Embolization for Sacral Tumors View Full Text


Ontology type: schema:Chapter     


Chapter Info

DATE

2017-05-31

AUTHORS

Andreas F. Mavrogenis , Vasilios Igoumenou , Andrea Angelini , Giuseppe Rossi , Pietro Ruggieri

ABSTRACT

Arterial embolization for tumors was first described in 1975 [1, 2]. Since then, embolization for sacral tumors either primary or metastatic has been used extensively as a useful primary, palliative, or adjuvant therapy [3–6]. Preoperative embolization of hypervascular metastatic lesions reduces intraoperative blood loss and improves the surgeon’s ability for resection. Additionally, embolization may cause tumor growth arrest, pain alleviation, and shorter hospital stay [4–6]. The timing of preoperative embolization is important. Typically, best results are achieved when surgery is performed within 24–48 h after embolization [7, 8]. Serial embolization is safe and feasible; it can be performed in patients with persistent pain and/or imaging evidence of progressive disease. Serial embolization has been related with high rates of successful pain relief, tumor devascularization, tumor size reduction, and calcification of margins [9–11]. Serial embolization is typically performed in 4–6-week intervals until symptomatic improvement occurs, or the tumor’s pathological vascularity disappears. Unless there is a clear indication for general anesthesia, most procedures are performed under light conscious sedation. The optimal arterial approach is determined based on lesion location; most often is the common femoral artery using a Seldinger technique. Commonly, an arterial catheter is placed and standard 4 French or 5 French angiographic catheters are used for main arterial selection, and a 3 French microcatheter for subselectivity. A diagnostic angiography is performed from a major vessel, more commonly the aorta to delineate vascular supply to the tumor and to identify vessels of potential concern that may result in nontarget embolization. In general, microspheres of 100–700 μm are used because of their ease of delivery, range of available sizes, and lower potential for recanalization. Sponge gel, once the embolic agent of choice, has now fallen in disuse, because of its temporary nature and propensity for recanalization. Coils are avoided as an embolic agent for tumor vessels, because re-treatment may be necessary and blocking access sites should be avoided. Completion of the procedure is determined by complete occlusion of the tumor blush compared with the initial diagnostic angiography [12]. Complication rate is generally low [13]; reported complications include post-embolization syndrome (fever, pain, malaise), nerve palsy, subcutaneous or muscle necrosis, ischemic pain (usually transitory), infection, and tumor bleeding [14]. More... »

PAGES

341-351

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/978-3-319-51202-0_25

DOI

http://dx.doi.org/10.1007/978-3-319-51202-0_25

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1085719470


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230 schema:name Department of Orthopaedics and Orthopedic Oncology, University of Padova, Via N. Giustiniani, 3, 35128, Padova, Italy
231 rdf:type schema:Organization
 




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