Uterine embolization for fibroids - stages of UAE, results of uterine artery embolization and price. Embolization of the uterine arteries: about the safety of the procedure and possible complications Vascular embolization tumor emboli

Embolization is one of the modern non-surgical methods for treating many diseases. What kind of procedure is this and what diseases it is used to treat will be discussed below. Embolization is considered a minimally invasive treatment method, an alternative to surgery, the essence of which is to block one or more blood vessels or channels.

The purpose of the procedure is to prevent blood supply to certain tissues, organs, structures to reduce the size of the tumor or block the aneurysm.

Before prescribing embolization, the doctor takes into account the patient’s age, the size and location of the tumor and nodes, and the severity of the manifestations.

The main indications for the procedure are:

Stopping bleeding:

after an unsuccessful operation;
after childbirth;
nosebleeds;
with aneurysm of cerebral vessels;
arteriovenous malformations;
in the esophagus

Treatment of tumors:

uterine fibroids;
kidney damage;
malignant neoplasms of the liver.

In addition, portal vein embolization is performed before liver resection.

Uterine artery embolization

The result of embolization of the uterine arteries is ischemia

The essence of this method is to block the uterine arteries, which results in the cessation of nutrition to the tumor nodes and their further death. After all, the uterine arteries are the only source of nutrition for fibroid nodes. During the procedure, special particles are injected into the vessels. As a result, the blood supply to the fibroid is stopped, ischemia of its nodes, necrosis and subsequent degeneration occurs.

Embolization of cerebral aneurysm

This procedure allows you to disconnect the damaged vessel from blood circulation without opening the skull. To do this, a catheter is inserted through a vein or artery and advanced through the circulatory system until it reaches the aneurysm. Then the vessel is disconnected from the circulatory system using special instruments.

Embolization of liver vessels

Blood reaches the liver from two sources. It enters the healthy organ through the portal vein. And cancer cells usually feed from the hepatic artery. In malignant liver tumors, the hepatic artery becomes blocked and as a result, the cancer cells die. In addition, this method is widely used for varicose veins.

Contraindications to embolization

The embolization procedure is not prescribed in the following situations:

pregnant women;
for the treatment of malignant neoplasms of the uterus, with the exception of inoperable tumors;
in case of intolerance to the administered drugs;
during acute inflammatory processes in the genitourinary organs;
the presence of blood clotting pathologies;
when the patency of the arteries is impaired.

The essence of embolization

The operation is performed using a minimally invasive method

Embolization is carried out in a cath lab with an angiography machine. The procedure is performed by an endovascular surgeon under local anesthesia.

The procedure includes the following steps:

A small puncture of the skin is done.
A thin catheter is inserted into the artery.
First, an iodide contrast agent is injected through the catheter and an x-ray is taken to ensure that the catheter is in the right place.
Then an embolization drug is injected through the catheter, blocking the vessels that feed the tumor.
The procedure is completed by control angiography, which makes sure that the tumor is drained of blood.
The doctor removes the catheter from the artery and closes the puncture site with a special device.

The operation is almost painless and can last from 10 minutes to 2.5 hours, depending on the complexity. Typically the duration of the procedure does not exceed 20 minutes. Embolization of an aneurysm or portal vein is performed under general anesthesia.

Advantages of embolization:

the uterus and reproductive function are preserved;
a minimally invasive safe method that does not require general anesthesia;
low risk of complications;
allows you to quickly and effectively get rid of the problem;
there are no relapses;
short rehabilitation period.

The disadvantages of embolization include:

Low information content compared to classical methods.
Impossibility of performing a biopsy of fibroid nodes.
High price.

Drugs used

Special embolization agents are used during surgery

Embolization is a minimally invasive procedure that requires the use of a sophisticated instrument.

The intervention kit includes:

embolic agent;
catheters and microcatheters;
puncture instrument;
hydrophilic conductors;
introducers.

Let's look at commonly used embolic agents:

Non-spherical particles of polyvinyl alcohol PVA are a commonly used product. Manufacturer USA. The particles are characterized by irregular shape and inaccurate sizing. There is a risk of particle aggregation, inflammation and insufficient embolization.
Bead Block spherical embolization spheres are capable of penetrating small bore catheters. Produced in Japan. The drug causes almost no inflammation.
Spherical Embozene particles. Made in the USA. It is considered a modern drug. Particles of the correct shape and exact size. The drug does not cause inflammation.

