Postembolization syndrome, or PES, is a frequent and expected outcome following an embolization procedure. Embolization is a minimally invasive treatment that blocks the blood supply to a specific area, such as a uterine fibroid, a tumor, or an abnormal blood vessel. Rather than being a complication, PES is the body’s natural response to this treatment. It is similar to how the body might react after a vaccination with systemic effects like feeling generally unwell.
Causes of Postembolization Syndrome
Embolization procedures are effective because they deprive targeted tissues of oxygen and nutrients by cutting off their blood supply. This deprivation, known as ischemia, causes the cells within the target tissue to begin to break down and die in a process called necrosis. The size of the tissue being treated can influence the intensity of the subsequent reaction.
As the targeted tissue undergoes necrosis, it releases various substances into the bloodstream, including cellular breakdown products and inflammatory mediators. The body recognizes these substances as signals of injury, triggering a body-wide inflammatory response. This systemic reaction is the direct cause of the symptoms associated with PES and is a sign that the embolization has successfully affected the target area.
Common Symptoms and Duration
The signs of postembolization syndrome typically manifest within the first 72 hours following the procedure. Patients commonly experience a cluster of flu-like symptoms. These include:
- A low-grade fever
- Pelvic or abdominal pain and cramping
- Nausea, and sometimes vomiting
- A general feeling of being unwell, or malaise
The specific symptoms and their intensity can vary significantly. Factors such as the location of the embolization and the size of the treated area play a role in the severity of the reaction. For instance, after uterine fibroid embolization, pelvic pain is a predominant symptom, while after prostatic artery embolization, urinary discomfort may occur.
While the onset is rapid, the duration of these symptoms is typically short-lived. Most individuals find their symptoms resolve on their own within a week, often improving noticeably after the first few days.
Managing the Symptoms
Management of postembolization syndrome is focused on providing comfort and alleviating the specific symptoms until the body’s inflammatory response subsides. Since inflammation is a central cause of the discomfort, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are frequently recommended. These medications can help reduce both pain and fever.
For controlling pain, which can be significant in the first 24 to 48 hours, a doctor may prescribe stronger pain medications. Nausea and vomiting are also managed with specific antiemetic medications. Prophylactic use of these medications, sometimes administered before the procedure begins, can help lessen the severity of the symptoms.
Beyond medication, simple at-home care measures are important for recovery. Getting plenty of rest allows the body to manage the inflammatory response more effectively. Staying well-hydrated by drinking plenty of fluids is also advised.
When to Contact a Doctor
While postembolization syndrome is an expected outcome, certain symptoms can indicate a more serious issue, such as an infection, that requires prompt medical attention. It is important to distinguish between the normal symptoms of PES and potential warning signs. Contact a healthcare provider if you experience:
- A high fever that rises above 101.5°F or 38.6°C
- Pain that is severe and does not get better with the prescribed pain medication
- The appearance of any new, foul-smelling discharge
- Symptoms that are not improving or are worsening after a week
While some pain is normal, it should gradually improve after the first couple of days. The normal course involves a gradual resolution of symptoms, so a reversal of this trend is a reason to seek medical advice.