no need for general anesthesia;
absence of surgical trauma (after UAE a small incision of about 2 mm remains in the area of the femoral artery) and adhesions;
rapid recovery in the postoperative period (on average, hospital stay lasts 3 days);
the possibility of preserving the uterus in the presence of a large node;
low number of complications and repeated relapses after the procedure;
preservation of reproductive function.

The operation is effective for the treatment of fibroids - changes in blood supply to the nodes are recorded in 97% of patients. The size of fibroids is reduced by 30-70% of the original, and the volume of the uterus is reduced by 40-70%.

The disadvantages of the method include the following:

High cost of treatment. This is due to the need to use expensive consumables - high-quality imported embolic compounds cost from 70 thousand rubles. and higher.
The need to install special equipment for radiographic monitoring of blood vessels. This equipment is also not cheap, so not every clinic can afford it.
The operation is performed only by an endovascular surgeon; high qualifications and experience are also required.

Preparing for surgery

Before the procedure, you must undergo tests and examinations from specialists:

Laboratory research:
- General, hormonal and biochemical blood tests.
- Coagulogram (test for blood clotting).
- General urine analysis.
Examination by a gynecologist:
- Bimanual palpation.
- Taking a smear to check for sexually transmitted infections.
- If cancer is suspected, curettage for histological and cytological examination.
Ultrasound of the pelvic organs (using Doppler sonography, transvaginal, three-dimensional scanning).
Consultation with a radiologist, angiosurgeon.
If necessary, additional types of examinations are prescribed - magnetic resonance imaging of the pelvic organs, endometrial aspiration biopsy and others.

Since the operation is performed on an empty stomach, eating and drinking should be stopped several hours before the operation. In some cases, patients are prescribed antibacterial drugs (Augmentin, Amoxicillin, Potassium Clavulanate and others) within a few days.

On the eve of surgery, it is necessary to shave the perineum and thighs. A few hours before embolization, women put on compression stockings on their legs, which must then be worn for several days. Immediately before the procedure, patients are given an injection of a sedative (Seduxen and others), and a catheter is installed in the bladder.

Carrying out embolization

To carry out embolization, the woman is placed on a special table of an angiographic machine, covered with sterile linen, and the puncture site in the area of the femoral artery is lubricated with an antiseptic. The surgeon injects an anesthetic injection into the thigh and punctures the artery. An introducer is inserted into the puncture - a hollow plastic tube of small diameter, which serves as a guide for surgical instruments and prevents reverse blood flow from the wound. Depending on where the fibroid is located, a puncture of the right or left femoral artery is performed, and in rare cases, both.

The surgeon's further actions are as follows:

Under X-ray control, a catheter is inserted into the aorta.
Angiography is performed - a radiopaque substance is injected, and the condition of the aorta, iliac vessels and the location of blood vessels is monitored on the screen of the angiographic machine.
A catheter is installed in the uterine artery so as to prevent the special solution from entering other blood vessels.
A solution with embolic granules is injected through a syringe.
Control angiography is performed using a contrast agent. With successful embolization, the contours of the vessels and fibroids become indistinct, blurry, and poorly visualized. This indicates the cessation of blood flow in them. In some cases, the introduction of additional embolic granules is required.
If necessary, the catheter is transferred to the opposite side, and the procedure is repeated for the second aorta.
The catheter is withdrawn and the puncture site is pressed for 10 minutes.

Introducers

During the procedure, the patient is conscious and can observe the process on the screen of the angiography machine. X-ray control is carried out continuously.

Angiogram

Depending on the complexity of the operation and the qualifications of the surgeon, the total duration of work is 20-40 minutes. A pressure bandage is applied to the puncture site, and the patient is transported to the ward. During the day, rest is required to avoid the appearance of hematoma or thrombosis at the puncture site. When using the modern hemostatic device ExoSeal, with the help of which a puncture in the artery is “brewed” with a biologically inert substance, the period of necessary rest is reduced to two hours.

Hemostatic device ExoSeal

Postoperative period

The embolization procedure itself is painless; the only discomfort in women is associated with the administration of the anesthetic. In the postoperative period, observation in a hospital is required for 3-5 days, depending on concomitant diseases and the volume of embolized tissue. The patient's blood and body temperature are monitored, and anticoagulants are administered according to indications to prevent thrombotic complications.

