Hypervascular Tumor Embolization

 

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General Embolization Information

As with many interventional procedures, therapeutic vascular embolization begins with detailed angiographic assessment. After percutaneous access to the vasculature is achieved and a guidewire is in place, an angiographic catheter is advanced over-the-wire and contrast is injected. It is critical that vessels to be embolized be clearly visualized.

Once the target vessel or vessels are accurately identified, the embolization phase of the procedure can proceed. This requires two steps, cannulization of the target vessel and injection of the embolic agent.

However, an angiographic catheter often cannot, however, provide superselective vascular access. Consequently, when this is required, a coaxial approach must be used. In the coaxial technique, a microcatheter/microguidewire system is advanced through the angiographic catheter. The microcatheter is advanced over-the-wire and the vessel is selected. The embolic agent is then delivered via the microcatheter.

Vessels vary widely in diameter. Therefore, to provide targeted occlusion – whether proximal or distal – the embolic agent must be available in a range of sizes so that its selection will block the vessel at the desired site, without impacting proximally or flowing distally from that site. Radiographic visualization of embolic material is critical.

Finally, the embolic agent must be able to be delivered. The agent should travel smoothly through the catheter – especially a microcatheter – without clogging.

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