title: Interventional management of hypervascular osseous metastasis: role of embolotherapy before orthopedic tumor resection and bone stabilization.
abstract: 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.
  
  
  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 calculated to be 1,119 mL, whereas in patients with partial embolization (grades 2 and 3) EBL was 1,788 mL and 2,500 mL. With respect to intraoperative EBL, no significant difference between devascularization grades was found (p > 0.05). Moderate correlation (r = 0.51, p = 0.019) was observed between intraoperative EBL and tumor size before embolization. Only low correlation (r = 0.44, p = 0.046) was found between intraoperative EBL and operating time. Major complications included transient palsy of the sciatic nerve and gluteal abscess in one patient.
  
  
  CONCLUSIONS
  The results of this study support the concept that there is no statistically significant difference among amounts of intraoperative EBL with varying degrees of embolization.
authors.affiliation: Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Berne, Freiburgstrasse 20, CH-3010 Berne, Switzerland. ralph.kickuth@insel.ch
authors.forename: Ralph
authors.initials: R
authors.lastname: Kickuth
authors.forename: Christian
authors.initials: C
authors.lastname: Waldherr
authors.forename: Hanno
authors.initials: H
authors.lastname: Hoppe
authors.forename: Harald M
authors.initials: HM
authors.lastname: Bonel
authors.forename: Karin
authors.initials: K
authors.lastname: Ludwig
authors.forename: Martin
authors.initials: M
authors.lastname: Beck
authors.forename: Jürgen
authors.initials: J
authors.lastname: Triller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000098:blood supply / Q000556:secondary* / Q000628:therapy*; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005260:Female; D005592:Fracture Fixation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000628:therapy*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome