Preoperative Embolization of Bone Tumours

Quick answer

Preoperative embolization of hypervascular bone tumours is performed 24 to 72 hours before surgical resection to reduce intraoperative bleeding. It makes the surgeon's task easier and lowers the risk of transfusion.

What is preoperative embolization of bone tumours?

Preoperative embolization of bone tumours is performed 24 to 72 hours before surgical resection of a hypervascular bone tumour (bone metastasis, giant cell tumour, vertebral haemangioma, etc.) to reduce intraoperative bleeding and make surgical resection easier.

By reducing tumour hypervascularisation before surgery, embolization can decrease intraoperative blood loss by 50 to 70%, reduce transfusions and improve visibility of the operative field. It is also performed with palliative intent to relieve bone pain in inoperable metastases.

Our team is part of the work of the Paris CARPEM Cancer Institute (AP-HP.Centre, Université Paris Cité), an integrated cancer research site accredited by the French National Cancer Institute (INCa).

Preoperative embolization of bone tumours at a glance: key figures

Before surgery for certain highly vascular bone tumours, a preoperative embolization reduces the blood supply to the lesion, limiting intraoperative bleeding and making the surgical procedure easier.

Criterion	Data
Objective	Reduce intraoperative bleeding and the risk of transfusion
Timing before surgery	Usually performed 24 to 48 hours before the operation
Typical indications	Giant cell tumours, certain highly vascular bone metastases, spinal tumours
Anaesthesia	Local or general, depending on the context
Decision	Always discussed beforehand with the surgical team
Cost	Covered by French national health insurance at Cochin AP-HP, no out-of-pocket fees

Sources: Kedra A, Dohan A, Biau D, Belbachir A, Dautry R, Lucas A, et al. "Preoperative Arterial Embolization of Musculoskeletal Tumors: A Tertiary Center Experience." Cancers (Basel). 2023;15(9):2657. Data validated by the team of Prof. Anthony Dohan, Department of Interventional Radiology, Cochin Hospital AP-HP, Université Paris Cité.

What are the expected benefits?

Preoperative embolization can be offered before surgical resection of a hypervascular bone tumour. The expected benefits are:

Major reduction in blood loss during surgery (50 to 80%)
Improved operative conditions (better visibility, easier dissection)
Reduced risk of transfusion
Can make resectable tumours that were initially considered inoperable because of the bleeding risk
Sometimes associated with a direct antitumour effect (partial tumour necrosis)
With palliative intent, can relieve bone pain in inoperable metastases

Principles and course of the procedure

Preoperative embolization of bone tumours consists of selectively blocking the arteries feeding the hypervascular tumour, in the 24 to 72 hours before surgery, in order to significantly reduce intraoperative bleeding and make surgical resection easier.

Main indications

Giant cell tumours: hypervascular and at high risk of bleeding
Hypervascular bone metastases (kidney, thyroid, melanoma, breast cancer)
Aggressive vertebral haemangiomas
Osteosarcomas and Ewing sarcomas: depending on vascularisation
Chordomas and other tumours of the sacrum

Note: Indications are discussed at the sarcoma multidisciplinary tumour board (RESAP AP-HP) with the orthopaedic surgeons. Our department works closely with the Orthopaedic Surgery department of Cochin Hospital.

How does it work?

Admission the day before surgery: local anaesthesia ± sedation

Complete diagnostic arteriography to map the tumour blood supply

Selective catheterisation of each artery feeding the tumour

Embolization with microparticles or polyvinyl alcohol (PVA)

Final arteriographic check confirming devascularisation: surgery planned 24-48 hours later

What happens afterwards?

Expected, transient effects:

Transient pain at the tumour site (post-embolization reaction), treated with painkillers
Clinical and neurological monitoring depending on the location
Surgery is performed within 24 to 48 hours after the embolization to benefit from the devascularisation

The complications are as follows:

Complication	Description	Frequency
Post-embolization syndrome	Pain, transient mild fever	Common
Non-target embolization (adjacent territory)	Neurological risk depending on the location (spine), prevented by precise localising arteriography	< 1%
Incomplete embolization	Reduced haemostatic benefit for surgery	5-10%

What are the limits of the treatment?

Embolization does not replace surgery: it is a preliminary step to reduce the bleeding risk
Depending on the vascular anatomy, embolization may be incomplete in some territories
For the spine, the risk of neurological complications requires precise arterial mapping before embolization

What are the other possible options?

🏥 Surgery without prior embolization

Possible, but with a higher risk of bleeding and transfusion for highly vascular tumours.

☢️ Radiotherapy

For painful, inoperable bone metastases, as an alternative or a complement.

What happens if I finally decline the treatment?

You remain entirely free in your decision. Your surgeon and the interventional radiology team will discuss with you the implications for the scheduled surgery and the possible alternatives.

What should I prepare before the consultation?

Report of the sarcoma or oncology multidisciplinary tumour board
Recent MRI and CT scan of the bone tumour
Biopsy and pathology result, if available
Coagulation tests

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Frequently asked questions

How long before surgery should the embolization be performed?

Embolization is generally performed 24 to 72 hours before surgery, so that the vascular reduction effect is at its maximum at the time of the operation.

Can all bone tumours be embolized?

Embolization is particularly effective for hypervascular tumours: metastases of kidney or thyroid cancer, giant cell tumours, vertebral haemangiomas, and certain primary bone tumours.

Is a referral letter necessary?

No letter is required, but one is welcome if you have it. Contact us directly through the contact form.

✅ Procedure covered by French national health insurance (Assurance Maladie) · No extra fees · Cochin Hospital AP-HP

New in the literature: 2026 review of musculoskeletal embolization

A narrative review published in October 2026 in CVIR Endovascular (Pelage JP, Aldalmani T, Geevarghese R, Zhang N, Jegonday MA, Berry G, Dohan A, Fohlen A, Grange S) sorts the indications of musculoskeletal arterial embolization by level of evidence. Hemostatic and selected tumour-related indications are established. Pain-directed embolization, including genicular artery embolization and embolization for tendinopathies, is performed as a stand-alone minimally invasive procedure targeting pathological neovascularity. Evidence remains heterogeneous: the authors stress careful patient selection, standardized outcome assessment and further comparative trials to define durability and clinical value. It includes selected tumour-related indications of embolization, the subject of this page.

Read the review (DOI) → · View on PubMed →

Why this page is trustworthy

Written by the Interventional Radiology team at Cochin Hospital AP-HP, Université Paris Cité. Medically reviewed by an interventional radiologist of the department. Last updated: July 2026.

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Preoperative embolization of bone tumours