Sclerosing materials are also used to seal the endothelial lining of blood vessels:

Ethanol. I use it to treat arteriovenous malformations. In large quantities, ethanol is toxic to the body. In addition, injections with this substance are painful.
Ethanolamine oleate. Used for procedures on varicose veins of the esophagus. In large doses, it can lead to the development of renal failure or hemolysis.
Sotradecol is used in procedures for varicose veins.

To carry out mechanical blockage, the following materials are used:

Embolic coils. Used for aneurysms, injuries, arteriovenous malformations;
Removable cylinders. Used for arteriovenous malformation and aneurysm.

The use of the above drugs allows embolization to be carried out with high accuracy and efficiency.

Possible complications

The embolization procedure is carried out under X-ray control.

The most common complications after surgery are:

the appearance of a hematoma in the puncture area;
temporary menstrual irregularities;
development of new fibroid nodes;
pathology, infectious nature.

In addition, arterial thrombosis and uterine necrosis may develop. However, if all technologies are followed, embolization performed by an experienced specialist will reduce the risk of complications.

Recovery

After surgery, it is necessary to maintain proper nutrition and drinking regime.

After the procedure, the patient may feel slight pain. The pain usually goes away within 8 hours. To alleviate the condition, the doctor prescribes painkillers. Over the course of a month, pain may occur as a result of hypothermia, overwork, or after lifting heavy objects. The temperature may rise and slight bleeding may appear.

A woman may notice weakness and fatigue. For a quick recovery, doctors recommend adhering to the following rules:

increase the amount of fluid consumed;
for several weeks do not take hot baths and avoid visiting the sauna;
do not engage in physical activity for a month;
Avoid sexual intercourse for a month.

The first menstruation after the intervention may be painful and occur with the presence of blood clots. Then everything will return to normal, the amount of bleeding will decrease, and the cycle will regulate. After a month, the uterus will decrease in volume. Complete disappearance of the tumor can take up to six months. In most cases, after embolization there is no need for additional treatment.

Embolization is an effective, low-traumatic method and an alternative to surgery.

After treatment, for example, during the treatment of fibroids, the uterus continues to function, and the woman’s reproductive function is preserved. According to statistics, up to 94% of women get rid of the tumor.

From this video you can learn more about uterine artery embolization:

Embolization of uterine fibroids is a minimally invasive procedure, the essence of which is to stop the movement of blood through the arteries supplying the fibroids. During and after this procedure, the blood supply to the healthy part of the organ is not disrupted. This operation is possible due to the fact that blood flows to the fibroid through vessels located on the periphery of the organ. The vessels that supply fibroids are much larger than those that supply healthy myometrium; their diameter can reach 0.5 mm. Embolization agents are injected into these vessels and the blood supply to the tumor is stopped. The neoplasm cells are replaced by connective tissue, which leads to a decrease in tumor size or even to its complete disappearance.

Uterine fibroid embolization procedure

To carry out embolization of fibroids, it is necessary to puncture the artery in the thigh under local anesthesia. Then a catheter is inserted into the artery and, under the control of X-ray television, it is guided to the fibroid. The movement of the catheter through the arteries does not cause any sensation and does not pose any health hazard. When the catheter has reached the vessel through which blood flow must be stopped, embolization agents are injected into it. Embolization particles have a diameter of 0.5 mm and are made of polyvinyl alcohol (an inert polymer used in medicine). During embolization of uterine fibroids, the vessels through which the tumor is fed are blocked. This procedure is performed on all myomatous nodes. The operation lasts from 20 to 90 minutes, depending on the number of tumors. Also, the structure of the uterine arteries affects the time of the operation; sometimes additional time is required to correctly install the catheter.

When the operation is completed, the doctor presses on the puncture site for 10-20 minutes, this is done to prevent a bruise from forming. Then a pressure bandage is applied to the patient’s right thigh, which will be removed after a day. At the end of all manipulations, the patient is taken to the ward; she must remain in bed for 12 hours.

