Preoperative Arterial Embolization of Musculoskeletal Tumors: A Tertiary Center Experience

SIMPLE SUMMARY: Musculoskeletal tumors often require surgical treatment, which can result in substantial peri-operative blood loss. Preoperative transarterial embolization (TAE) is used to reduce peri-operative blood loss during the surgery of musculoskeletal tumors but there is no consensus about the actual place of TAE in the musculoskeletal tumor therapeutic algorithm, and there is no firm recommendation about its best technical approach. The purpose of this study was to report our experience in preoperative TAE of musculoskeletal tumors regarding the effectiveness of preoperative TAE in terms of blood loss and functional outcomes. For 31 patients, we found that TAE led to complete (58%) or near-complete (42%) tumor devascularization, allowing bloodless surgery in 71% of patients and moderate transfusion needs for the remaining 29%. A total of 27% of patients had complete improvement of the initial symptoms at the end of the follow-up, 15 (50%) with partially satisfying improvement, 4 (13%) with partially unsatisfying improvement and 3 (10%) with no improvement. ABSTRACT: The purpose of this study was to report the effectiveness of preoperative transcatheter arterial embolization (TAE) of musculoskeletal tumors in terms of blood loss and functional outcomes. Patients who underwent preoperative TAE of hypervascular musculoskeletal tumors between January 2018 and December 2021 were retrospectively included. The patients’ characteristics, TAE procedure details, degree of post-TAE devascularization, surgical outcomes in terms of red blood cell transfusion and functional results were collected. The degree of devascularization was compared between patients who had peri-operative transfusion and those who did not. Thirty-one patients were included. The 31 TAE procedures led to complete (58%) or near-complete (42%) tumor devascularization. Twenty-two patients (71%) had no blood transfusion during surgery. Nine patients (29%) had a blood transfusion, with a median number of red blood cell packs of three (q1, 2; q3, 4; range: 1–4). Eight patients (27%) had complete improvement of the initial musculoskeletal symptoms at the end of the follow-up, 15 (50%) had partially satisfying improvement, 4 (13%) had partially unsatisfying improvement and 3 (10%) had no improvement. Our study suggests that preoperative TAE of hypervascular musculoskeletal tumors allowed for bloodless surgery in 71% of patients and minimal transfusion needs for the remaining 29%.