Preoperative Embolization of Renal cell Carcinoma Femoral Mets with Pathological Fracture: Case Series

Background: Renal cell carcinoma (RCC) accounts for 3% of all cancers, with peak incidence between 60 and 70 years of age. RCC is very aggressive tumour and almost 20-30% of patients have metastatic disease at time of presentation. Most common metastasis in RCC occurs to lung, followed by bone, lymph nodes, liver, adrenal gland and brain. Skeletal metastasis may present with pain, impending fractures, nerve compressions, hyperkalemia and even pathological fracture which may require surgical interventions. As RCC is normally a hypervascular tumor, seen in 65%–75% of patients that bleed profusely even after a simple biopsy. We present here two cases of Renal cell carcinoma metastasized to femur with pathological fracturs and were pre-operatively embolized and then underwent operation fixation with minimal blood loss. Method(s): Angiography and embolization was done using state of art, digital substraction angiography unit (Siemens artis zee floor mounted), under local anesthesia by a single interventional radiologist with experience of more than 10 years. Transfemoral route was used in both cases. Access was gained through 5-6 Fr cathether and combination of gelfoam particles and tornado coils were used for embolization. No immediate post operative complications observed. Result(s): At our institution, embolization of femoral metastasis showed high technical success and reduced intraoperative blood loss. Conclusion(s): At our institution, embolization of femoral metastasis showed high technical success and reduced intraoperative blood loss, in keeping with published series from across the world. Preoperative embolization of hypervascular tumour /metastases should be considered to decrease intraoperative blood loss.

 

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Publication History

Article published online:
11 May 2021