One or two hours after fibroid embolization, most patients begin to feel pain in the lower abdomen. Each woman has her own intensity of pain: some report unbearable pain, others note that the pain is similar to menstruation, but can be tolerated. All patients, regardless of pain intensity, receive painkillers. The pain usually goes away the next day.

Pain relief after embolization

For 8 to 12 hours after fibroid embolization surgery, patients will experience pain of varying degrees of intensity. These are the consequences of stopping blood flow through the arteries leading to tumors. To relieve pain, patients are prescribed painkillers. At their request, women can choose one of the proposed methods:

Taking painkillers (diclofenac, paracetamol) orally, administering suppositories or injections.
Epidural anesthesia, which leads to numbness of the lower half of the body and, as a result, the absence of pain.
Patient-controlled anesthesia: the woman herself, by pressing a button, administers intravenous painkillers.

If a woman has chosen anesthesia using method 2 or 3, then they are introduced before embolization.

Advantages of treating fibroids with tumor artery embolization

Compared to other surgical methods, embolization has the following advantages:

the quality of life does not change after surgery;
there is no blood loss and, as a result, there is no need for blood transfusion;
after embolization, the uterus returns to its previous size;
after the tumor size decreases, the pressure on nearby organs (bladder and intestines) stops;
the amount of menstrual bleeding decreases;
the operation is performed under local anesthesia;
short recovery period;
no scar after surgery;
low percentage of fibroid recurrence;
low-invasiveness of the method;
the reproductive organ is preserved;
the possibility of embolization of fibroids in case of multiple lesions of the uterus by nodes.

Contraindications for uterine artery embolization

Although treatment of fibroids with arterial embolization is a minimally invasive method and has many advantages, there are contraindications even for its use:

Inability to conduct radiopaque studies during surgery. This may be due to the following reasons: tortuosity of the iliac vessels, the presence of renal failure, intolerance to the contrast agent.
Cervical location of fibroids.
Subserous myomatous node on a thin stalk (due to the high risk of expulsion of the necrotic fibroid node into the abdominal cavity).
Active infectious process in the pelvis.
Malignant neoplasms.
Pregnancy.
Endometritis.

Complications after uterine artery embolization

Embolization of uterine fibroids is a minimally invasive operation, therefore there are much fewer complications after it than after abdominal operations, but they still occur, although rarely. The most common complications are separation of tissue from decaying fibroids and amenorrhea.

About 5% of patients observe the discharge of fibroid tissue through the vagina within several months after fibroid embolization. This does not pose a health threat if the cervical canal is freely passable and the woman is warned about this possibility. In a small proportion of patients, myomatous tumor tissue, for some reason, may linger in the cervical canal, which leads to infection. In this case, the woman needs to undergo curettage and hysteroscopy.

About 2% of patients report permanent or temporary (several cycles) amenorrhea. Permanent amenorrhea is observed in women over 45 years of age.

4.125 4.13 out of 5 (16 Votes)

Uterine artery embolization is a high-tech method of treating neoplastic and other diseases of the female reproductive system. The essence of the procedure is the deliberate provocation of total occlusion of the lumen of the artery that feeds the tumor structure (usually fibroids). For treatment purposes, small balls of absorbable polymer filled with saline, so-called emboli, are used. As time passes, they are dissolved by phagocyte cells. The lumen of the artery becomes clogged and local blood flow is disrupted, embolization itself occurs. The trophism of the tumor is disrupted and it dies.

Complications after the procedure are possible, but they occur in 1% of cases. Some sources say even lower numbers. The combination of therapeutic effectiveness and safety makes uterine artery embolization a non-alternative treatment for many gynecological pathologies. Including fibroids.

You can read more about the principles of UAE surgery, indications and contraindications in our.

Adverse consequences

Complications after uterine artery embolization are varied in nature.

Pain syndrome

Why does it occur?

Severe pain after UAE is the most common condition. It is described by many authors. We are talking about a significant intensity of the manifestation; the patients themselves compare the nature of the discomfort with labor pains. The consequence is physiological in nature and is associated with a local disturbance of hemodynamics and, as a result, spasm of the muscular structures of the uterus.

What to do?