Full recovery may take up to 7 days. During this period, most women experience pain, which is associated with the cessation of blood supply to the fibroids. Regular pain relief is required (Analgin, Diphenhydramine, Ketoprofen and other drugs). The pain subsides after a few hours, but can periodically intensify over the course of a month with heavy lifting, hypothermia and other provoking factors.

The natural “birth” of a necrotic node, observed in every fourth woman operated on, is accompanied by pain, as during labor contractions, and bleeding. The node may come out within the first day after surgery or after a few weeks. When fibroids are small in size, they are destroyed and replaced with connective tissue. Sometimes, as a second step, it is necessary to remove the fibroids using one of the traditional surgical methods.

As a systemic manifestation of the body on the processes occurring in the uterus, a temperature increase of up to 38 degrees may occur within 1-3 days after embolization. This is normal and does not require therapeutic measures.

A week after the operation, you must undergo an examination by a gynecologist. Over the next 12 months, ultrasound monitoring of the condition of the uterus is carried out (every 3 months). Degradation of fibroids lasts on average 6-8 months. In the case of natural rejection of large nodes into the uterine cavity, an operation to remove them is necessary. If necessary, anti-inflammatory or antibacterial therapy may be prescribed.

Your first period may come earlier or later than usual. Clots may be present in the discharge and pain may increase. Over time, the menstrual cycle normalizes. Immediately after the operation, there is a decrease in the volume of bloody menstrual flow.

Complications

The following phenomena are observed in rare cases as complications after surgery:

Severe necrosis of the uterus, requiring its complete removal. This complication has been observed in the past, during clinical trials of the method, and was associated with the use of embolic particles that were too small, leading to blockage of intact uterine arteries.
Premature cessation of menstruation in women at the beginning of menopause.
Thrombosis of the artery that was punctured. This occurs if the patient has increased blood clotting and atherosclerosis. This complication requires surgical intervention.
Allergic reaction due to intolerance to radiopaque contrast agent.
Acute renal failure.
Purulent-septic complications appear in the presence of infectious diseases in the female genital organs.
Movement of necrotic fibroids into the abdominal cavity.
Disruption of the ovaries due to unintentional embolization of their arteries.
Blockage of the pulmonary artery or its branches (extremely rare).
Temporary absence of menstruation (for 2-3 months). Usually the menstrual cycle returns on its own, but hormonal therapy may be required.
With low qualifications of the surgeon and rough manipulations, perforation of the pelvic arteries or embolization of non-target arteries is possible.

Most often, the only complication of the operation is the appearance of a hematoma at the puncture site. A hematoma is formed as a result of violation of bed rest, dislocation of the bandage, or due to the patient’s excess weight. It goes away on its own within 2 weeks and does not require treatment.

According to medical statistics, today the total number of complications remains no more than 1% of the number of operations performed.

Modern angiographic devices are characterized by a low dose of X-ray radiation. Therefore, the total dose received by the patient during surgery does not exceed that during chest fluorography.

Is it possible to get pregnant after surgery?

Embolization allows you to save the uterus without leaving scar changes. The general blood supply to the endometrium after surgery is restored within several days. Therefore, there is no reason not to use this method of treating fibroids for women planning a pregnancy.

Extensive studies on the relationship between UAE and subsequent pregnancy have not yet been conducted. Today, the nature of pregnancy after transvaginal removal of fibroids and embolization is the same. The hormonal functions of the ovaries are disrupted due to changes in blood flow, but their restoration occurs within a year. Women of childbearing age are recommended to plan pregnancy a year after surgery, and if a second stage of treatment is required for mechanical removal of fibroid remnants, after a year and a half.

The term “embolization” refers to a minimally invasive intravascular procedure, which is an alternative to classical surgery. Embolization is aimed at stopping the supply of blood to certain tissues, organs, and structures of the body.

More about embolization

This is a radiosurgical procedure, it is minimally invasive and is used to prevent recurrence of tumors or before surgery.

