About Your Hepatic Embolization

This information will help you get ready for your hepatic embolization (heh-PA-tik EM-boh-lih-ZAY-shun) procedure at MSK.

A hepatic embolization stops the blood flow to liver tumors. The hepatic artery is the main source of blood for most liver tumors. During your procedure, your doctor will thread a small catheter (thin, flexible tube) into your hepatic artery. Then, they will inject (put) tiny particles through the catheter into your hepatic artery. These particles will block the blood flow to the tumors, which will kill them.

Your hepatic embolization will be done by an interventional radiologist (also called an IR doctor). This is a doctor who has special training in doing image-guided procedures.

What to do before your procedure

Ask about your medicines

You may need to stop taking some of your usual medicines before your procedure. Talk with your healthcare provider about which medicines are safe for you to stop taking.

We’ve included some common examples below, but there are others. Make sure your care team knows all the prescription and over-the-counter medicines you take. A prescription medicine is one you can only get with a prescription from a healthcare provider. An over-the-counter medicine is one you can buy without a prescription.

‌ It is very important to take your medicines the right way in the days leading up to your procedure. If you don’t, we may need to cancel your procedure.
 

Blood thinners (anticoagulants)

A blood thinner is a medicine that changes the way your blood clots.

If you take a blood thinner, ask the healthcare provider doing your procedure what to do before your procedure. They may tell you to stop taking the medicine a certain number of days before your procedure. This will depend on the type of procedure you’re having and the reason you’re taking a blood thinner.

Examples of common blood thinners are listed below. There are others, so be sure your care team knows all the medicine you take. Do not stop taking your blood thinner without talking with a member of your care team.

Read How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil. It has information about medicines you must avoid before your procedure.

Diabetes medicines

If you take insulin or other diabetes medicines, ask the healthcare provider who prescribes it what to do before your procedure. You may need to stop taking it or take a different dose (amount) than usual. You may also need to follow different eating and drinking instructions before your procedure. Follow your healthcare provider’s instructions.

Your care team will check your blood sugar levels during your procedure.

Diuretics (water pills)

A diuretic is a medicine that helps control fluid buildup in your body. Hydrochlorothiazide (Microzide^®) and furosemide (Lasix^®) are examples of diuretics.

If you take a diuretic, ask the healthcare provider doing your procedure what to do before your procedure. You may need to stop taking it the day of your procedure.

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs, such as ibuprofen (Advil^® and Motrin^®) and naproxen (Aleve^®), can cause bleeding. Stop taking them 1 day (24 hours) before your procedure. If your healthcare provider gives you other instructions, follow those instead.

To learn more, read How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil.

Reactions to contrast dye

Contrast is a special dye that makes it easier for your doctor to see differences in your internal organs. Internal organs are the organs inside of your body. This procedure is usually done with contrast. The dye will be injected into an artery in your arm or groin. Your groin is the area between your belly and thigh.

Some people can have an allergic reaction to contrast. Most reactions are mild, such as hives.

Some people can have very rare but more serious reactions, such as anaphylaxis (A-nuh-fih-LAK-sis). This is a bad allergic reaction that can cause hypotension (a sudden drop in blood pressure) or trouble breathing. Anaphylaxis is treated with an epinephrine (eh-pih-NEH-frin) autoinjector, commonly known as an EpiPen^®. This is an injection (shot) of epinephrine (adrenaline) into a muscle.

If you have had an allergic reaction to contrast dye in the past, tell your healthcare provider. You may need to take medicine before your procedure to help with the allergy.

If you’re breastfeeding, you may choose to continue after your procedure with contrast. If you have questions about contrast and breastfeeding, talk with your care team. They will arrange for a healthcare provider from the lactation team to contact you.

Take devices off your skin

You may wear certain devices on your skin. Before your scan or procedure, device makers recommend you take off your:

• Continuous glucose monitor (CGM)
• Insulin pump

Talk with your healthcare provider about scheduling your appointment closer to the date you need to change your device. Make sure you have an extra device with you to put on after your scan or procedure.

You may not be sure how to manage your glucose while your device is off. If so, before your appointment, talk with the healthcare provider who manages your diabetes care.

Arrange for someone to take you home

You must have a responsible care partner take you home after your procedure. A responsible care partner is someone who can help you get home safely. They should be able to contact your care team if they have any concerns. Make sure to plan this before the day of your procedure.

If you don’t have a responsible care partner to take you home, call one of the agencies below. They’ll send someone to go home with you. There’s a charge for this service, and you’ll need to provide transportation. It’s OK to use a taxi or car service, but you still need a responsible care partner with you.

