preembolization

Preembolization is the preparatory phase before an embolization procedure in interventional radiology and related medical fields. It encompasses planning, assessment, and coordination aimed at depriving a target tissue or vascular lesion of its blood supply through downstream occlusion. The goal is to improve outcomes by reducing intraoperative bleeding, decreasing lesion vascularity, or enabling subsequent treatments.

Indications for preembolization include the planned devascularization of hypervascular tumors (such as renal cell carcinoma, hepatocellular carcinoma, or certain meningiomas), management of arteriovenous malformations or fistulas, and hemorrhage control in selected vascular pathologies. In oncology and vascular surgery, preembolization can facilitate safer resection or embolic therapy by identifying and characterizing feeding arteries and collateral networks.

Common elements of preembolization involve comprehensive imaging and planning. Contrast-enhanced CT or MRI helps delineate anatomy, while angiography maps arterial feeders, assesses collateral supply, and evaluates the risk of non-target embolization. Patient optimization addresses factors such as renal function, allergies, and anticoagulation status. Selection of embolic materials (particles, coils, liquid agents, or plugs) and access routes is determined during this phase, and multi-stage approaches may be considered for complex lesions.

Risks during or after preembolization mirror those of embolization, including non-target embolization, tissue ischemia, post-embolization syndrome, contrast-induced nephropathy, and radiation exposure. Limitations include incomplete devascularization due to collateral circulation or rapid revascularization.

Outcomes of well-planned preembolization commonly include reduced intraoperative blood loss, clearer surgical planes, and improved procedural safety, with effectiveness contingent on lesion vascularity and planning quality.