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The authors evaluated the effectiveness of preoperative ethanol renal artery embolization in reducing transfusion requirements during nephrectomy for renal cell carcinoma.Of 93 consecutive patients who underwent nephrectomy for renal cell carcinoma from 1980 to 1990, 24 patients underwent embolization within 24 hours of nephrectomy. Finding in this group were compared with those in 69 control patients who underwent surgery without preoperative embolization.Embolized tumors were larger than nonembolized ones (mean volume, 595 vs 257 mL) (P.05). Patients with large hypervascular tumors (volume over 250 mL) who underwent complete embolization received significantly smaller mean blood transfusion volumes than control patients (250 vs 800 mL; P = .01). The transfusion volume associated with incomplete embolization was higher than that associated with no embolization.Complete alcohol embolization significantly reduces the volume of blood transfused during nephrectomy for large hypervascular renal cell carcinomas, and incomplete embolization is associated with larger transfusions. Preoperative embolization must be complete and should be performed more widely.

An 81-year-old man was diagnosed as having primary hyperparathyroidism and consequently had two adenomatous parathyroid glands removed. Postoperatively, the patient remained asymptomatic. Subsequent blood tests revealed hypercalcemia and increased parathormone (PTH) levels consistent with recurrent hyperparathyroidism. Tc-99m sestamibi imaging revealed a large parathyroid adenoma in the superior anterior mediastinum. Due to the patient's age, an angiographic embolization of the tumor was attempted. The thyrocervical trunk was selectively catheterized and a total of 30 cc of renographin 76 was administered. Although an extreme vascular blush was noted within the mediastinum, persisting for approximately 45 minutes, the .PTH level remained elevated after the procedure, suggesting an unsuccessful ablation. A follow-up Tc-99m sestamibi scan 4 days after the angiographic intervention demonstrated persistent, but less intense, uptake with a central photopenic area indicating only partial embolization of the adenoma's blood supply, resulting in subsequent partial infarction of the central region. The patient underwent elective surgery and a well-circumscribed 8-g adenoma measuring 2.5 x 2.5 x 1.5 cm was removed. A large zone of infarction was noted, confirming the scintigraphic diagnosis.