Preoperative Embolization of Bone Metastases

Advances in oncological treatments have resulted in increased survival rates, which has led to a rise in bone and spine metastases. Surgical resection is the mainstay for locoregional control of bone metastasis, which is often associated with increased morbidity and mortality due to uncontrolled perioperative bleeding. Current standard-of-care strategies, despite emphasizing preoperative patient assessments and adjunct drugs to control bleeding, face challenges, especially in oncological cases with heightened bleeding risks due to tumor vascularity and different drug usage. Furthermore, efforts to reduce blood loss, including allogeneic blood transfusions, pose increased risks of mortality and infection, impacting patient outcomes. In this context, preoperative transarterial embolization (TAE) emerges as an innovative approach to mitigate intraoperative blood loss during hypervascular tumor metastasectomy. TAE showcases promising outcomes in reducing blood loss, transfusion volumes, and operative duration. This chapter reviews the role of TAE in limiting perioperative bleeding, appropriate multidisciplinary patient selection, and describes techniques, best practices, and outcomes.