The embolization procedure is carried out endovascularly, using equipment for x-ray surgical (interventional) procedures. Most often it is performed without anesthesia or with minimal anesthesia. This depends on the organ being embolized. When embolizing a portal vein aneurysm or cerebral vessels, general anesthesia is performed.

Access to the vessel that is undergoing embolization is performed using a guide and catheter. Sometimes it is difficult and requires more time to carry out - it depends on which organ is being treated. If the exact location of the artery or vein supplying the lesion is unknown, digital subtraction angiography (DSA) is used. The images obtained in this way are used to gain access to the required vessel by selecting a catheter and guide.

Afterwards, the process of blocking the lumen of the blood vessel begins. For this purpose, artificial emboli of the following types are used:

particles;
spirals;
gelatin sponge;
cylinders;
cylinders.

Emboli are injected into the desired vessel, after which another angiography is performed to monitor the success of the procedure.

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Carrying out the procedure

The embolization process is carried out as follows:

A cancer patient undergoes angiography. This examination of the blood supply using a contrast agent is necessary to clarify the method by which the embolus will be introduced;
treat the puncture point with an anesthetic solution;
the femoral artery is punctured directly;
a catheter is inserted into the arterial vessel and advanced to the cancer artery;
emboli are passed through the catheter and the blood supply to the pathological area is cut off.

On a note! This treatment technique is used in many areas of medicine. It has gained particular popularity in oncological surgery due to its relative simplicity of technique, low trauma and painlessness.

Mechanical cessation of blood flow in a malignant tumor is carried out for the following purposes:

disrupt the blood supply to mutated tissues, which will lead to persistent remission or tumor disintegration. In some cases, this therapy option can save the patient from surgery;
to prevent spontaneous bleeding during tumor resection surgery;
reduce the size of the tumor for further tumor removal;
provide palliative care for seriously ill patients by reducing the growth of pathology and relieving pain. Improvement in well-being is temporary.

Types of embolization

It is customary to distinguish between the following types of embolization:

Preoperative. It refers to the initial stage of surgical intervention.
Independent technique. This type is used for kidney and liver tumors.
Palliative care. It is performed to stop bleeding, reduce pain and stabilize the growth of a malignant neoplasm.

Embolization materials

To carry out embolization, emboli of different types are used: liquid, sclerosing, embolizing microparticles, mechanical.

Liquid emboli

They are used to treat arteriovenous malformation (AVM). They easily pass through the branches of the vessels, so there is no need to install a catheter in each vessel separately:

N-butyl-2-cyanoacrylate is a fast-acting liquid substance similar to glue; it polymerizes after contact with ions and enters into an exothermic reaction that destroys the vascular wall.
Lipiodol- viscous material, its base materials are iodine and opium poppy seed oil. Lipiodol is used for malignant hepatomas. Embolization of blood vessels with lipiodol is temporary, since the half-life of this substance is five days.

Sclerosing emboli

These substances compact the endothelial vascular lining, their action is much slower than that of liquid materials, and therefore they cannot be used for vessels with high blood flow:

ethanol used for permanent embolization and suitable for AVM therapy. Alcohol activates the blood coagulation system, this does not happen immediately, so some surgeons do embolization with removable balloons, which stop the blood flow temporarily, until the ethanol begins to act. The disadvantages of using this substance include toxicity, as it can provoke compartment syndrome. It should also be noted that these injections are very painful;
ethanolamine oleate– it is used for sclerosis of the esophageal veins. It contains only 2% benzyl alcohol, and is administered less painfully than ethanol. But in large doses it can lead to hemolysis and renal failure;
sotradecol We use it to treat shallow dilated veins on the legs with varicose veins. A side effect of this substance is its ability to cause hyperpigmentation (about 30% of cases).

Embolic microparticles

They are used for deep arteriovenous malformations (AVMs), small arteries, and precapillary arterioles. The disadvantage of application is the difficulty of getting into the required vessel.