Tell us if you’re sick

If you get sick (including having a fever, cold, sore throat, or flu) before your procedure, call your IR doctor. You can reach them Monday through Friday from 9 a.m. to 5 p.m.

After 5 p.m., during the weekend, and on holidays, call 212-639-2000. Ask for the Interventional Radiology fellow on call.

Note the time of your appointment

A staff member will call you 1 to 2 business days before your procedure. If your procedure is scheduled for a Monday, they’ll call you on the Thursday or Friday before. They’ll tell you what time to get to the hospital for your procedure. They will also remind you where to go.

If you don’t get a call by noon (12 p.m.) on the business day before your procedure, call 646-677-7001. If you need to cancel your procedure for any reason, call the healthcare provider who scheduled it for you.

What to do the day before your procedure

Instructions for eating

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Stop eating at midnight (12 a.m.) the night before your surgery. This includes hard candy and gum.

If your healthcare provider told you to stop eating earlier than midnight, follow their instructions. Some people need to fast (not eat) for longer before their surgery.

Medicine to prevent allergy to contrast dye

Your doctor may have told you to take medicine to prevent an allergy to contrast. If they did, take your first dose 13 hours before your arrival time.

What to do the day of your procedure

Instructions for drinking

Between midnight (12 a.m.) and 2 hours before your arrival time, only drink the liquids on the list below. Do not eat or drink anything else. Stop drinking 2 hours before your arrival time.

• Water.
• Clear apple juice, clear grape juice, or clear cranberry juice.
• Gatorade or Powerade.
• Black coffee or plain tea. It’s OK to add sugar. Do not add anything else.
  • Do not add any amount of any type of milk or creamer. This includes plant-based milks and creamers.
  • Do not add honey.
  • Do not add flavored syrup.

If you have diabetes, pay attention to the amount of sugar in these drinks. It will be easier to control your blood sugar levels if you include sugar-free, low-sugar, or no added sugar versions of these drinks.

It’s helpful to stay hydrated before surgery, so drink if you are thirsty. Do not drink more than you need. You will get intravenous (IV) fluids during your surgery.

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Stop drinking 2 hours before your arrival time. This includes water.

Things to remember

• Follow your healthcare provider’s instructions for taking your medicines the morning of your procedure. It’s OK to take them with a few sips of water.
• If you’re taking pain medicine, take it before your procedure with a few sips of water. You can take acetaminophen (Tylenol®). Do not take any NSAIDs, such as ibuprofen (Advil® and Motrin®) and naproxen (Aleve®).
• Do not put on body cream, lotion, or petroleum jelly (Vaseline®). You can use deodorant and facial moisturizers. Do not wear eye makeup.
• Do not wear any metal objects. Take off all jewelry, including body piercings. The tools used during your procedure can cause burns if they touch metal.
• Leave valuable items at home.
• If you wear contact lenses, wear your eyeglasses instead, if you can. If you do not have eyeglasses, bring a case for your contacts.
• Wear something comfortable and loose-fitting.
• When it’s time for your procedure, you must remove any hearing aids, dentures, prosthetic devices, wigs, and religious articles.

What to bring

• A list of all the medicines you take at home, including prescription and over-the-counter medicines, patches, and creams.
• Medicines for breathing problems (such as your inhaler), medicines for chest pain, or both.
• Your cell phone and charger.
• Only the money you may want for small purchases, such as a newspaper.
• A case for your personal items, if you have any. Eyeglasses or contacts, hearing aids, dentures, prosthetic devices, wigs, and religious articles are examples of personal items.
• Your Health Care Proxy form and other advance directives, if you filled them out.
• Your breathing device for sleep apnea (such as your CPAP machine), if you use one. If you cannot bring it, we will give you one to use while you’re in the hospital.

What to expect when you arrive

Many doctors, nurses, and other staff members will ask you to say and spell your name and date of birth. This is for your safety. People with the same or similar names may be having procedures on the same day.

Once you’re brought to the presurgical area, you’ll get a hospital gown and nonskid socks to wear. You’ll take off your eyeglasses, hearing aids, dentures, prosthetic devices, wig, and religious articles.

Meet with a nurse

You’ll meet with a nurse before your procedure. Tell them the dose of any medicines you took after midnight (12 a.m.) and the time you took them. Make sure to include prescription and over-the-counter medicines, patches, and creams.

Your nurse will place an IV line into a vein in your arm or hand, unless you already have:

• A central venous catheter (CVC) or any other type of CVC.
• A peripherally inserted central catheter (PICC).
• An implanted port (also called a mediport or Port-A-Cath).

You will get anesthesia (medicine to make you sleep) during your procedure. It will be given through the IV line, CVC, PICC line, or implanted port. You may also get fluids through the same line before your procedure.

