Endovascular Embolization

How is endovascular embolization performed?

This procedure is performed in an angiography suite by a team of physicians, nurses and technologists.  The interventional neuroradiologist is the primary doctor in the procedure. 

You initially undergo a thorough pre-admission process including a history and physical by your primary care provider.  Additional blood tests and other diagnostic studies may be completed prior to the procedure depending upon your history.

The procedure is performed while you are under general anesthesia.  While you are asleep, a small incision is made over the artery in the groin area.  A needle is used to puncture the artery.  A thin hollow tube called a sheath is placed into the artery providing constant access to it.  A catheter is then threaded through the sheath into the arteries leading to the aneurysm.  This entire process is done under x-ray visualization.  Once the catheter is in position, a delivery system is used to deploy the embolic material into the aneurysm.    

 

Some aneurysms require the use of adjunctive devices to aid in embolization:

 

A balloon may be temporarily inflated to keep the embolic material inside the aneurysm. 

For some aneurysms a stent is necessary to keep the coils in place.

 

How do I prepare for endovascular embolization?

Before
Endovascular embolization requires a pre-operative history and physical.  You should have this scheduled with your primary care physician within 30 days of your scheduled procedure.  Blood work will need to be drawn within 14 days of your scheduled procedure.  Blood work needed includes BUN, creatinine, platelets, hemoglobin, potassium, sodium and INR.

You will called by telephone to pre-register for your procedure.

 

Eating: 

Do not eat or drink anything for 6 hours prior to your procedure.  Maintain hydration – drink extra fluids for 2 days prior to your procedure, unless you are on fluid restrictions from your physician.

 

Medication:  

Medications can be taken in the morning with a sip of water.  Please bring a list of your medications with you to your appointment.

  • If you are a diabetic and take Glucophage (Metformin) DO NOT take your morning dose.  If you take insulin, ask your doctor about modifying your insulin dose for the day of the procedure.

  • If you are taking blood thinners (Coumadin/Warfarin, Pradaxa/dabigatran, Aggrenox/aspirin/dipyridamole (or similar medications) ask your doctor about stopping these medications at least 5-6 days prior to your procedure.  Please let us know if you are taking clopidogrel (Plavix) or prasugrel (Effient). 

  • If you are taking aspirin DO NOT stop this medication prior to the procedure

 

Allergies: 

If you are allergic to contrast dye, please let us know.  You will need to take a prescription steroid medication methylprednisolone (Medrol) and diphenhydramine (Benedryl) prior to your procedure. 

 

Kidney Function: 

If you have a history of renal insufficiency (an increased creatinine level or a decreased GFR) please let us know as you may need to be pretreated with Mucomyst (a medicine that helps to protect your kidney function).  Ask your primary care physician about withholding potential nephrotoxic medications you may be taking prior to your procedure.

 

Smoking: 

No smoking for 72 hours prior to your procedure.

 

Driving: 

You will not be allowed to drive for 24-48 hours after general anesthesia or if you are taking narcotics.  You will need a driver to take you home when you are discharged from the hospital.

 

What happens on the day of the procedure?

The day of the procedure you will check in at the Pre-operative Care Center 2 hours prior to your procedure time. 

A nurse and anesthesiologist will review your health history as well as your medications and allergies.

You may need blood drawn, if not already completed within 14 days of your procedure.

The interventional neuroradiologist doing the procedure will meet with you prior to the procedure to, answer any questions you may have and have you sign a consent form.

 

During

You will be taken by cart to the interventional neuroradiology suite where you will be transferred to an x-ray exam table.  

Your heart rate and blood pressure will be monitored.  Your groin will be shaved, prepped and draped.  A small nick is made in the skin over the femoral artery.  Using x-ray guidance (fluoroscopy) a thin, small tubing (catheter) is inserted through the skin into the blood vessel and guided to the area to be examined (neck, head or spine).  A contrast dye is then injected though the catheter to allow for pictures of the aneurysm to be taken.  This enables the interventional neuroradiologist performing the procedure to know what type and how much embolic material will be needed to treat your aneurysm.  The aneurysm is then filled with embolic material.  Once the aneurysm is excluded from the circulation all catheters are removed and pressure is applied to the groin puncture site to stop any bleeding.  The opening is then covered with a bandage. 

 

After

Following the procedure you will go to the post-anesthesia recovery area.  When the nurse feels you are ready you will be transported to your room for an overnight stay and most likely be discharged the following morning.  It is not uncommon to feel groggy and fatigued following the procedure.  Headaches may occur in some patients following endovascular embolization of their aneurysm.  These headaches usually resolve within several days.  If needed you may be sent home with additional medication to treat headaches.

 

Aftercare

  • It is important to drink plenty of fluids for the next several weeks.  This will help to avoid headaches. 

  • Gradually increase your activity as tolerated.

  • You should avoid lifting objects heavier than 10 pounds for 5 days

  • Avoid bending your leg at the hip and straining. 

  • Support your groin site with your hand when you cough, climb stairs or change positions for the first 48 hours following your procedure.

  • Keep the puncture site dry.  If you have bleeding or swelling under the skin, lie down and put firm pressure slightly above the puncture site for 10 to 20 minutes.  

  • You may shower 24 hours after your procedure.  Gently wash the site with warm water.  Dry gently.  If there is still a slit in the skin cover with a bandage until it closes.  Your may shower.  Do not take tub baths, or swim in lakes of pools until your puncture site is healed without a scab.

  • You will not be allowed to drive for 48 hours after general anesthesia or if you are taking narcotics. 

  • Additionally, you should not drink alcoholic beverages or make critical decisions or sign important documents for 48 hours.

     

Follow-Up

You will need to have a follow-up evaluation of your treated brain aneurysm.  Expect to have a cerebral angiogram 6 months following the procedure. 

Additional follow-up may be necessary thereafter.