Preoperative embolization in spinal and pelvic metastases.

OBJECTIVE. The purpose of this study was to evaluate, in relation to intraoperative estimated blood loss (EBL), the effectiveness of preoperative transcatheter arterial embolization of hypervascular osseous metastatic lesions before orthopedic resection and stabilization.MATERIALS AND METHODS. Between June 1987 and November 2007, 22 patients underwent transcatheter arterial embolization of tumors of the long bone, hip, or vertebrae before resection and stabilization. Osseous metastatic lesions from renal cell carcinoma, malignant melanoma, leiomyosarcoma, and prostate cancer were embolized. All patients were treated with a coaxial catheter technique with polyvinyl alcohol (PVA) particles alone or a combination of PVA particles and coils. After embolization, each tumor was angiographically graded according to devascularization (grades 1–3) based on tumor blush after contrast injection into the main tumor-feeding arteries.RESULTS. In patients with complete devascularization (grade 1), mean EBL was calculate...

Interventional Management of Hypervascular Osseous Metastasis: Role of Embolotherapy Before Orthopedic Tumor Resection and Bone Stabilization

Background: Pancreatic injury is a dangerous complication in multiple injury, and experience with its diagnosis and treatment is usually limited. Method: Retrospe

Pancreatic Injury in Severe Trauma: Early Diagnosis and Therapy Improve the Outcome

Transarterial embolization of primary and secondary tumors of the skeletal system.

Surgery of long bone metastases is associated with a significant risk of perioperative blood loss, which may necessitate blood transfusion. Successful embolization (> 70% obliteration of vascularit...

/pdf/preoperative-embolization-in-surgical-treatment-of-long-bone-1kdms3ad1l.pdf

Preoperative embolization in surgical treatment of long bone metastasis: a systematic literature review

Purpose Arterioportal and arteriovenous fistulas (APF, AVF) are rare vascular disorders occurring as a result of congenital vascular malformation, trauma, iatrogenic causes or neoplasms. The clinical spectrum of presentation ranges from symptom-free individuals to patients with severe portal hypertension or congestive heart failure. While the majority of patients have been treated surgically in the past, interventional radiological procedures are being performed with increasing frequency. To prove this trend we reviewed the international literature. Review We reviewed the clinical presentation and management of 79 cases reported between 1980 and 1996 in the literature and six own patients. Results Review of the literature and our own six cases show that these fistulas can be divided in intrahepatic (n = 49, 75%) and extrahepatic fistulas (n = 20, 25%). The most important causes are trauma (n = 29, 37%), iatrogenic induced by procedures (n = 21, 27%) and congenital vascular malformations (n = 10, 13%). APFs and AVFs can be diagnosed by ultrasound, computed tomography and magnetic resonance imaging. Angiography confirms the diagnosis and in many cases allows definitive interventional radiologic treatment. Conclusion Management of AVFs and APFs remains a challenge. However, interventional radiologic procedures provide a safe, low-cost, and effective method for treatment. Due to these facts in the last three years we notice an increasing part of interventional procedures for treatment.

[Abdominal arteriovenous and arterio-portal fistulas: etiology, diagnosis, therapeutic possibilities].

Eighteen patients (11 renal tumours, 3 bronchogenic carcinomas, 4 others) with 24 different bone metastases were embolized for preoperative devascularization (11 x) or for intractable pain (7 x). Metastases were localized in the spine (17 x), pelvis (5 x), and shoulder girdle (2 x). All metastases were hypervascularized. Post-embolization showed no complications. Intraoperative blood loss was minimized to 2100 ml (600 ml-4200 ml). Pain relief was achieved in 6 out of 7 patients. Eight of 18 patients died as a result of underlying diseases (follow-up 7 months).

Embolization of bone metastases

Forty-two patients with locally advanced breast cancer (n = 8) or recurrent breast cancer (n = 34) received regional chemotherapy (mitoxantrone 25 mg/m2 per 24 h) via the internal mammary artery or other vessels of the subclavian artery. To prevent artery thrombosis 500-1000 U heparin per hour were administered i.v. Tumour perfusion was monitored by intra-arterial angio-CT. Remission rates (CR + PR) were 100% (primary breast cancer) and 89% (recurrent tumours), respectively. Intra-arterial chemotherapy was well tolerated. No complications were noted.

[Superselective intra-arterial chemotherapy in breast cancer].

[Side effects and complications of intra-arterial tumor therapy--experiences with 577 interventions].

Spinal cord ischemia complicating hepatic artery chemoembolization in a patient with prior hemihepatectomy

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