You must contact the clinic where the procedure was performed. It is advisable to see the specialist who performed the intervention. As prescribed by the doctor, analgesic drugs based on metamizole sodium and stronger antispasmodics and muscle relaxants are used (with great caution). Specific names of pharmaceuticals are selected by a specialist.

The lack of postoperative pain relief indicates insufficient qualifications of hospital staff.

Menstrual irregularities

Causes

The change in the nature of menstruation after embolization is due to impaired blood circulation in the uterine structures. The body needs time to adjust to a new way. The complication rate does not exceed 10%. In most situations the cycle remains the same. If outdated embolization technologies are used, a delay of 1-6 months is possible.

How does it manifest?

Immediately after intervention for fibroids, slight exudation from the genital tract is noted: the volume of discharge does not exceed 20-50 ml. The exudate is mixed, serous-bloody in nature. Menstruation does not occur at the right time or is characterized by a small volume of blood coming out (secondary). Possible lengthening of the cycle (opsomenorrhea).

How is the issue resolved?

Cyclic processes will restore themselves. No specific treatment is required. If UAE is performed in a patient over 45-50 years of age, menstruation may not begin. Uterine artery embolization accelerates the onset of menopause.

Birth of a myomatous node

For what reasons is it observed?

Expulsion or birth of fibroids after UAE can be predicted in advance based on the results of ultrasound examination of the uterine structures. More often, submucosal formations are “born”. The reason is the death of fibroids. This is the process of natural evacuation of a foreign object from the genital tract. At the moment, the birth of a node is not considered a complication. On the contrary, it is the desired outcome of the procedure. Expulsion will have adverse consequences only if the surgeon’s further actions are incompetent.

How to recognize?

According to characteristic symptoms:

weaknesses;
intense pain in the lower abdomen (projection of the uterus) of a pulling, cramping nature;
a drop in blood pressure, possibly decreasing to critical levels;
sweating for no apparent reason;
pale skin;
bleeding of varying degrees of intensity from the genital tract;
tachycardia (increased heart rate).

What kind of help is needed?

At the birth of fibroids, treatment is surgical. The formation needs to be removed. The consequences of illiterate actions of a specialist are unpredictable: tissue necrosis, shock, secondary infertility.

You can read about the tactics of treating a nascent myomatous node and the management of patients after surgery.

Continued growth of fibroids

Why does it occur?

With properly performed embolization, continued growth is not observed. The development of the neoplastic process is due to the insufficient experience of the operating surgeon: perhaps there was more intense vascularization than previously expected. The blood flow is disrupted, but not completely: the tumor is fed by other vessels. Therefore, magnetic resonance imaging is recommended before the intervention.

How to recognize?

Based on the results of routine ultrasound diagnostics. Continued growth is determined by the size of the neoplasia, its structure, and location.

What to do?

You should contact the surgeon who performed the operation (or another specialist) to resolve the issue of repeating the procedure or selecting other therapeutic methods. If embolization of the uterine arteries is ineffective or repeated surgery is impossible, excision of fibroid tissue is resorted to.

Acute necrosis of uterine structures

Uterine necrosis after uterine artery embolization was described in the late 90s and early 00s. We are talking about isolated cases. The complication was associated with the selection of low-quality material for the intervention and low qualifications of the personnel. At the moment, such consequences are impossible. This is nothing more than a myth spreading unknowingly across the Internet. Doctors are also to blame for insufficiently informing patients about the mechanism of the procedure. The vascularization of the uterus is sufficient and is not limited to one artery.

Exit of myomatous formation into the abdominal cavity

These are fibroids that grow on a long stalk outside the uterine structures. This is nothing more than a myth. It is spread by doctors themselves, who do not sufficiently understand the mechanism of the therapeutic effect of uterine artery embolization. Over the years of practice there has not been a single similar case. There is nothing to fear in this case.

Weight gain

Why is it observed?

The exact reasons for weight gain have not been established. It is also not clear whether there is a direct cause-and-effect relationship between embolization and this consequence. It is assumed that there is a hormonal imbalance in the structure of the balance and. Possible coincidences.

How to cope with the condition?

