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Vascular Embolization A Minimally Invasive Treatment Option

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What is Vascular Embolization

Vascular embolization is a minimally invasive medical procedure used to block one or more blood vessels or abnormal vascular channels. It is performed by inserting a thin tube called a catheter inside an artery or vein through a small incision in the skin. Using imaging guidance like fluoroscopy or angiography, the catheter is advanced to the target blood vessel supplying a tumor, hemorrhaging site, or vascular malformation.

Various embolic agents like gelfoam, coils, polyvinyl alcohol particles (PVA), or liquid embolic agents are then injected through the catheter into the vessel. These agents clot or plug the vessel, restricting or stopping blood flow to that specific area. By blocking the blood supply, the procedure treats certain tumors, hemorrhages, or vascular malformations in an effective and localized manner without the need for open surgery.

Applications of Vascular Embolization

Uterine Fibroid Embolization

Uterine fibroid embolization or UFE is used to treat fibroid tumors of the uterus by blocking the blood vessels supplying the fibroids. It is an effective minimally invasive alternative to hysterectomy for symptomatic fibroids, preserving the uterus and fertility. During the procedure, tiny particles are injected to cutoff blood flow to the fibroids, causing them to shrink over time.

Kyphoplasty / Vertebroplasty

These procedures are used to treat compression fractures of the spine due to osteoporosis, cancer or traumatic injury. Through a small needle puncture in the back, bone cement is injected under imaging guidance into the fractured vertebral body to stabilize and strengthen the bone. Embolization helps prevent cement leakage outside the vertebra.

Tumor Ablation

Embolization is often performed before tumor ablation procedures like radiofrequency ablation (RFA) or cryoablation to prevent blood loss and make the treatment more effective. By blocking blood vessels feeding the tumor beforehand, embolization shrinks the tumor and makes it more vulnerable to destruction by RFA or freezing during cryoablation. This combined approach gives better local tumor control.

Arteriovenous Malformation (AVM) Treatment

AVM refers to tangled, abnormal clusters of blood vessels connecting arteries and veins. Embolization can be used to treat cerebral AVMs (brain), spinal AVMs, or AVMs elsewhere. Through a series of sessions, the aim is to occlude as many abnormal blood vessel channels as possible, making any remaining ones more amenable to surgical excision or reducing the risk of bleeding.

Other Applications

Embolization is commonly used for hemorrhages (atraumatic splenic/liver, post-traumatic), traumatic arteriovenous fistulas, proximal extremity arterial injuries, varicocele treatment, pre-surgical embolization to reduce blood loss for tumors/lesions. It is also increasingly used in interventional oncology for downstaging large tumors prior to resection or ablation.

Benefits and Risks of Vascular Embolization

Key benefits of embolization include its minimal invasiveness compared to open surgery, shorter hospital stay and recovery time, reduced blood loss and transfusions, organ function preservation. Complications are infrequent when performed by skilled interventional radiologists but may include post-embolization syndrome (fever, pain), infection, allergic reactions to contrast/embolic agents, inadvertent non-target embolization.

Rarely vessel perforation, dissection, nerve injury, abscess formation, tissue necrosis can occur. Despite risks, embolization offers cure or significant symptom relief in many cases and maintains or improves quality of life when used appropriately as primary or adjuvant therapy. Ongoing research is further enhancing safety, efficacy and expanding applications. Overall, embolization has revolutionized minimally invasive treatment of various vascular diseases and tumors.

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