Pediatric Embolization

Using an ultrasound machine, your child's radiologist will access a blood vessel with a needle and insert a guide wire through this needle, using live X-rays for guidance. The guide wire will be exchanged for a catheter and contrast dye injections will delineate the vascular anatomy and allow your child's radiologist to navigate to the particular vessel of interest. The embolic agent will then be injected into the blood vessel through the catheter. Multiple blood vessels may be embolized in one embolization procedure. The procedure is finished once repeat X-ray images show a satisfactory level of decreased blood flow to the targeted region. The catheter will be removed, pressure will be held at the insertion site for many minutes, and a bandage will be placed.

Your child will not feel pain during the procedure but some children may feel pain and discomfort around the catheter insertion site for a few days following the procedure. This is well controlled with over-the-counter medications but stronger prescription medications may be given.

The length of the procedure will vary depending on the location and extent of embolization. Generally, embolizations take about a couple hours.

This procedure requires your child to be asleep for which we will administer intravenous sedation or general anesthesia.

Embolization procedures are considered low-risk. However, potential complications include:

• Bleeding
• Infection
• Tenderness at the catheter insertion site
• A numbing or cooling sensation in the arm or leg
• Blood vessels injury
• Nontarget-site embolization
• Formation of blood clots
• Stroke
• Allergic reaction to the contrast dye
• Transient injury to the kidney and reduced kidney function as a side-effect of the contrast dye
• Post-embolic syndrome (fever, nausea and pain)

We encourage good communication between you and your child about the procedure, the reason for it and ensuring them that you will be close by the entire time. Holding them or their hands until they leave for the procedure is a great way to provide support.

You will be given specific instructions along the way but you may need to arrive a few hours before the scheduled procedure to have some blood tests done. When you arrive at the hospital, a doctor will review the procedure and associated risks, after which you will sign a consent form. When we are ready to get started with the procedure, a nurse will place an intravenous line to deliver sedating medications and you will be allowed to accompany your child in the operating room until they are asleep, after which you will be escorted to a waiting room.

Nurses will monitor your child in the recovery area for 4-6 hours for successful recovery from anesthesia and any immediate complications. The physician may decide to admit your child to the hospital overnight for observation. It is vital to keep the extremity that was accessed straight for many hours following the procedure to ensure minimal bleeding and injury to the blood vessel. Laboratory tests looking at the blood may also be ordered to ensure a safe recovery.

The bandage and dressing covering the skin must stay dry and in place for 48 hours during which time your child may sponge-bathe. Allow the white strips covering the catheter insertion site to fall off naturally within a week. Do not allow full submersion in water until these white strips have fallen off. They may be manually removed if they have not fallen off within one week.

We recommend complete bed rest for the remainder of the day after the procedure. The next day, your child may resume normal light activities like normal school-going or daycare attendance but must refrain from intense physical activity like contact sports and rough playing for one week.

• Redness, pain, swelling or bruising at the needle insertion site.
• Fever higher than 101° Fahrenheit or 38° Celsius.
• A change in color or temperature to the associated extremity.
• Numbness, swelling or pain of the associated extremity.

The Department of Interventional Radiology can be reached at: 202-476-3791, Monday through Friday, between 8 a.m. and 5 p.m.

At all other times please call 202-259-8643, which is the on-call pager. Follow the instructions and wait for a call back.