Consultation with an endocrinologist and, if indicated, a nutritionist is required. A study is carried out on the concentration of active substances of the pituitary gland, thyroid gland, estrogens, and ultrasound diagnostics of the abdominal and pelvic organs. The level of the transport glycoprotein SHBG is also examined to identify possible pathologies of the gonads, liver, and pancreas. Optimization of diet, drinking regimen and physical activity regimen is shown.

Infectious consequences

For what reasons do they arise?

Infectious complications of uterine artery embolization are excluded with proper preparation for surgery and qualified actions of the doctor. The likelihood of developing an infection is influenced by existing inflammatory processes, which may worsen after the procedure. The extreme form of the process is peritonitis or inflammation of the peritoneum. In most cases, there is an iatrogenic effect (the doctor is to blame for not informing the patient enough or for allowing the operation if there were contraindications).

How to recognize?

According to typical symptoms. Among them:

pain in the lower abdomen, pressing, pulling;
discharge from the genital tract of a bloody, serous or purulent nature;
heaviness in the stomach;
increased body temperature (hyperthermia at the febrile level);
nausea;
headache;
dizziness;
manifestations of general intoxication of the body (weakness, drowsiness, decreased performance, a feeling of weakness, “cottoniness” of the body).

When the peritoneum is involved in the process, unbearable pain of a diffuse, widespread nature is added, nausea, indomitable vomiting that does not bring relief, forced position of the body (on the side, with legs bent to the stomach), confusion, sweating, fainting, stupor, coma.

What to do?

Call an ambulance to resolve the issue of transportation to a specialized gynecological or surgical hospital.

Bleeding

There can be no bleeding after total embolization. The artery is blocked. If the operating surgeon does not act competently, a vessel may rupture with intense bleeding. The situation is considered urgent and requires urgent intervention for the purpose of hematostasis and suturing of the blood supply structure. Otherwise, death is possible. The likelihood of such a scenario is minimal, there is nothing to fear.

Ovarian embolization

Is it possible for emboli to enter the ovaries? This situation is, in principle, impossible when the operation is performed by an experienced doctor in an operating room.

Catheter embolization (CE) is used in the following cases:

Prevention or control of abnormal bleeding, including:
- Bleeding due to trauma, tumors or lesions of the gastrointestinal tract, such as ulcers or diverticula. Embolization is the first choice treatment for gastrointestinal bleeding of any etiology. In addition, this treatment method is very often used to control bleeding into the abdominal or pelvic cavity due to injuries due to road traffic accidents.
- Unusually long or extremely heavy menstruation that occurs due to uterine fibroids. At the same time, embolization is an excellent alternative to hysterectomy, that is, removal of the uterus. Since fibroids have an intense blood supply, its disruption after CE makes it possible to reduce the size of the tumor and control the amount of blood loss during menstruation.
Occlusion (blockage) of the blood vessels carrying blood to the tumor, especially in cases where the tumor cannot be surgically removed. Carrying out CE reduces the size of the tumor or slows down its growth, which increases the effectiveness of subsequent chemotherapy or surgical treatment.
Treatment of arteriovenous malformations or arteriovenous anastomoses, or fistulas, which are abnormal connections between arteries and veins. These abnormalities can occur in any organ, including the brain or spinal cord. They act like short bypasses that remove blood from the normal circulation, which disrupts blood supply and nutrition to tissues and organs.
Treatment of aneurysms, that is, protrusions in the area of weakening of the vascular wall. The artery supplying the aneurysm is occluded, or the protrusion itself is blocked, which is an excellent alternative to surgery.
Treatment of varicocele, that is, dilation of the veins in the scrotum, which can cause male infertility.

CE is used alone or in combination with other treatments, such as radiotherapy or surgery.

How should you prepare for catheter embolization?

As a rule, before the procedure, a series of blood tests are performed to assess the function of the liver and kidneys, as well as the functioning of the blood coagulation system.

It is very important to inform the doctor about all medications the patient is taking, including those of herbal origin, as well as any allergies, especially to local anesthetics, anesthesia drugs, or iodinated contrast materials. Some time before the procedure, you should stop taking aspirin or other blood thinners, as well as non-steroidal anti-inflammatory drugs.