The particles are permeable to radiation; before being introduced into the vessel, they are impregnated with a radiopaque substance for visualization under X-ray:

embolic gelatin sponge used for temporary vascular occlusion. The sponge consists of gelatin, so the sponge particles move to the required distance, clogging the capillaries. You can concentrate the sponge in the right place using a spiral, which is placed in the desired area of the vessel, after which sponge particles are introduced through the catheter, which settle inside the coils;
polyvinyl alcohol (PVA)— material for temporary embolization. It consists of tiny balls 50-1200 microns. The introduction of these particles does not always lead to mechanical blockage of blood vessels, and may even contribute to inflammation. Occlusion of large proximal vessels or “pseudo-embolization” of the target vessel may also occur, where clusters of PVA particles disintegrate after a few days;
acrylic gelatin microspheres considered best for temporary small particle embolization. They are similar to PVA, but the particle shape is perfectly round so they don't stick together. These microspheres are fragile and may crack in narrow catheters.

Materials for mechanical occlusion

These materials are suitable for any vessels. Their advantage is the possibility of precise installation:

embolic coils are used for traumatic injuries, aneurysms, and arteriovenous malformations. They are suitable for vessels with high blood flow as they cause immediate thrombus formation. They are made from platinum or stainless steel. The spiral is clearly visible on x-rays. The curvature of the catheter can deform the coils, and there is a risk of the coil being displaced relative to its original position;
removable balloons are used in the treatment of AVMs and aneurysms. This balloon is placed in the required vessel, then filled through a one-way valve with saline solution. The blood flow in the vessel stops and the endothelium grows around the balloon until the vessel is completely closed. Sometimes the pressure in the balloon exceeds the blood pressure, and then the balloon can burst, and if the pressure in the balloon is lower than the blood pressure, the balloon can shrink and move to another place.

Indications for embolization

Embolization is carried out before surgery, for example, against tumor recurrences, prevention of postoperative bleeding, and is used to treat a wide range of pathologies of various organs.

Preparation for the procedure is minimal - 4-5 hours before the procedure, it is not recommended to consume food or carbonated drinks; it is recommended to use sedatives.

After studying the obtained X-ray data, the doctor inserts a catheter into the femoral artery. The embolus enters a large cancer vessel, completely blocking its lumen. Embolization is used for:

bleeding:
1. gastrointestinal;
2. nasal;
3. in the early postpartum period;
4. caused by unsuccessful surgery or injury.
vascular anomalies:
1. arteriovenous malformation (AVM);
2. aneurysms of cerebral vessels.
neoplasms, when there is a need to slow down or stop the blood supply to a cancerous tumor to reduce its size:
1. liver (hepatocellular carcinoma),
2. kidneys (perform embolization of the splenic artery);
3. BPH;
4. uterine fibroids.

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Using the embolization method in gynecology for uterine fibroids

Uterine artery embolization (UAE) is used for:

uterine fibroids during growth;
myomatous nodes;
adenomyosis, when there are no abnormalities of the cervix or ovaries;
with uterine bleeding, when there is a threat to the woman’s life.

The main factor for prescribing this technique is the desire to have children in the future, to preserve the integrity of the uterus, and also if there is a phobia before surgery. Sometimes this uterine artery procedure is performed before surgery to remove fibroids to reduce the risk of bleeding. For this purpose, laparoscopic occlusion of the internal iliac arteries is used.

This technique is considered innovative against the background of previously used surgical intervention. When embolizing the arteries of the uterus, there is no introduction of a foreign body into the body, and general anesthesia is not used. This method is less aggressive and more gentle on the female body.

The process of embolization of uterine fibroids

To eliminate the risk of cancer and inflammation in the pelvic organs, when embolization is not recommended, patients undergo ultrasound and collection of cervical mucus. The next step is a puncture in the groin fold, and a catheter tube is inserted into the femoral artery (the introduction is carried out under local anesthesia). After this, the doctor inserts a catheter into the uterine artery (using radiography, monitoring the insertion process), then to the beginning of the branch, from where the blood supply to the fibroid nodes begins.

An arteriogram is done to prove the accuracy and correctness of the catheter, as well as to confirm the presence of fibroids. To do this, a contrast agent is injected into the catheter. Once the correct insertion of the catheter is confirmed, small particles of sponge or plastic preparations are introduced into the artery. These particles clog them, and blood does not reach the tumor tissue. To completely block the fibroids, this procedure is performed in both femoral arteries. A control arteriogram is performed to completely exclude the presence of blood supply to the tumor. A bandage is applied to the puncture sites for 12 hours.

