Post-embolization syndrome

Post-embolisation syndrome (PES) is one of the most common complications of transarterial embolisation and chemoembolisation. The condition comprises of 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 symptoms are usually self limiting and subside after 72 hours over time¹.

It is postulated that PES is caused by tissue infarction and necrosis, leading to the release of breakdown products, inflammatory mediators, and vasoactive substances from the embolised tissue. Embolisation of larger tumours/fibroids/organs may increase the likelihood of PES.

Features may overlap with infection, and clinical judgement 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

Imaing following embolisation may reveal intralesional gas in the early post procedure period. It is important not to be mistake this for abscess without additional findings³.

Treatment and prognosis

Treatment is supportive, including the use of analgesia and IV fluids where necessary¹. The condition is usually self-limiting². Prophylactic use of antipyretic and antiemetic therapy may be considered prior to embolisation of large tumours/ fibroids.