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KEY WORDS: embolization, osseous metastases, hypervascular malignanciesPatients with hypervascular malignancies such as renal cell cancer occasionally develop lytic osseous metastases that are large enough to present a risk of pathologic fracture. In some patients, these lesions first present as pathologic fractures. In either case, surgical curettage of the lesion and stabilization of the bone is required, but surgical procedures in the presence of these extremely hypervascular tumors are associated with severe hemorrhage.We use preoperative percutaneous embolization in these patients to reduce operative blood loss. Arteriography of these lesions will invariably identify an area of hypervascularity corresponding to the tumor (Fig. l), as well as enlarged arterial feeders. Transcatheter embolization of feeding vessels is performed with particulate em- bolic agents such as fragments of absorbable gelatin sponge (Gelfoam Pledgets, Upjohn, Kalamazoo, MI), a temporary agent (Fig. 2), or polyvinyl alcohol foam particles (Ivalon, Contour Emboli, Interventional Therapeutics Corp., South San Francisco, CA), a more permanent agent. Occasionally, stainless steel or platinum coils may be used as well (Fig. 2). Fig. 1. A 64-year-old male with a pathologic fracture of the left midhumerus through a metastasis from renal cell cancer. A digital subtraction arteriogram (DSA) of the left axillary and brachial arteries demonstrates angulation of the humerus (short black arrows) at the fracture site. There is a sharp bend in the brachial artery as a result (long black arrow). The metastasis is a hypervascular mass (white arrows) at the fracture site, supplied primarily by branches of the deep brachial artery, and to a lesser extent by branches of the brachial artery.

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