• Endovascular Embolization

    (Endovascular Coiling)

    Definition

    This is a procedure to fill and/or close blood vessels. This prevents bleeding and rupture. It is an alternative to open surgery.

    Reasons for Procedure

    Endovascular embolization can treat many conditions, including:
    • Brain aneurysm —a weakened blood vessel in the brain that collects blood and can bleed
    • Vascular malformations —abnormal connections between arteries and veins (usually present at birth)
    • Tumors
    Brain Aneurysm
    IMAGE
    Copyright © Nucleus Medical Media, Inc.
    The procedure can be used alone or with other treatments. It will not fix damaged areas of the brain, but it can improve quality of life by stopping bleeding or preventing rupture.

    Possible Complications

    If you are planning to have this procedure, your doctor will review a list of possible complications, such as:
    • Bleeding
    • Weakness
    • Numbness or tingling
    • Speech disturbances
    • Visual changes
    • Confusion, memory loss
    • Seizures
    • Infection
    • Reaction to the anesthesia or contrast solution
    • Blood clots
    • Ruptured aneurysm during surgery
    Factors that may increase the risk of complications include:
    Talk to your doctor about these risk factors.

    What to Expect

    Prior to Procedure

    Your appointment before the surgery may include:
    • Physical exam, blood and imaging tests
    • Discussion of allergies, your medicines, recent illness or conditions, risks and benefits of the procedure
    Also:
    • Arrange for a ride home.
    • The night before the procedure, do not eat or drink anything after midnight.
    • Discuss your medicines with your doctor. You may be asked to stop taking certain medicines, such as:
      • Anti-inflammatory drugs (NSAIDs)
      • Anti-coagulants (blood thinners)
    Women should let their doctor know if they are pregnant or planning to become pregnant.

    Anesthesia

    General anesthesia will be used. It will block any pain and keep you asleep through the surgery.

    Description of the Procedure

    The doctor will monitor your blood pressure, heart rate, and pulse. An IV will be placed in your arm for sedation and anesthesia. The nurse will shave and sterilize the groin area. The catheter will be inserted in this area.
    The doctor will make a tiny incision in your groin area to access a vein. The catheter will be placed in the vein and threaded up to the site. A special dye will be given through the catheter. The doctor will be able to see the catheter pathway on a monitor. X-rays will help the doctor find the exact weakened or malformed area.
    Once the catheter is in position, medicine, coils, or man-made material will be inserted into the catheter to the site. This will close or fill the blood vessel. Imaging tests will be done to make sure the blood vessels have closed.

    Immediately After Procedure

    The catheter and IV line will be removed. You will lie still for 6-8 hours.

    How Long Will It Take?

    30 minutes or longer—More complex procedures may take several hours.

    How Much Will It Hurt?

    Pain or soreness after the procedure can be managed with pain medicine.

    Average Hospital Stay

    This procedure is done in a hospital setting. The usual length of stay is two days. If you have any complications, you will need to stay longer.

    Post-procedure Care

    At the Hospital
    • You will rest for several hours in bed.
    • Your vital signs will be monitored.
    At Home
    You may return to regular activities within a week. When you return home, do the following to help ensure a smooth recovery:
    • Rest for a few days.
    • Clean the incision site with lukewarm water and mild soap. Use a soft wash cloth to gently wipe the incision area and keep it dry.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Take medicine as directed.
    • Engage in rehabilitative therapy as directed.
    • Follow all of your doctor’s instructions.

    Call Your Doctor

    After you leave the hospital, call your doctor if any of the following occurs: 
    • Any changes in physical ability (eg, balance, strength, or movement)
    • Any changes to mental status (eg, consciousness, memory, thinking)
    • Weakness, numbness, tingling
    • Signs of infection including fever and chills
    • Redness, swelling, increasing pain, bleeding, or discharge from the incision site
    • Headache
    • Changes in vision
    • Fainting
    • Pain that you cannot control with the medicines you have been given
    • Nausea, vomiting
    • Trouble controlling your bladder and/or bowels
    Call for medical help or go to the emergency room right away if any of the following occurs: 
    • Seizure
    • Shortness of breath or chest pain
    • Loss of consciousness
    If you think you have an emergency, call for medical help right away.

    RESOURCES

    The Brain Aneurysm Foundation http://www.bafound.org/

    National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/

    CANADIAN RESOURCES

    Brain Injury Association of Alberta (BIAA) http://www.biaa.ca/

    Heart and Stroke Foundation Canada http://ww2.heartandstroke.ca/splash/

    References

    Center for Vascular Surgery (Hyman-Newman Institute for Neurology and Neurosurgery). Embolizations. Hyman-Newman Institute for Neurology and Neurosurgery website. Available at: http://neuro.wehealny.org/endo/proc%5Fembolizations.asp . Accessed June 2, 2010.

    Neff D. Brain Aneurysm. EBSCO Patient Education Reference Center. Available at:  http://www.ebscohost.com/thisTopic.php?marketID=16&topicID=1034 . Published May 1, 2010. Accessed June 2, 2010.

    Radiological Society of North America. Catheter embolization. Radiological Society of North America website. Available at: http://www.radiologyinfo.org/en/info.cfm?pg=cathembol . Accessed June 2, 2010.

    The Toronto Brain Vascular Malformation Study Group. Endovascular (Embolization) Treatment of aneurysms. The Toronto Brain Vascular Malformation Study Group website. Available at: http://brainavm.oci.utoronto.ca/malformations/embo%5Ftreat%5Faneurysm%5Findex.htm . Accessed June 2, 2010.

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