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Information about Angioembolisation in Urology

Angioembolisation is the combination of angiography (imaging of blood vessels) and embolisation (blocking off small blood vessels that feed abnormal tissue). Interventional radiologists perform these procedures, generally under local anaesthetic and sometimes with sedation.

The principle indications for angioembolisation in urology are:

1. Embolisation of angiomyolipoma

An angiomyolipoma (AML) is a benign lesion of the kidney. They are commoner in women. They always remain benign, but can grow over time. A rare complication of AML is bleeding, and there is some evidence that they are more likely to bleed spontaneously if they are over 4cm in size. The risk is still small, but urologists tend to suggest treatment if an AML is larger than 4cm. Also, we think they grow in response to female hormones, particularly the progestogens, which are high during pregnancy. Therefore, women who are considering pregnancy and who have an AML may be advised to have treatment. Treatment options include surgery and angioembolisation.

What does angioembolisation of an AML involve?

Angioembolisation is less invasive than surgery, and may be the preferred option. Using local anaesthetic, and sometimes sedation, a small needle accesses an artery in the groin, and a soft wire is passed up to the kidney artery. Dye is injected, and the blood vessels that supply the AML are identified. They are then blocked off (different things can be used, including small coils or gels/foams that block the small blood vessels).

Preparation for the angioembolisation

You will receive detailed instructions on how to prepare for the procedure from the radiology provider.

Is it painful?

The procedure can be mildly uncomfortable while you are having it done. The local anaesthetic injection stings initially, but then you should not feel much. Sometimes, sedation is given as well, and you should talk to the radiologist performing your procedure about this. After the procedure, you can have a reaction, with pain in the affected kidney, and a temperature. This is due to the body reacting to the tissue (AML) that has been killed off. It is normal and expected, and will pass, but you may require pain-killers to help with the discomfort. This is why you will generally be admitted to hospital overnight.

Are there any risks of AML angioembolisation?

  • You should expect to have the usual reaction outlined above. Sometimes with a large AML this can be quite marked, and leave you feeling unwell for a couple of days.
  • It is rare to have an allergic reaction to the intravenous contrast material used for imaging of the blood vessels, but this can occasionally happen.
  • X-ray imaging is used throughout the procedure (fluoroscopy) and there is some radiation exposure involved with this, but the dose is quite low. The risks of not having the AML treated are thought to outweigh the risks of radiation exposure.
  • Rarely, you can have bleeding from the arterial puncture site in the groin, or the formation of a swelling of the artery called a 'false aneurysm'.
  • Sometimes, the entire AML cannot be embolised, and you may need to have another procedure, or on-going follow up to ensure the remaining area of AML does not increase in size.

2. Embolisation of a varicocoele

A varicocoele is a dilated collection of veins in the scrotum, almost always on the left side. Detailed information about varicocoele can be found here http://www.nickbrookurology.com/varicocoele-surgery

Different treatment options are available, and the treatment that is best for you depends on your individual situation, and also your wishes. Nick Brook will discuss this with you in detail.

X-ray showing dilated veins of a varicocoele outlined by intravenous contrast injected at the time of treatment

The x-ray above shows the dilated veins of a varicocoele outlined by intravenous contrast injected at the time of treatment.

What does angioembolisation of a varicocoele involve?

Angioembolisation of a varicocoele is a good option for many men as it is less invasive than surgery. An interventional radiologist performs this procedure. Using local anaesthetic, a vein in the opposite groin (the femoral vein) is accessed with a small needle. A soft wire is then passed into the vein, and over to the other side where the dilated veins of the varicocoele are. Dye is injected to outline the blood vessels, and these are then blocked off with coils or special gel or foam that stops the blood flow. This causes (over a number of weeks) the veins to shrink away.

Please click this video link to see an animation of the procedure:

Preparation for the angioembolisation

You will receive detailed instructions on how to prepare for the procedure from the radiology provider.

Is it painful?

The procedure can be mildly uncomfortable while you are having it done. The local anaesthetic injection stings initially, but then you should not feel much. Sometimes, sedation is given as well, and you should talk to the radiologist performing your procedure about this. After the procedure, you can have a reaction, with pain in the affected side, from the scrotum to the groin. Usually, you go home the same day, but are advised to take some time off of work, and you will have some discomfort for a few days.

Are there any risks of varicocoele angioembolisation?

  • You should expect to have the usual reaction as outlined above. Sometimes with a large varicocoele this can be quite marked, and can leave you feeling quite sore for a few days.
  • It is rare to have an allergic reaction to the intravenous contrast material used for imaging of the blood vessels, but this can occasionally happen.
  • X-ray imaging is used throughout the procedure (fluoroscopy) and there is some radiation exposure involved with this, but the dose is quite low.
  • Rarely, you can have bleeding from the venous puncture site in the groin.
  • Sometimes, the entire varicocoele can’t be embolised, and you may need to have another procedure.
  • A varicocoele may recur after initially successful treatment, and may need treating again.

If you have any questions, please contact your chosen Radiology provider. The administration staff at Nick Brook Urology do NOT have information about your appointment times for radiology, and are not able to give medical advice or answer questions about radiological investigations. The staff are not able to give you your results – these need to be given to you either by the radiographer or by Nick Brook. Use the links below for contact details for the radiology companies in South Australia:

Radiology SA http://www.radiologysa.com.au

Benson Radiology http://bensonradiology.com.au

Dr Jones & Partners http://www.drjones.com.au


Disclaimer

This information is intended as an educational guide only, and is here to help you as an additional source of information, along with a consultation from your urologist. The information does not apply to all patients.

Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.

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