Recovery after the procedure

Absolute recovery after this procedure is about 14 days. No hospital stay is required. Features of care consist of: compliance with bed rest for 6-7 days, taking painkillers and monitoring body temperature (to monitor the inflammatory process).

For successful rehabilitation after endovascular embolization, it is recommended to adhere to the following rules:

increase fluid intake in the first week after the procedure;
do not use aspirin and other blood thinning drugs;
do not take baths or visit baths or saunas for several days after the procedure;
complete physical and sexual rest for several weeks is required;
do not use hygienic tampons in the first 3 months after the procedure.

Embolization for uterine fibroids has its advantages, contraindications and complications:

Benefits of the procedure:

efficiency - about 95%;
no visible marks in the form of cuts or scars;
low risk of recurrence of fibroids;
no long recovery after anesthesia is required;
allowed for many categories of patients, in contrast to surgery and chemotherapy (for oncology);
the possibility of conceiving a child remains completely.

Contraindications:

submucous fibroid;
inflammation in the pelvic organs;
pregnancy;
allergic reaction to drugs used for anesthesia.

Complications and consequences of endovascular embolization are very small and occur infrequently (about 1% of cases). These include:

disruptions in the menstrual cycle for 6 months after the procedure;
the appearance of inflammation in the first few days after embolization;
perforation of the uterine arteries (an extremely rare complication).

If complications occur, the patient may need surgical removal of the fibroids to complete treatment, but this likelihood is very low.

General pros and cons of embolization

General advantages of embolization for various diseases:

low risk of infection;
absence of seams and scars;
rapid recovery after the procedure due to the non-use (or rare use) of full anesthesia;
high percentage of effectiveness compared to other procedures;
maintaining the integrity of anatomical structures and fertility.
the procedure does not mechanically damage tissues close to the tumor;
the manipulation is easy to perform;
there is a minimum of postoperative complications;
there is a point effect on malignant neoplasm.

The disadvantages of the procedure for all categories of patients are as follows:

the success of embolization depends on the qualifications and experience of the surgeon;
there is a risk of emboli entering normal tissue;
this procedure is not suitable for everyone;
relapses are possible.

Contraindications:

the presence of chronic or acute infection;
renal and respiratory failure;
allergic reaction in the form of anaphylactic shock or Quincke's edema;
individual intolerance by the patient to the contrast agent or other components used in the procedure.

Embolization (embolotherapy) is a minimally invasive x-ray surgical endovascular procedure. The essence of this operation is the selective occlusion (blockage) of arteries with specially introduced emboli (special particles). This type of surgery is performed by an endovascular surgeon or an interventional radiologist (radiologist).

When is there a need for surgery?

The need for vascular occlusion may arise in the following situations:

If the patient has a benign tumor with increased blood flow.
When pathologically altered arteries are detected in the body.
With valvular incompetence of the spermatic vein (varicocele).
When areas of pathological blood flow (aneurysms) occur.
With kidney damage.
For bleeding of the gastrointestinal tract.
For bleeding in the early postpartum period.

Vessels may also require embolization in a number of other cases.

How exactly does embolization occur?

Embolization intervention is minimally invasive, which means there are no wide incisions or tissue trauma, the procedure is performed in an outpatient setting and there is minimal risk for the patient.

Embolization actions are as follows:

the patient receives local anesthesia or no anesthesia is used (however, embolization of an aneurysm in the vessels of the brain or portal vein most often takes place under general anesthesia);
through a puncture with the help of a guide, a catheter is inserted into the patient’s vessel;
Special substances (emboli) or devices are delivered into the artery in need of occlusion through a tube of minimal diameter.

At the end of the operation, a series of angiographic images are taken to monitor how successful the embolization was.

Products used

Specialists use a number of auxiliary structures and drugs to carry out embolization, thanks to which it is possible to achieve rapid and reliable blockage of blood vessels. The main embolization devices are:

Spirals. Injected into a vein or artery, they stop blood flow in the installation area.
Plastic (gelatin) particles. Mixed with liquid, they are introduced into the vessel and seal it. During the operation, it is possible to close a large number of even small arterial branches.
Sclerosants. Such fluids are injected into a vein or artery, where they cause blood to clot. Sclerosants are effective in areas with low blood flow.

