What is an embolization procedure and why is it performed

According to a statement released Monday afternoon by the White House, First Lady Melania Trump underwent an embolization procedure to treat a “benign kidney condition”. The White House said the “procedure was successful and there were no complications.” Mrs. Trump is expected to remain in the hospital for the duration of the week to recover.

Based on reports and years of clinical experience, Dr. Gautam Jayram, MD, a kidney surgeon with TriStar Centennial Medical Center specializing in benign and malignant disorders of the kidneys,  further explains “embolization”, which saw a 145,000 percent increase in searches on Merriam-Webster, and what this procedure might mean for the First Lady.

What does “benign kidney condition” mean to you?

A benign kidney condition is a medical or surgical kidney issue which is not cancerous and does not carry the risk of spreading to other organs like cancer does.  The most common benign kidney issue in women is what’s called an angiomyolipoma.   These tumors are composed of fat, blood vessels and connective tissue. It is completely benign and carries no risk of cancer.  However, these tumors can cause local problems. It can cause damage by replacing part of the kidney; also, the tumor can burst or start to bleed either within or outside of the kidney. For those reasons, this abnormal growth should be monitored and at times treated.

What type of symptoms might someone be experiencing with this condition?

Most of the time, this condition is asymptomatic and this condition is picked up on an X-ray done for an unrelated symptom, something we call an incidental finding.  For example, if a patient has GI upset or lower back pain, a CT scan may be ordered that shows the abnormal growth on the kidney.

However, in larger tumors, these can be associated with:

• flank (side) pain,
• blood in the urine, or
• swelling or bruising of the abdominal wall.

What is an embolization procedure?

It’s a procedure where the blood supply to the abnormal growth is “shut off” or blocked. An interventional radiologist would perform the procedure in consult with a urologist.  The procedure involves going in through the big veins in your thigh, placing a wire into the kidney and isolating the blood vessel that’s feeding this abnormal growth. Then these specific blood vessels are basically “corked” – plugging it with one of various materials like foam, gel, or metal coils. There are various ways to perform the procedure, depending on what the radiologist chooses to use.

What is the purpose of embolization?

The purpose is to make the tumor stop growing. The “plug” sometimes causes it to shrink and, many times, it will stop growing and not pose any further risks to the patient.

Can embolization procedures occur on other parts of the body?

Yes, you can have embolization procedures performed on organs such as the liver, brain, or bladder – essentially any blood vessel in your body can be corked. Although, the repercussion is that may be less blood flow to those organs after the procedure, so we would need some sort of major indication to perform it.

After the embolization procedure, is the organ going to function as it should?

The nice thing about the kidney is that it has an arcade of blood vessels. What most likely happened with Mrs. Trump was a selective embolization, meaning, only the part of the kidney that had the abnormal growth was embolized. Her caregivers were likely able to find a third, fourth, or fifth level branch that just served the growth and that’s the only thing that was embolized. Hopefully, the remainder of her kidney will continue to function normally.

Do you believe this embolization procedure was planned or emergent?

Based on the information that we have, it likely was, what I would call, a semi-planned procedure. Her physicians probably performed a scan, found this, and then somewhat quickly – not necessarily emergently, said, “Ok, we’re going to schedule you for this in the next couple of days to get this taken care of.” It would only be an emergency procedure if we knew she had some sort significant bleeding or sudden pain that she could not tolerate.  More likely they were doing this to prevent these issues from happening in the future.  Less likely is the chance she had an acute accident or trauma that led her kidney to start bleeding or an aneurysm to develop which posed a threat of bleeding. In this case, it would be more of an emergent procedure.

I have many patients with angiomyolipomas of the kidney and I choose simply to watch them in many instances.  If small, these tumors pose very small risk and an embolization procedure or surgical removal may carry more significant side effects.

What does post-procedure look like?

After the procedure, they will likely monitor her blood pressure, blood count and kidney function.  Almost everyone has a full recovery within a week or two. However, her care team will need to follow up and make sure that the lesion or growth is responding. They will probably do some follow up x-rays, once or twice a year to make sure it’s not growing.

What’s the recovery time?

It’s usually an outpatient or an overnight stay after the procedure. In experienced hands, there’s typically not much that can go wrong. Sometimes there can be issues with the puncture site through the thigh or some bleeding and swelling in that area that needs to be watched. Or, sometimes after you stop the blood supply to a part of the kidney, a patient can get a flu-like reaction called post-embolization syndrome. That reaction can require monitoring with symptoms like fever, nausea and a bit of fatigue. Alternatively, sometimes these benign growths of the kidney are associated with syndromes that have other dangerous manifestations if not detected.  To be safe, many of these patients have their head and chest scanned as well to make sure there aren’t any other related lesions that could harm them. That could be another explanation as to why Mrs. Trump will remain in the hospital a few more days.

What are other treatment options for benign kidney growths?

Many patients simply will be observed for this condition. There also are plenty of patients with small lesions that are not recommended to have any treatment because it won’t affect them. Patients can have the tumors embolized with a small procedure like Mrs. Trump or they may have the tumors surgically removed, which is called a partial nephrectomy. In this surgery, the patient will have the lesion removed and then the area where it was located in the kidney will be closed up, preserving the majority of the kidney. We can do those laparoscopically with small incisions and achieve a nice outcome.  It’s a little more invasive than embolization but is usually more successful for larger growths.

Dr. Gautam Jayram is a urologic oncologist affiliated with TriStar Centennial Medical Center, a member of the HCA Healthcare hospital system.