You should also tell your doctor if you have any recent illnesses or other conditions.

Women should always inform their doctor and radiologist of any possibility of pregnancy. As a rule, studies using x-rays are not carried out during pregnancy to avoid negative effects on the fetus. If x-rays are necessary, every effort should be made to minimize the effects of radiation on the developing child.

The doctor should provide the patient with detailed instructions for preparing for the procedure, including any necessary changes to the usual drug regimen.

In addition, you should stop eating and drinking 12 hours before the procedure. You should check with your doctor about what medications you can take in the morning.

Before the procedure, the patient must be examined by the attending physician and an interventional radiology specialist.

CE is performed in a hospital, requiring short-term hospitalization for several days (usually no more than three).

You must wear a special hospital gown during the procedure.

What does catheter embolization equipment look like?

During the procedure, X-ray equipment, a catheter, and various synthetic and medicinal substances called embolic materials are used.

CE typically uses an x-ray tube, a patient table, and a monitor located in the radiologist's office. To monitor the process and control the doctor’s actions, a fluoroscope is used, which converts X-ray radiation into a video image. To improve image quality, a special amplifier is used, suspended above the patient's table.

The catheter is a long, thin plastic tube smaller than a pencil in diameter.

The choice of embolic material depends on the size of the blood vessel or malformation and the need for temporary or permanent treatment. The following embolic agents are distinguished:

Gelfoam™, or gel foam, is a material in the form of a gelatin sponge, which is cut into small pieces and injected into the artery. With the blood flow, gelatin reaches any obstacle in the vessel and stops near it. After a certain time (from several days to two weeks), the material is absorbed.
Embolic microparticles, such as polyvinyl alcohol and gelatin-coated acrylic microspheres, which are injected into the bloodstream mixed with fluid to occlude small vessels. These materials are used for permanent occlusion of blood vessels, including in the treatment of uterine fibroids.
Embolic coils of various sizes made of stainless steel or platinum, which are used to close the lumen of large vessels. The structure of the spiral allows it to be very accurately placed in the lumen of the injured artery in order to stop bleeding or to stop blood flow in the aneurysm.
Liquid sclerosants, such as alcohols, which are used to destroy blood vessels or vascular malformations. The introduction of sclerosing materials promotes the formation of a blood clot that closes the lumen of abnormal vascular channels.
Liquid adhesive compositions that quickly harden when introduced into a container.

In addition, other devices and equipment are used during the procedure, such as intravenous infusion systems and machines to monitor blood pressure and heart rate.

What is the basis for catheter embolization?

To visualize the blood vessel, X-ray examination is used against the background of the introduction of contrast material. Under X-ray control, the doctor inserts a catheter through the skin into the vessel and advances it to the required point. After this, a synthetic material or a medicinal substance (embolic drug) is injected into the vessel or vascular malformation through a catheter.

How is catheter embolization performed?

Minimally invasive image-guided procedures, such as catheter embolization, should be performed by an interventional radiology specialist in the operating room.

Before the procedure, the doctor prescribes an instrumental examination: ultrasound, computed tomography (CT) and/or magnetic resonance imaging (MRI).

The doctor helps the patient position himself on the operating table. Devices that are connected to the patient's body are used to monitor heartbeat, pulse and blood pressure during the procedure.

The nurse is setting up an intravenous infusion line that will be used to administer sedatives to a client. In other cases, general anesthesia is possible.

The skin at the site of catheter insertion is thoroughly cleaned of hair, disinfected and covered with a surgical drape.

A pinpoint skin incision or small puncture is made.

A catheter (a long, thin, hollow plastic tube) is passed into the diseased artery through the skin under visual guidance.

To determine the exact location of the vascular abnormality or cause of bleeding, contrast material is injected through the catheter, followed by a series of x-rays. After completion of the procedure, an additional series of images is necessary to ensure that there is no blood flow in the desired artery or vascular malformation.

After the procedure is completed, the catheter is removed, bleeding is stopped, and a pressure bandage is applied to the wound. No stitches are required. The nurse then removes the IV line.

When treating an intracranial arteriovenous malformation (AVM), a control injection of a small amount of embolic agent is initially performed, followed by a neurological examination of the patient. This makes sure that there is no negative impact on important parts of the brain. If the examination results are normal, the embolic drug is administered in a full dose.

