Embolization of Spinal Metastases Reduces Peroperative Blood Loss: 21 Patients Operated on for Renal Cell Carcinoma

Olerud, Claes; Jónsson, Halldór; Löfberg, Ann-Marie; Lörelius, Lars‐Erik; Sjöström, Lennart

doi:10.3109/17453679308994517

Cited by 135 publications

(87 citation statements)

References 10 publications

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“…Therefore, preoperative embolization of spinal tumors is recommended to reduce intraoperative bleeding. Several investigators have reported results with preoperative endovascular embolization of hypervascular spinal tumors and clearly showed its benefit in reduction of intraoperative blood loss [3,4,5,6,10]. In a paper by Berkefeld et al, the estimated intraoperative blood loss was 4,350 ml in non-embolized patients and 1,800 ml in patients with particle embolization [1].…”

Section: Discussionmentioning

confidence: 99%

“…The most highly vascularized vertebrae are those with metastases originating from renal cell and thyroid carcinoma [7]. Life-threatening blood losses have been described in cases without preoperative embolization [3,6] Abstract The aim of this study was to evaluate the impact of preoperative devascularization of spinal metastases in relation to the preembolization tumor vascularization degree and in relation to the intraoperative blood loss. Twenty-four patients underwent preoperative transarterial embolization of hypervascular spinal metastases.…”

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confidence: 99%

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Preoperative transarterial embolization of vertebral metastases

et al. 2004

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IntroductionSpinal neoplastic lesions of metastatic origin severely affect patient quality of life. Metastasizing tumors show spinal manifestation in 30-70% of cases [2]. Most common primary tumors of vertebral metastases are localized in the breast, lung, prostate and kidney. Surgical intervention with corporectomy, body replacement and stabilization, although controversial, is still the best treatment option for spinal instability, neurological complications and severe pain that cannot be managed conservatively or by local radiation [8,9]. However these extensive surgical procedures are often complicated by massive intraoperative blood loss. Compared with normal vertebrae, tumorous vertebrae show extensive vascularization. The most highly vascularized vertebrae are those with metastases originating from renal cell and thyroid carcinoma [7]. Life-threatening blood losses have been described in cases without preoperative embolization [3,6] Abstract The aim of this study was to evaluate the impact of preoperative devascularization of spinal metastases in relation to the preembolization tumor vascularization degree and in relation to the intraoperative blood loss. Twenty-four patients underwent preoperative transarterial embolization of hypervascular spinal metastases. Each tumor was assigned a vascularization grade (I-III) according to tumor blush after contrast agent injection in the main feeding artery. Embolization was performed with polyvinyl alcohol particles in all patients. Surgical reports were reviewed in terms of estimated blood loss. A mild hypervascularization was found in three patients (group I), medium in six patients (group II) and extensive in 15 patients (group III). In 22 out of 24 patients embolization could be performed with a complete devascularization. In two patients, only partial embolization could be performed, due to the main feeding artery arising from the artery of Adamkiewicz. In patients with complete devascularization the mean intraoperative blood loss was 1,900 ml, whereas in the two patients who were not embolized it was 5,500 ml. Intraoperative blood loss was not correlated to the vascularization grade. Angiography and embolization could be performed in all patients without causing permanent neurologic deficit, skin or muscle necrosis. The surgeons concluded that radical tumor resection after embolization was facilitated. Intraoperative blood loss is not correlated with the pre-interventional vascularization degree, if complete devascularization can be achieved with embolization. Preoperative embolization of vertebral hypervascular tumors is safe, effective and facilitates tumor resection.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Preoperative transarterial embolization of vertebral metastases

et al. 2004

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“…Pre-operative embolisation of such hypervascular tumours aims to reduce intra-operative blood loss and improves the surgeon's ability to decompress the spinal cord and maximize tumour resection [4][5][6][7][8][9][10][11][12]. Other potential benefits include reducing mass effect, arresting tumour growth, alleviating pain, and shortening hospital stays [3,13].…”

Section: Introductionmentioning

confidence: 99%

Outcome of embolised vascular metastatic renal cell tumours causing spinal cord compression

et al. 2013

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Purpose To present the results of the surgical management of metastatic renal cell tumours of the spine with cord compression who underwent pre-operative embolisation. Methods We conducted a retrospective cohort study of all embolised vascular metastatic renal cell tumours of the spine that underwent urgent surgical intervention over a 7-year period (2005)(2006)(2007)(2008)(2009)(2010)(2011). All medical notes, images and angiography/embolisation details were studied. We recorded the timing (immediate vs. delayed) and grade of embolisation and compared this to the estimated blood loss (EBL); extent of metastatic spinal cord compression (using the Tomita score and Bilsky scores) was also compared to EBL. Finally, neurological (Frankel grade), surgical outcome and complications were reviewed in all patients. Results During the study period, we operated on 25 emergency patients with metastatic renal cell carcinoma causing spinal cord compression who had received preoperative embolisation (mean age 59.6 (24-78) years; 8 females, 17 males). All but one of our patients had hypervascularisation/arterio-venous fistulae on angiography. We were able to achieve greater than 90 % embolisation in the majority (17/25, 68 %) The estimated blood loss was 1,696 (400-5,000) ml; mean operating time was 276 (90-690) min and an average of 2.3 (0-7) units of whole blood was transfused. Nine patients had a posterior only decompression/stabilisation, nine patients had a posterior decompression ± cement augmentation, six had combined anterior/posterior procedures and one had anterior corpectomy/reconstruction alone. There was no statistical difference in the EBL between immediate versus delayed surgery after embolisation or the grade of embolisation. Immediate surgery after embolisation and interestingly less complete embolisation showed a trend towards less EBL. The extent of the tumour as graded by the Bilsky score correlated with increased EBL (p = 0.042). No complications occurred during the embolisation procedure. The surgical complication rate was 32 % (8/25) including two major complications (septicaemia (1) and metal work failure (2)) and five minor complications. Postoperatively, 52 % (13/25) had no change in neurological status, 36 % (9/25) improved by at least one Frankel grade and 12 % (3/25) had neurological deterioration by one Frankel grade. The average survival following surgery was 14.1 (0.5-72) months. Conclusion Blood loss (mean 1,696 ml) and complications (32 %) remain a concern in the operative treatment of vascular metastatic spinal cord compression. Most patients remained the same neurologically or improved by at least 1 grade (22/25, 88 %). Paradoxically, greater embolisation showed a trend to more blood loss which could be due to more extensive surgery in this group, a rebound 'reperfusion' phenomena or even the presence of arterio-venous fistulae. Interestingly, we also found that the extent of the tumour, as graded by the Bilsky score, correlated with increased blood loss suggesting that more extensive...

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“…This helps in decreasing the size of the tumor and reduction in the vascularity of the tumor. The margins between the tumor and the surrounding tissues become better-delineated thus facilitating surgically safe resection and also reduce the operative time thereby decreasing the intra-operative blood loss (26,27) . This is particularly important that high transfusion requirements in patients undergoing tumor resection is complicated by coagulopathy.…”

Section: Discussionmentioning

confidence: 99%