Hevascol (Ethiodized Oil)

Hevascol is employed in several specialized imaging and interventional procedures where detailed visualization of vessels or lymphatic channels is required, allowing clinicians to plan diagnostic or therapeutic actions with greater precision.

• Lymphangiography to delineate lymphatic vessels, nodes, and potential leaks for diagnostic evaluation.
• Intra‑arterial angiography for assessment of arterial anatomy, stenosis, aneurysms, and collateral circulation.
• Embolization procedures to occlude abnormal vascular channels or hypervascular tumors, reducing bleeding risk.
• Tumor localization and marking prior to surgery or radiotherapy, facilitating accurate targeting.
• Intralymphatic administration for sentinel‑node mapping, aiding oncologic staging and treatment planning.

• Ethiodized oil consists of an iodinated triglyceride that provides a high concentration of iodine atoms within a lipid carrier. When injected intra‑arterially or intralymphatically, the oil remains in the vascular or lymphatic lumen, and the iodine atoms absorb X‑ray photons, creating a dense radiopaque column. This physical attenuation of X‑ray beams enhances the contrast between the filled structures and surrounding tissues, allowing clear visualization on fluoroscopic and radiographic images.

Adverse reactions to Hevascol are generally related to the iodine content and the oil vehicle; they can range from mild, transient symptoms to rare but serious complications.

Common

• Transient warmth or flushing at the injection site.
• Mild headache or nausea.
• Temporary metallic taste in the mouth.
• Brief urticaria or skin erythema.
• Mild dizziness or light‑headedness.
• Transient increase in heart rate.
• Temporary visual disturbances such as blurred vision.

Serious

• Severe allergic or anaphylactoid reaction, including bronchospasm and hypotension.
• Pulmonary embolism from oil droplets.
• Acute renal impairment in susceptible patients.
• Persistent pain or inflammation at the injection site.
• Cardiac arrhythmias related to iodine load.
• Severe vasospasm of the treated vessel.

When using Hevascol, clinicians should evaluate patient history and clinical status to minimize the risk of adverse events and ensure optimal imaging outcomes.

• Assess for known iodine allergy or prior contrast reactions before administration.
• Review renal function, especially in patients with pre‑existing impairment.
• Use the lowest effective volume to achieve adequate radiographic opacification.
• Monitor vital signs and for signs of hypersensitivity during and after injection.
• Avoid use in pregnant or breastfeeding women unless the benefit outweighs potential risk.
• Ensure proper catheter placement to prevent extravasation or non‑target embolization.
• Provide resuscitation equipment and medications for anaphylaxis on hand.

Hevascol may interact with other agents that affect iodine handling, renal function, or coagulation; awareness of these interactions helps prevent complications.

Avoid

• Concurrent use of other iodinated contrast media within a short interval, which can increase cumulative iodine load.
• High‑dose iodine supplements or medications containing iodine, which may exacerbate allergic potential.

Use with caution

• Nephrotoxic drugs such as aminoglycosides, NSAIDs, or radiographic contrast agents, requiring close monitoring of kidney function.
• Anticoagulants or antiplatelet agents, as embolization may increase bleeding risk.
• Beta‑blockers, which can mask signs of anaphylaxis.
• Thyroid‑affecting drugs (e.g., levothyroxine, antithyroid agents) because excess iodine may alter thyroid hormone synthesis.