The following types of artificial emboli are also in demand:

gelatin sponge (“gel foam”);
cylinders;
cylinders.

Sometimes all of the listed embolic agents and devices are used in combination. In this case, embolization is most effective.

Details of the embolotherapy procedure

Embolotherapy (artery blockage) has the following features:

On average, embolization takes about thirty to forty minutes; complex procedures can last up to several hours. The operation time depends on many factors, one of the main ones being the professionalism of the surgeon. Experienced doctors usually perform embolization fairly quickly.
Discomfort during embolization of any vessel is relieved with special medications, so the procedure is virtually painless.
Minimally invasive intervention does not leave scars on the patient’s body.
Embolization of any vessel is always carried out in a hospital setting. The patient will need to stay in the clinic for 1-2 days. In some cases (for example, to exclude possible or already occurring complications), the length of hospitalization is increased.

Patient care after vessel embolization is provided by clinic specialists in accordance with the type and degree of complexity of the minimally invasive intervention.

Within a week after embolization surgery, you will be able to return to normal life. Rapid recovery of patients who have undergone embolization is ensured by a combination of rest and compliance with several simple conditions. First of all, operated patients must adhere to the following rules:

Strengthen the drinking regime in the first 7 days after surgery.
Avoid water procedures - taking baths, swimming in the pool, visiting the bathhouse for 3-5 days. You can also take a shower.
Maintain complete physical rest for 2-3 weeks after surgery. During this time, you should not lift weights or play sports.

The main advantages of the embolization method

Endovascular embolization is a low-traumatic procedure. It differs radically from standard surgical interventions in the absence of large incisions. This reduces numerous risks associated with conventional operations, including the risk of infection. In addition, embolization rarely requires the patient to be placed under general anesthesia.

Opportunities for eliminating tumors located in hard-to-reach places. A catheter inserted into an artery can penetrate places that are difficult to reach with a scalpel.
Reducing the likelihood of relapse. The technique used to block the vessel allows blood flow to be quickly and reliably stopped.
No discomfort. During vessel embolization, the patient does not experience pain. All unpleasant sensations are eliminated with the help of special medications.
Short recovery period. For minor vascular interventions, the patient may be discharged on the day of the procedure. In this case, special care, complex treatment, and regular dressings are not required.
Minimal number of contraindications and complications. The success of the operation largely depends on the professionalism of the doctor. That is why it is important to choose a surgeon wisely.
Opportunities for organ preservation. For example, embolization on the vessels of the uterus allows a woman to become a mother and bear a healthy child, even if she has a history of a large tumor.

Embolization measures, that is, stopping blood flow through a vessel, in some cases are the only possible medical solution to the problem in the presence of general contraindications to standard surgery.

Embolization effectiveness

For example, when treating uterine fibroids, after 14 days the process of replacing the muscle tissue of the nodes with connective tissue begins. In this case, the nodes are significantly reduced and are unable to grow again and provoke the progression of the disease. Reduction of nodes takes approximately 6-8 months.

Note! The effectiveness of the method has been clinically proven. In addition, embolotherapy allows you to block a wide variety of vessels. Patients who have undergone the embolization procedure quickly forget about pain and discomfort, returning to their normal lives in the shortest possible time.

Advantages of visiting Professor Kapranov’s clinic

At the Center for Endovascular Surgery, Prof. Kapranov carries out vascular embolization using the most modern techniques and using the latest equipment. We invite patients to independently choose a clinic for embolization intervention. This will allow you to take into account all the wishes of the patient:

to the conditions of hospital stay;
on personnel qualifications;
other important treatment factors.

Today, Professor S. A. Kapranov and highly qualified staff of the endovascular surgery center offer their patients:

targeted staged and partial embolization, taking into account the individual characteristics of the body and the degree of development of the disease;
selection of drugs used depending on the size and shape of the arteries;
the use of only the most modern drugs, such as Contour (Boston Scientific), BeadBlock (Terumo, Japan) and Embosphere (Merit Medical, USA).

You can sign up for an operation to embolize uterine arteries, large fibroids, prostate vessels, and cerebral aneurysms. In our center, professional medical care is provided in full.