Post-embolization syndrome

Radioembolization with yttrium-90 ( Y) microspheres represents an innovative approach that has gained increasing awareness and clinical use over the past 5-10 years. The minimal toxicity of radioembolization and the ability to discharge the patient on an outpatient basis make the therapy an attractive alternative in the treatment of primary and metastatic liver malignancies. Patients are able to resume normal activities shortly following treatment, with minimal side effects, in contrast to the post-embolization syndrome often associated with current chemoembolic techniques. 

The post-embolization syndrome comprises a constellation of symptoms including pain, fever, nausea, vomiting, and leukocytosis due to ischemia or infarction of the embolized organ [85]. The postembolization syndrome per se is almost expected sequelae of the procedure and should not be considered a complication. It is much more common with a solid organ embolization and when sclerosant agents are used. Shock and cardiovascular collapse have also been rarely described during embolization with absolute alcohol [51]. 

Post-embolization syndrome should be expected in all patients post UAE and consists of low-grade fever, malaise, nausea and leukocytosis. It can occur... 

If surgical resection is planned, ablation of entire lobar or main renal arteries can be performed with ethanol. This requires the use of a balloon occlusion catheter such as a single lumen Balloon Wedge-Pressure Catheter (Arrow International, Reading, PA) to prevent systemic spread of alcohol. Ethanol ablation should be performed within one or two days of the planned resection. This will help to avoid a prolonged post-embolization syndrome, idiich can be quite uncomfortable for patients and can reduce the risk of abscess formation from the ensuing infarction. 

Such complications from radioembolization are exceedingly rare allowing the vast majority of patients to have this procedure on an outpatient basis. Rarely, treatment may be complicated by post-embolization syndrome and symptomatic support may be necessary. Nontarget embolization can be all but eliminated by meticulous technique and pre-procedure planning... 

Severe/prolonged post-embolization syndrome Carcinoid crisis... 

Similar to complete splenic arterial embolization, PSE is prone to complications and adverse effects, but PSE is much better tolerated than complete splenic ablation. In addition to those mentioned above, patients might develop pancreatitis (likely a result of nontarget embolization of dorsal pancreatic and pancreatic magna arteries), pleural effusions requiring thoracentesis, paralytic ileus, or the post-embolization syndrome consisting of fever, leukocytosis, and abdominal pain [119]. 

Pomoni M, Malagari K, Mosdiouris H, Spyridopoulos TN, Dourakis S, Komezos J, et al. Post embolization syndrome in doxorubicin eluting chemoembolization with DC bead. Hepatogastroenterology 2012 59(115) 820-5. 

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