 
<b>Embolization requires snaking a catheter [a long narrow tube] into the arteries feeding a tumor, and then injecting particles into that artery.  The particles clog up the arteries, and clots form.  This robs the tumor of its blood supply, so it dies. </b> Embolization could also be used to cut  off possible areas of bleeding if used preoperatively in hypervascular tumors.  Operating on very vascular tumors usually means there is heavy bleeding. So embolization can either directly attack a tumor so that it dies back, and stops eroding bone, or it can be used to decrease blood flow to the area, allowing cleaner removal of tumor with less blood loss.

''The technique of selective embolization has been in use for years in the treatment of vascular anomalies, severe hemorrhage and benign or malignant tumors, notably renal cell cancer vertebral metastases. Because this technique is relatively easy to perform and can offer immediate relief of symptoms, it is an attractive option for patients with hypervascular vertebral metastases with signs of spinal cord compression. Selective catheterization of the arteries feeding the metastases is performed, followed by infusion of polyvinyl alcohol particles.  Embolization results in rapid resolution of neurological symptoms, sometimes within hours. The therapeutic effect lasts from months to years. Embolization of hypervascular vertebral metastases is a palliative therapeutic option that may offer rapid relief of symptoms.''[44]

Embolization can also stop tumors from bleeding spontaneously.  "Embolization therapy is reported in three patients bleeding from metastatic carcinoma of the breast. Two had life threatening hemorrhage from sternal erosion;.... The third patient had intermittent bleeding of extensive fungating axillary and anterior chest wall metastases. Autologous clot alone was used in the first case with immediate cessation of bleeding and transient neurological symptoms secondary to back flow of thrombus into the vertebral artery were noted. The second and third patients received Oxycel-Ivalon and Gel-foam respectively; bleeding ceased and no complications were noted." [15]

Embolization alone can often reduce metastatic spinal cord compression, so surgical decompression is either not necessary or can be postponed. [7,11, 12]  

Massive perioperative hemorrhage is often associated with surgery for vertebral metastases. Preoperative embolization reduces operative blood loss so that  hypervascular tumors may be removed safely after embolization.  The resulting devascularization allows for an aggressive resection of pathologic tissue [4,5,6,8,18,57,72,87] 

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