For massive AVMs, treatment is divided into several stages, each of which is carried out according to a prescribed schedule. For example, a course may consist of 2-3 stages at intervals of 2-6 weeks.

After the procedure, you need to stay in bed for 6-8 hours.

Depending on the severity of vascular changes, the duration of CE ranges from 30 minutes to several hours.

What should you expect during and after catheter embolization?

Machines are connected to the patient's body to monitor heartbeat and blood pressure.

When setting up an intravenous infusion system, as well as when administering a local anesthetic, you may feel a slight prick.

If the procedure is performed under local anesthesia, then sedatives (calming) drugs are administered intravenously, which is accompanied by drowsiness and a feeling of relaxation. Depending on the degree of sedation, the patient's consciousness may or may not be maintained.

The insertion of the catheter is accompanied by slight pressure, but there is no significant pain.

When contrast material is injected, you will often feel a warm or hot sensation.

Side effects during CE develop in most patients. The most common of these is pain, which can be controlled with painkillers in tablets or injections.

If embolization is performed for uterine fibroids, women often experience severe cramping-type pain immediately after the procedure and for 8-12 hours after it. Rarely, pain persists for 3-5 days, requiring painkillers.

CE for intracranial arteriovenous malformation may be accompanied by mild headaches.

In most cases, after treatment, the patient remains in the hospital for a day, but severe pain requires a longer hospitalization.

The recovery period is usually about a week.

In 20% of cases, after CE for fibroids, the so-called post-embolization syndrome develops, which is expressed by an increase in temperature to 38.5 ° C and above, loss of appetite, nausea and vomiting. This syndrome can occur during the treatment of any tumor, but most often after embolization of a single and large fibroid. Symptoms usually go away within three days, but if they persist longer, they require appropriate treatment.

The occurrence of symptoms is associated with the body’s reaction to tumor decay products and most often develop during embolization of a fairly large fibroid.

Who analyzes the results of catheter embolization and where can I find out about them?

You can inquire about the success of CE from your attending physician: a specialist in interventional radiology after completion of the procedure.

If treatment was carried out for bleeding, then its complete stop can be judged only after a day. With CE for a tumor, vascular malformation or uterine fibroids, 1-3 months must pass before a complete cure can be considered.

After completion of the procedure or other treatment, the specialist may recommend that the patient undergo a dynamic follow-up examination, during which an objective examination, blood tests or other tests, and instrumental examination are performed. During this examination, the patient can discuss with the doctor any changes or side effects that have appeared after the treatment.

Benefits and risks of catheter embolization

Advantages:

Embolization can control bleeding very effectively, especially in emergency situations.
When treating women for uterine fibroids, the effectiveness of the procedure is 85% or higher.
Vascular embolization is much less traumatic than open surgery. As a result, the patient’s hospitalization is reduced (up to one day) and the incidence of complications. The amount of blood loss is reduced compared to traditional surgical treatment, and there are no visible scars.
Embolization is suitable for the treatment of tumors and vascular malformations that cannot be removed surgically and in cases where surgery is high risk.
Embolization does not require surgical incisions: the doctor makes only a small puncture in the area where the catheter is inserted, which does not even need to be closed with sutures.

Risks:

There is an extremely low risk of developing an allergic reaction to the contrast material.
Any procedure that involves inserting a catheter into a blood vessel carries some risks. These include the risk of damage to the vessel wall, hemorrhage or bleeding at the catheter insertion site, and infection.
There is always the possibility of an embolic substance entering healthy tissue, which is accompanied by disruption of their blood flow and nutrition.
There is a risk of infection, even with antibiotics.
In some women, uterine artery embolization causes injury to the uterine wall, requiring emergency hysterectomy (removal of the uterus). In rare cases, especially in women over 45 years of age, menopause develops within a year after CE. The effect of embolization on fertility is not fully established. Therefore, before deciding to undergo CE for uterine fibroids, patients who are planning a pregnancy should carefully consult with an interventional radiologist.
There is a low risk of kidney damage from contrast material, especially in patients with diabetes or pre-existing kidney disease.

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.