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Category: Volume 05 Issue 09 September 2017
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Title: Is Pre-Operative Angio-Embolisation an Effective Modality to Control Intraoperative Blood Loss in Extremity Bone Tumors?

Authors: Vineet Aggarwal, Rajeev Bhardwaj, Ravi Kant Thakur

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i9.36

Abstract

Introduction: Bone tumors of the extremity and metastatic lesions of the long bones are hypervascular lesions. Limb salvage is besieged with a number of complications and the earliest to occur is inadvertent and unexpected blood loss during surgery. Pre-operative angio-embolization has been offered as a rescue treatment to prevent or minimize blood loss during surgery. The benefits of this technique are in the form of reduced blood losses, less need for autologous transfusions, better surgical resections and improved patient survival.

Material and Methods: A prospective study was undertaken wherein 12 patients who had pre-operative embolization for an extremity tumor were subsequently operated upon. The intra operative blood loss was calculated as per established protocols in literature.

The factors taken into consideration were tumor volumes, efficacy of the embolization procedure, duration of surgery and intra-operative blood losses. Each variable was independently calculated against the actual blood loss. Statistical analysis of the data was performed to calculate the significance of individual variables by calculating the p values.

Results: Out of 12 cases, 6 patients underwent wide resection, 4 patients underwent margical resection and 2 patients had intra-lesional resection.

In all cases, pre-operative embolization led to significant decrease in actual blood losses as compared to estimated losses. The blood loss was higher when the tumor volumes exceeded 400cm3 and the duration of surgery exceeded 270 minutes.

In 50% cases, the duration of surgery was >270 min and the actual losses were 1174+_ 492 ml. Actual losses were 556+_171ml for surgeries lasting 270 min. The statistical correlation for this observation was significant (p value 0.003).

Discussion: Pre-operative angio-embolization where the vascular tumor bed is occluded with the help of embolic agents has come to be recognized as an effective method to achieve this goal. Though other factors like tumor volume, duration and complexity of the surgical exercise and degree of devasculaization achieved also contribute to the overall blood loss, embolization is helpful in decreasing iintra-operative blood loss.

Keywords- bone tumors, angioembolization, intra-operative blood loss.

 

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Corresponding Author

Vineet Aggarwal

Professor, Department of Orthopaedics

Indira Gandhi Medical College, Shimla

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