What is Hepatic Artery Radioembolization

Hepatic artery radioembolization is a combination of radiation therapy and a procedure to block blood supply to a tumor in the liver (embolization). It delivers tiny glass or resin beads (microspheres) into the blood vessel (hepatic artery) that supplies blood to the tumor.

The microspheres lodge at the tumor site and deliver a high dose of radiation to the tumor but not to healthy tissue. The goal of this procedure is to slow or stop the growth of a cancerous tumor. You may need radioembolization if you have liver cancer or another type of cancer that has spread to the liver.

After this procedure, the microspheres will release radiation into the tumor for about 2 weeks. Radiation will be completely gone after 30 days. If your tumor continues to grow or it returns after treatment, the procedure can be repeated.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines or dyes.
• Blood clots.
• Stomach ulcer (if some microspheres travel to the stomach).

There is also a risk of damage to other structures or organs, such as:

• The affected blood vessel.
• Healthy cells that are close to the radioembolization site.
• The liver.

What happens before the procedure?

Medicines

Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• You may have blood tests.
• You may have a urine sample taken.
• You will have an X-ray of the blood vessels in your liver (angiogram).
• Ask your health care provider how your surgical site will be marked or identified.
• To reduce your risk of infection:
  • You may be given antibiotic medicine to help prevent infection.
  • You may be asked to shower with a germ-killing soap.
• Plan to have someone take you home from the hospital or clinic.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb your groin area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
• A needle will be inserted into a large blood vessel in your groin (femoral artery).
• A thin tube (catheter) will be passed through the needle and into your femoral artery. The catheter will be guided to the hepatic artery.
• Dye will be injected through the IV tube, and X-rays will be taken (fluoroscopy). This helps to show the exact location of the blood vessels that supply your tumor. Your surgeon will use the X-rays as a guide during the procedure.
• Microspheres will be injected through the catheter into the parts of the hepatic artery that supply the tumor.
• More X-rays will be taken to make sure the blood supply to the tumor has been blocked as planned.
• The catheter will be removed, and pressure will be applied to the area to stop any bleeding.
• A bandage (dressing) will be applied.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
• You may continue to receive fluids and medicines through an IV tube.
• You may have pain, nausea, vomiting, or a fever. These symptoms are called post-embolization syndrome. You may be given medicine to help relieve these symptoms.
• You will need to stay lying down for 6–8 hours.
• You may need to avoid contact with people during your hospital stay. You may also need to avoid contact for a certain amount of time after you leave the hospital. Ask your health care provider if this applies to you.
• Do not drive for 24 hours if you were given a sedative.

Hepatic Artery Radioembolization, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• A slight fever for 1–2 weeks. If your fever gets worse, tell your health care provider.
• Fatigue.
• Loss of appetite. This should gradually improve after about 1 week.
• Abdominal pain on your right side.
• Soreness and tenderness in your groin area where the needle and catheter were placed (puncture site).

Follow these instructions at home:

Puncture site care

• Follow instructions from your health care provider about how to take care of the puncture site. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your puncture site every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Activity

• Rest and return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not drive for 24 hours after the procedure if you were given a medicine to help you relax (sedative).
• Do not lift anything that is heavier than 10 lb (4.5 kg) until your health care provider says that it is safe.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive or use heavy machinery while taking prescription pain medicine.

Radiation precautions

• For up to a week after your procedure, there will be a small amount of radioactivity near your liver. This is not especially dangerous to other people. However, you should follow these precautions for 7 days:
  • Do not come in close contact with people.
  • Do not sleep in the same bed as someone else.
  • Do not hold children or babies.
  • Do not have contact with pregnant women.

General instructions

• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine clear or pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Eat frequent small meals until your appetite returns. Follow instructions from your health care provider about eating or drinking restrictions.
• Do not take baths, swim, or use a hot tub until your health care provider approves. You may take showers. Wash your puncture site with mild soap and water and pat the area dry.
• Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
• Keep all follow-up visits as told by your health care provider. This is important. You may need to have blood tests and imaging tests done.

Contact a health care provider if:

• You have more redness, swelling, or pain around your puncture site.
• You have more fluid or blood coming from your puncture site.
• Your puncture site feels warm to the touch.
• You have pus or a bad smell coming from your puncture site.
• You have pain that:
  • Gets worse.
  • Does not get better with medicine.
  • Feels like very bad heartburn.
  • Is in the middle of your abdomen, above your belly button.
• Your skin and the white parts of your eyes turn yellow (jaundice).
• The color of your urine changes to dark brown.
• The color of your stool changes to light yellow.
• Your abdominal measurement (girth) increases in a short period of time.
• You gain more than 5 lb (2.3 kg) in a short period of time.

Get help right away if:

• You have a fever that lasts longer than 2 weeks or is higher than what your health care provider told you to expect.
• You develop any of the following in your legs:
  • Pain.
  • Swelling.
  • Skin that is cold or pale or turns blue.
• You have chest pain.
• You have blood in your vomit, saliva, or stool.
• You have trouble breathing.