Single Point of Care Embolization, Ablation, and Stabilization of Unstable Pelvic Metastatic Disease

Anthony Brown, MD, and Daniel M. Lerman, MD A 56-year-old man presented with intractable pain and inability to ambulate. Computed tomography showed an osteolytic renal cell carcinoma metastasis in the left ilium causing instability (Fig 1).

Anthony Brown, MD, and Daniel M. Lerman, MD

A 56-year-old man presented with intractable pain and inability to ambulate. Computed tomography showed an osteolytic renal cell carcinoma metastasis in the left ilium causing instability (Fig 1). Following a multidisciplinary discussion, percutaneous embolization, ablation, and pelvic stabilization were planned subsequent to radiation of the tumor. Triple therapy was necessary as nonembolized vascular renal cell carcinoma metastases may cause heat sink, incomplete ablation, and tumor progression, resulting in the failure of hardware. Institutional review board approval was waived for this case report.

The procedure was performed in a hybrid operating room under general anesthesia. Transradial access was obtained, and embolization was performed via the internal iliac, deep circumﬂex iliac, and femoral circumﬂex arteries (Fig 2a, b). The patient was placed in the right decubitus position, and cone-beam computed tomography was performed. Augmented ﬂuoroscopy guidance was used for the following:(a) overlapping microwave ablation, and (b) cannulated screws and polymethyl methacrylate stabilization (Fig 3). Microwave ablation was favored for a large ablation zone, shorter ablation time, and resistance to heat sink. Fourteen ablations were required to cover the tumor volume. The hemipelvis was then reconstructed with ﬁve 7.3-mm cannulated screws (Fig 4). Balloon cavity creation and polymethyl methacrylate augmentation were performed to secure the screw landing zones and to reinforce the supra-acetabular region (Fig 5). The ﬁnal images showed near-anatomic restoration of the pelvis (Fig 6). The total cement volume approximated 115 mL, with ﬂuoroscopy time of 104 minutes and air kerma of 1.45 Gy. After the procedure, the patient was able to bear weight and ambulate a short distance with an assist device on day 1. By day 14 after the procedure, he was able to ambulate 1 block without assistance.

Single Point of Care Embolization, Ablation, and Stabilization of Unstable Pelvic Metastatic Disease 1

Single Point of Care Embolization, Ablation, and Stabilization of Unstable Pelvic Metastatic Disease 2

Single Point of Care Embolization, Ablation, and Stabilization of Unstable Pelvic Metastatic Disease 3

Single Point of Care Embolization, Ablation, and Stabilization of Unstable Pelvic Metastatic Disease 4

Single Point of Care Embolization, Ablation, and Stabilization of Unstable Pelvic Metastatic Disease 5

Single Point of Care Embolization, Ablation, and Stabilization of Unstable Pelvic Metastatic Disease 6

ACKNOWLEDGMENTS

The authors acknowledge Lisa Lewis, RT, and Aya Rebet, MSc.

AUTHOR INFORMATION

From Radiology Imaging Associates Endovascular (A.B.), Denver, Colorado; and Colorado Limb Consultants (D.M.L.), Presbyterian Saint Luke’s Medical Center, Denver, Colorado. Received July 1, 2021; final revision received August 26, 2021; accepted September 12, 2021. Address correspondence to A.B., Radiology Imaging Associates Endovascular, 8200 E Belleview ave #600e, Greenwood Village, CO 80111; Email: anthony.brown@riaco.com

(https://www.jvir.org/article/S1051-0443(21)01385-3/fulltext)