Preoperative embolization to reduce morbidity and mortality in hypervascular mediastinal tumor surgery

Background: This study aims to describe the preoperative embolization procedures to reduce morbidity and mortality in hypervascular mediastinal tumor surgery and to evaluate the efficacy and safety of these procedures. Methods: Between January 2008 and December 2014, nine patients (5 males, 4 females; mean age 37 years; range 17 to 48 years) with mediastinal tumors underwent preoperative embolization of the feeding arteries before surgery. All patients received a combination of polyvinyl alcohol particles (300-1200 mu m) in combination with coils. The criterion for the embolization effectiveness was to reduce intraoperative hemorrhage. Results: In eight patients, embolization was successfully completed without any complication. The feeding vessels of each tumor were occluded. No symptomatic complications related to embolization were observed. Tumors were totally removed in eight patients. Embolization clearly reduced the severity of bleeding during surgery, lowered the surgical risks due to blood loss, and reduced the difficulty of tumor resections. No intra-or postoperative complication was seen. Conclusion: Our study highlights the importance and essence of preoperative embolization to control bleeding during surgery, particularly in large-size tumor resections with an excessive vascular nature. Based on our study results, we suggest interventional embolization as a prerequisite before hypervascular mediastinal tumor surgery to reduce morbidity and mortality.