Arterial embolization in the management of connective tissue tumours
A 31-year-old man with multiple skeletal metastases from phaeochromocytoma presented with painful pathological fractures of the right humerus and tibia. Radiographic findings are given in .\nThe patient underwent pre-operative SACE (via a left femoral approach) in order to reduce the risk of bleeding at surgery. Pre-embolization angiography revealed highly vascular tumours. Embolization of the humeral tumour was carried out using coils, PVA particles and Gelfoam, leading to immediate reduction in vascular filling of around 30% (). Similarly, embolization of the tibial tumour by Embozene spheres and coils immediately reduced vascular filling by around 60%.\nSACE enabled subsequent uncomplicated open reduction and internal fixation (ORIF) of the humeral fracture (), followed by radical excision of the tibial tumour together with bone grafts and ORIF (). The patient subsequently underwent radiotherapy to both tumours. Hence, SACE facilitated surgery with reduced risk of peri- or post-operative haemorrhage, and SACE itself was uncomplicated. The patient remains alive with good local tumour control at follow up of 10 months.