Gelfoam embolization is a medical procedure designed to intentionally block blood flow within a specific vessel. This minimally invasive technique aims to stop abnormal bleeding or reduce blood supply to certain areas of the body. It uses Gelfoam, a medical-grade, absorbable gelatin sponge, as the material to create the blockage inside the blood vessel.
Medical Uses for Gelfoam Embolization
Gelfoam embolization addresses various medical conditions by controlling blood flow to specific areas. It is frequently employed to manage significant bleeding, such as from traumatic injuries affecting organs like the liver or spleen, or complex pelvic fractures.
Another application is in managing postpartum hemorrhage, a serious complication after childbirth. By embolizing the uterine or internal iliac arteries, Gelfoam helps control severe bleeding when other methods are insufficient. The technique is also used to treat uterine fibroids by cutting off their blood supply, which helps reduce their size and alleviate associated symptoms.
The procedure also finds use in controlling bleeding from gastrointestinal sources or before certain surgical procedures to minimize blood loss. It can also be applied to reduce blood flow to tumors, preparing them for surgical removal or managing symptoms. Additionally, Gelfoam embolization can correct abnormal connections between arteries and veins or address aneurysms, which are bulges in blood vessel walls.
The Gelfoam Embolization Procedure
Before a gelfoam embolization, patients typically prepare by fasting for a period and may undergo imaging tests. Upon arrival at the interventional radiology suite, a patient receives mild to moderate sedation through an intravenous (IV) line, with general anesthesia used in some cases. A small area, usually in the groin or sometimes the wrist, is numbed with a local anesthetic.
A tiny incision is made, and a thin, flexible tube called a catheter is inserted into an artery. Using real-time imaging, known as fluoroscopy, the catheter is carefully guided through the blood vessels to the target site. A contrast material is injected through the catheter, allowing a series of X-ray images to visualize the blood vessels and confirm the precise location of the problem.
Once the catheter is positioned correctly, the gelfoam slurry, prepared for injection, is delivered through the catheter to block the targeted vessel. The entire procedure can last from 30 minutes to several hours. Following the successful delivery of the Gelfoam, the catheter is removed, and pressure is applied to the insertion site to prevent bleeding.
The Role and Properties of Gelfoam
Gelfoam is a medical material derived from purified porcine (pig) gelatin. It comes in a dry, sterile sponge form, which interventional radiologists prepare into a “slurry” for embolization. This preparation involves cutting the sponge into tiny pieces and mixing them with a saline solution or contrast agent, creating a liquid suspension that can be injected through a catheter.
Once injected into a blood vessel, Gelfoam functions as a physical plug, creating a mechanical obstruction. It also provides a scaffold within the vessel, promoting the body’s natural clotting cascade to form a stable thrombus, thereby halting blood flow.
A significant property of Gelfoam is its temporary and absorbable nature. When placed in soft tissues, it is typically absorbed completely by the body within four to six weeks. In areas like nasal, rectal, or vaginal mucosa, it may liquefy within two to five days. The vessel often recanalizes, or reopens, in as little as two weeks, making Gelfoam suitable for temporary occlusions where long-term blockage is not desired.
Post-Procedure Expectations
Immediately following a Gelfoam embolization, patients are moved to a recovery area for observation. Most patients can expect to stay overnight in the hospital, though some may be discharged the same day, while others might require a longer stay if pain persists. The insertion site, typically in the groin, will have a small dressing but no stitches are usually needed.
Common post-procedure symptoms include pain and cramping, which may feel similar to menstrual cramps, and can often be managed with prescribed oral medications. Patients may also experience a mild headache, fatigue, mild nausea, or a low-grade fever. Discomfort at the catheter insertion site is also common.
A known inflammatory response called Post-Embolization Syndrome (PES) can occur, typically within the first 72 hours after embolization. Its symptoms include pain, fever, nausea, and vomiting. This syndrome results from tissue infarction and the release of inflammatory mediators from the embolized area, rather than an infection. These symptoms are generally self-limiting and subside over several days.
Regarding activity, doctors typically advise minimal activity for about a week after the procedure, including avoiding heavy lifting for at least two days. Most patients can return to their normal daily activities within a few days to a week, with full recovery often taking a few weeks. Following up with the care team for symptom check-ins and imaging is also recommended.