Meet with an anesthesiologist

You will also meet with an anesthesiologist (A-nes-THEE-zee-AH-loh-jist). An anesthesiologist is a doctor with special training in anesthesia. They will give you anesthesia during your procedure. They will also:

• Review your medical history with you.
• Ask if you’ve had any problems with anesthesia in the past. This includes nausea (feeling like you’re going to throw up) or pain.
• Talk with you about your comfort and safety during your procedure.
• Talk with you about the kind of anesthesia you’ll get.
• Answer questions you have about anesthesia.

Meet with a doctor

Before your procedure, you will meet the IR doctor who will do the hepatic embolization. They will explain the procedure to you and answer your questions. You’ll be asked to sign a consent form, which says you agree to the procedure and understand the risks.

During your procedure

When it’s time for your procedure, you’ll be brought into the procedure room and helped onto the table. You’ll lie flat on your back.

A member of your care team may put compression boots on your lower legs. These gently inflate and deflate to help blood flow in your legs. You’ll be attached to equipment to keep track of your heart, breathing, and blood pressure. You’ll also get oxygen through a thin tube that rests below your nose.

Then, your anesthesiologist will give you anesthesia and you’ll fall asleep.

A member of your care team will clean the skin in the area where your doctor will be working. This area is called the insertion site. The insertion site will be either your arm or groin. They will shave the area if needed and cover it with sterile (clean) drapes.

You’ll get an injection (shot) of a local anesthetic to numb the insertion site. Then, your doctor will make a small incision (surgical cut) into the site. They will insert a catheter through the incision and into an artery. They will thread the catheter through the artery until it reaches your hepatic artery. This is the artery that brings blood to your liver.

To make sure the catheter is in the right place, your doctor will do an angiogram (AN-jee-oh-gram). An angiogram is an imaging test that uses X-ray pictures and contrast dye to look at your blood vessels. The X-ray pictures will help your doctor guide the catheter through the artery to your hepatic artery. 

Your doctor will also give you contrast dye through the catheter. The dye will help them see your blood vessels clearly in the X-ray pictures. They will see where the tumors are and see the blood vessels that feed (bring blood to) the tumors.

Once the tumors are found and the catheter is in the right place, your doctor will start the embolization. They will inject tiny particles through the catheter into your hepatic artery. The particles will plug up the artery, which will reduce or stop the blood flow to the tumors. Blocking the blood supply to the tumors will kill them. It will keep them from getting oxygen and nutrients that help them survive and grow.

When the procedure is done, your doctor will take out the catheter. The insertion site will be cleaned and covered with a dressing (bandage).

The procedure takes about 2 to 3 hours.

After your procedure

In the hospital

After your procedure, you’ll be brought to the Post-Anesthesia Care Unit (PACU). While you’re in the PACU, tell your nurse if your dressing feels wet or warm.

Your nurse will monitor (keep track of) your insertion site for any bleeding. You’ll need to lie flat on your back in bed with your leg straight for at least 1 hour. This will help prevent bleeding from the site. Depending on how the site was closed, you may need to lie like this for up to 4 hours.

Once your anesthesia has worn off, you’ll be taken to your hospital room. Most people stay in the hospital for at least 1 night. You’ll be discharged (released) when your doctor says it’s safe for you to go home.

At home

Caring for yourself

• You can shower 24 hours (1 day) after your procedure. Shower with your bandage in place. Gently wash around the insertion site with soap and water. Pat it dry with a clean towel.
  • Change your bandage right after your shower. Place a new bandage (Band Aid®) over the insertion site. Never leave a wet bandage on. A wet bandage can irritate your skin and make it sore.
• Your insertion site must not be submerged (kept under water). Do not swim, sit in a hot tub, or take a bath for 1 week after your procedure.
• Your incision may feel sore. This should get better within 1 or 2 days. You can take over-the-counter pain medicine, such as acetaminophen (Tylenol®) or ibuprofen (Advil®), if you need it.
• Change your bandage right away if it becomes wet or dirty.
• Once a scab forms over your insertion site, you do not need to wear a bandage anymore.

Side effects

After your procedure, you may have:

• A fever of 100.4 °F (38 °C) or higher.
• Pain at the insertion site or abdominal (belly) pain.
• Nausea (feeling like you’re going to throw up).
• Vomiting (throwing up).
• Fatigue (feeling more tired and weak than usual).

You’ll get medicine to manage your symptoms if you need it.

When to call your healthcare provider

Call your healthcare provider if you have:

• A fever of 100.4° F (38° C) or higher.
• Pain, nausea, or vomiting that will not stop or is worse than it was before your procedure.
• Redness, swelling, or bleeding around the insertion site.
• Any symptoms that are worrying you.