SIR 2024
Embolization
Andrew Ahn, AB
Medical Student
Hospital of the University of Pennsylvania
Financial relationships: Full list of relationships is listed on the CME information page.
Mandeep Dagli, MD
Associate Professor of Radiology
Hospital of the University of Pennsylvania
Disclosure information not submitted.
William Stavropoulos, MD, FSIR
Professor of Radiology
University of Pennsylvania
Disclosure information not submitted.
Shilpa Reddy, MD
Assistant Professor of Clinical Radiology
Hospital of the University of Pennsylvania
Disclosure information not submitted.
Tamim Khaddash, MD
Assistant Professor of Clinical Radiology
University of Pennsylvania
Disclosure information not submitted.
Terence P. Gade, MD PhD
Assistant Professor of Radiology
Penn Image-Guided Interventions (PIGI) Lab, Hospital of the University of Pennsylvania
Disclosure information not submitted.
Daniel M. DePietro, MD
Assistant Professor
Perelman School of Medicine at the University of Pennsylvania
Financial relationships: Full list of relationships is listed on the CME information page.
1) Discuss the utility of pre-operative embolization of osseous metastatic lesions prior to orthopedic surgical procedures
2) Review the relevant anatomy, surgical and interventional techniques, and available literature regarding common treatment sites, including the humerus, acetabulum, and femur
3) Provide an image-rich case-based review of pre-operative embolization of humeral, acetabular, and femoral osseous metastatic lesions
Background:
Multiple retrospective studies have been conducted to analyze the use and utility of preoperative embolization. With respect to orthopedic oncology, much of that work has been centered around peri-operative bleeding rates {1-12}. Although there have been several studies published in the space, there is no clear consensus on outcomes {1-12}. Some studies tout a resultant decrease in intra- and post-op bleeding rates, while others dispute this {5, 6, 8, 9, 10, 11}. The purpose of this exhibit is to summarize current literature and review common interventional radiology techniques/targets in order to guide clinical management.
Clinical Findings/Procedure Details:
This educational exhibit will include: 1) A critical appraisal of the literature regarding pre-operative embolization of osseous metastases prior to orthopedic surgical procedures, with an emphasis on outcomes as they relate to intra-operative blood loss, transfusion requirements, and morbidity/mortality 2) Graphical illustration and description of the types of lesions and common orthopedic procedures for which IRs are often asked to perform pre-operative embolization 3) Diagrams reviewing the relevant anatomy and arterial blood supply of commonly treated sites (humerus, acetabulum, femur), and 4) Multiple case examples highlighting the relevant anatomy and procedural techniques used in pre-operative embolization of humeral, acetabular, and femoral lesions.
Conclusion and/or Teaching Points:
While additional research is needed to determine the efficacy of pre-operative embolization prior to orthopedic oncologic cases, many studies demonstrate reduced intra-operative blood loss and decreased need for transfusion. IR can play an important role in the treatment of these patients. After reviewing this exhibit, IRs will have improved knowledge of the relevant literature, arterial anatomy, and technical considerations, facilitating the effective incorporation of pre-operative embolization of osseous metastatic lesions into their practice.