B-17: Embolization, Arterial

• Indications
  • Active hemorrhage
  • Control of intraoperative blood loss
  • Tumor ablation or palliation
  • Vascular malformations
• Contraindications
  • Contrast allergy (premedicate)
  • Embolization target served by "end" arteries (relative)
• Patient Evaluation
  • Ability to lie still in required position and cooperate during procedure
  • Pharmacological blockade for hormonally active tumors (i.e., carcinoid, pheochromocytoma)
• Preprocedure Orders
  • Routine
  • Consider epidural anesthesia for renal ablation and large hepatic tumors
• Tools
  • 6 Fr. vascular sheath, various diagnostic catheters,
  • Coaxial microcatheter or balloon occlusion system
  • Embolic agents appropriate to lesion (see discussion)
• Entry site
  • Femoral, brachial, axillary or popliteal artery (antegrade or retrograde puncture
• Technique
  • Thorough angiographic evaluation and taking protective measures for non-target vessels (coil or gelfoam pledget occlusion of branches, balloon occlusion, highly selective catheter placement) prior to embolization is critical. Particulates are mixed with half strength contrast and injected short, quick pulses under magnification fluoroscopy. Sclerosants are injected slowly, preferably into opacified vessels using balloon occlusion. Coils are pushed through the diagnostic catheter (not polyurethane) with a Bentson wire and formed by partially withdrawing the catheter while pushing with the wire. Micro-coils may be pushed with a wire or with a saline injection. Embolization progress is monitored with frequent angiography
• Post-procedure Note
  • Describe pre- and post-embolization angiographic appearance and materials used
  • Note peripheral pulses and appearance of extremities distal to embolization site
• Post-procedure Orders
  • Use preprinted standard orders for arteriography. Additional orders:
    • Check skin and extremities distal to embolization site for embolic changes with VS checks
    • Pain medications per H/O

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