Figures & data
Table I. Anatomic distribution of metastases and clinical response to embolization
Figure 1. Forty eight-year-old M patient who presented with constant sternal and chest pain, aggravated with movement. He required continuous intravenous narcotics and was developing respiratory depression and somnolence. A) Detail from a contrast-enhanced CT scan of the chest showing the hypervascular metastatic lesion in the manubrium. B) Angiogram performed via the internal mammary arteries (IMA). The metastasis received blood supply from both the right and left IMA. C) Post-embolization angiogram of the right IMA following embolization with 45–150 uM PVA. Microcoils were deployed distally in the IMA to redirect PVA particle flow into the small feeding vessels. The left IMA injection showed a similar elimination of the tumor stain. On the morning following the procedure, the patient had his intravenous narcotics discontinued, was awake and alert, and was able to move without further pain.
Figure 2. This example of a pelvic metastasis (left inferior pubic ramus) was treated with 250–355 micron PVA only. The patient experienced complete resolution of his pain for 9 months. A) Pre-procedure pelvic radiograph with destruction of the left inferior pubic ramus. B) Selective left internal iliac artery angiogram demonstrating the hypervascular renal cell carcinoma metastasis. C) Post-embolization angiogram showing elimination of the hypervascularity in the region of the inferior pubic ramus. D) Follow-up post-embolization pelvic radiograph showing sclerosis of the treated metastasis. This finding is unusual, but has been reported. (19).
Table II. Relationship between size of PVA particles and clinical response to the embolization procedure