Successful Treatment of Aneurysmal Bone Cyst of the Hip in a Child by Selective Transcatheter Arterial Embolization

Department of Interventional Angiographic Radiology, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy.
Journal of vascular and interventional radiology: JVIR (Impact Factor: 2.41). 10/2010; 21(10):1591-5. DOI: 10.1016/j.jvir.2010.06.016
Source: PubMed


Aneurysmal bone cysts are rare lesions that occur more commonly in the first and second decades of life. In children, a juxtaepiphyseal location is associated with increased risk of growth plate damage, skeletal deformity, and recurrence. Different treatments have been reported for the management of aneurysmal bone cysts, including surgical excision with or without adjuvants, intralesional injection of sclerosing agents, radiation therapy, cryotherapy, systemic calcitonin therapy, and selective arterial embolization. The authors present the case of a 5-year-old girl with a large aneurysmal bone cyst at the proximal femur, complicated by a pathologic fracture; treatment with two selective transcatheter arterial embolizations was curative.

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    ABSTRACT: This study was designed to evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) for stopping bleeding following hip surgery. We performed a 12-year retrospective analysis of 13 patients (M:F = 6:7, median age 72 years) who underwent angiography for bleeding following hip surgery. The types of surgery, latency time, angiographic findings, TAE details, procedure-related complications, and clinical outcomes were analyzed. Technical success was defined as no further bleeding detected on angiography following embolization. Total hip replacement arthroplasty was the most common surgery performed for these patients (n = 10). Seven of the 13 study patients underwent angiography the same day as their surgery. Angiograms showed active (n = 11) or suspicious (n = 1) bleeding in 12 of the 13 patients. Gelatin sponge particles, coils, NBCA, PVA, and their combinations were used as the embolic material. For the one patient without obvious signs of bleeding, prophylactic TAE was done to achieve bleeding control. For the 11 patients with active bleeding, 10 underwent technically successful TAE, and 1 patient underwent surgery due to a large pseudoaneurysm located near the bifurcation of the common femoral artery. There were no major procedure-related complications or patient mortality. The 30-day mortality rate was 15 % (2/13), and both of these patients died of multiorgan failure. Transcatheter angiography is useful for identifying bleeding arteries. TAE is safe and effective for managing bleeding after hip surgery.
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