Post-embolization syndrome

Last revised by jay argue on 8 Jan 2023

Post-embolization syndrome (PES) is one of the most common complications of transarterial embolization and chemoembolisation. The condition comprises a constellation of symptoms including pain, fever, nausea and vomiting. PES usually occurs within the first 72 hours after solid organ embolization such as that of liver lesions (TACE) or uterine fibroids (UFE), symptoms are usually self-limiting and subside over time 1.

PES may be caused by tissue infarction and necrosis, leading to the release of breakdown products, inflammatory mediators, and vasoactive substances from the embolized tissue. Embolization of larger tumors/fibroids/organs may increase the likelihood of PES.

Features may overlap with infection, and clinical judgment is required. Evidence suggests that there may be an associated significant leukocytosis in approximately 20% of patients with PES within the first 24 hours 4. It may therefore become necessary to differentiate PES from sepsis and tumor lysis syndrome, conditions which require alternate management.

Radiographic features

Imaging following embolization may reveal intralesional gas in the early post-procedure period. It is important not to be mistake this for abscess without additional findings 3.

Treatment and prognosis

Treatment is supportive, including the use of analgesia and IV fluids where necessary 1. The condition is usually self-limiting 2. Prophylactic use of antipyretic and antiemetic therapy may be considered prior to embolization of large tumors/ fibroids.

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