Endovascular embolization

Answer 1

Definition

Endovascular embolization is a medical procedure to treat abnormal blood vessels in the brain and other parts of the body. It is an alternative to open surgery.

Alternative Names

Treatment - endovascular embolism; Coil embolization

Description

A small surgical cut will be made in the groin area. The health care provider will use a needle to create a hole in the femoral artery, a large blood vessel. Next, a tiny, flexible tube called a catheter is passed through the open skin and into the artery. Dye may flow through this tube so that the artery may be seen on medical images.

While looking at live medical images of the area, the health care provider gently moves the catheter through the blood vessel up to the area being studied.

Once the catheter is in place, the health care provider sends small plastic particles, glue, metal coils, foam, or a balloon through it to seal off the bad blood vessel. The sealing material used depends on your individual condition. (If coils are used, it is called coil embolization.) More than one type of material may be used.

Why the Procedure Is Performed

The procedure is most often used to treat aneurysms in the brain, but it may be used for other medical conditions when open surgery is considered risky. The general goal of the treatment is to prevent bleeding in the problem area and to reduce the risk of blood vessel rupture.

It may be used to treat:

• Arteriovenous malformation (AVM)
• Brain aneurysm
• Carotid artery cavernous fistula (a problem with the large artery in the neck)
• Certain tumors

Risks

• Bleeding
• Bleeding in the brain
• Failure to completely treat the lesion
• Infection
• Damage to artery
• Stroke
• Symptoms that keep returning

After the Procedure

The procedure can take several hours. You will receive medicine to make you feel sleepy during the procedure.

Afterwards, you will need to rest, and may need to stay in the hospital overnight or longer.

Outlook (Prognosis)

How fast you recover depends on your overall health, severity of your medical condition, and other factors.

References

Johnston SC. Recommendations for the endovascular treatment of intracranial aneurysms: a statement for healthcare professionals from the Committee on Cerebrovascular Imaging of the American Heart Association Council on Cardiovascular Radiology. Stroke.2002; 33(10): 2536-4.

Schnipper D. Management of intracranial complications of sinus surgery. Otolaryngol Clin North Am. 2004; 37(2): 453-72, ix.

Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery, 17th ed. St. Louis, M0: WB Saunders; 2004.

Answer 2

Definition

Endovascular embolization is a medical procedure to treat abnormal blood vessels in the brain and other parts of the body. It is an alternative to open surgery.

This procedure cuts off the blood supply to a certain part of the body.

Alternative Names

Treatment - endovascular embolism; Coil embolization; Cerebral aneurysm - endovascular; Coiling; Saccular aneurysm - endovascular; Berry aneurysm - endovascular repair; Fusiform aneurysm repair; Aneurysm repair - endovascular

Description

You may have general anesthesia and a breathing tube. Or, you may be given medication to relax you, but not enough to put you to sleep.

A small surgical needle hole will be made in the groin area. The health care provider will use a needle to create a hole in the femoral artery, a large blood vessel.

• A tiny, flexible tube called a catheter is passed through the open skin and into the artery.
• Dye is injected through this tube so that the blood vessel can be seen on x-ray images.
• The health care provider gently moves the catheter through the blood vessel up to the area being studied.
• Once the catheter is in place, the health care provider places small plastic particles, glue, metal coils, foam, or a balloon through it to seal off the bad blood vessel. (If coils are used, it is called coil embolization.)

This procedure can take several hours.

Why the Procedure Is Performed

The procedure is most often used to treat aneurysms in the brain, but it may be used for other medical conditions when open surgery is considered risky. The goal of the treatment is to prevent bleeding in the problem area and to reduce the risk that the blood vessel will break open (rupture).

Not all aneurysms need to be treated right away. Those that are very small (less than 3 mm) are less likely to break open.

Your doctor will help you decide whether it is safer to have surgery to block off the aneurysm before it can rupture.

This procedure may be used to treat:

• Arteriovenous malformation (AVM)
• Brain aneurysm
• Carotid artery cavernous fistula (a problem with the large artery in the neck)
• Certain tumors

Risks

• Bleeding at the site of the needle puncture
• Bleeding in the brain
• Damage to the artery where the needle is inserted
• Dislodged coil or balloon
• Failure to completely treat the abnormal blood vessel
• Infection
• Stroke
• Symptoms that keep returning

Before the Procedure

This procedure is often performed on an emergency basis. If it is not an emergency:

• Tell your doctor or nurse what drugs or herbs you are taking and if you have been drinking a lot of alcohol.
• Ask your doctor which drugs you should still take on the day of the surgery.
• Try to stop smoking.
• You will usually be asked not to eat or drink anything for 8 hours before the surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive.

After the Procedure

If there was no bleeding before the procedure, you may need to stay in the hospital for 1 - 2 days.

If bleeding occured, your hospital stay will be longer.

Outlook (Prognosis)

How fast you recover depends on your overall health, the severity of your medical condition, and other factors.

In most cases, endovascular embolization is a successful procedure with good outcomes.

The outlook also depends on any brain damage that occurred from bleeding before, during, or after the surgery.

References

Brinjikji W, Lanzino G, Cloft HJ, Rabinstein A, Kallmes DF. Endovascular treatmetn of very small (3 mm or smaller) intracranial aneurysms: report of a consecutive series and a meta-analysis. Stroke. 2010;41:116-121.

Meyers PM, Schumacher HC, Higashida RT, Barnwell SL, Craeger MA, Gupta R, et al. American Heart Association Indications for the performance of intracranial endovascular neurointerventional procedures: a scientific statement from the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research. Circulation. 2009;119:2235-2249.

Patterson JT, Hanbali F, Franklin RL, Nauta HJW, Neurosurgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 72.

Reviewed By

Review Date: 01/26/2011

Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.