Selective Embolization Research Articles

Coil embolization of a giant pseudoaneurysm associated with a disrupted axillary artery: a case report

BackgroundStent-graft placement is generally used to treat pseudoaneurysm (PSA) of the axillary artery (AA) trunk to maintain the patency of peripheral vessels. Coil embolization of a PSA associated with a disrupted AA trunk has rarely been reported.Case presentationA 54-year-old woman presented with swelling of her right shoulder. She had had a right proximal humeral fracture 12 years earlier. Contrast-enhanced computed tomography (CECT) and subsequent angiograms revealed a giant PSA at the disrupted, distal right AA. There were collateral flows to the brachial artery from the proximal to the right AA. To preserve collateral flows to the brachial artery, selective embolization of the inflow artery that derived from the distal AA was performed with hydrogel-coated coils. The post-embolization arteriogram showed no flow into the PSA, but collateral flows to the brachial artery we preserved. The post-embolization course was uneventful. The patient regained warmth in her right arm and hand on post-embolization day 4. Repeat CECT on post-embolization day 9 confirmed blood-flow to her right radial artery.ConclusionsWhile a stent-graft should be used if the AA trunk can be preserved, coil embolization should be considered for PSA if the AA trunk is disrupted but collaterals are preserved.

A novel swine model of selective middle meningeal artery catheterization and embolization

BackgroundMiddle meningeal artery (MMA) embolization is a promising intervention as a stand-alone or adjunct treatment to surgery in patients with chronic subdural hematomas. There are currently no large animal models...

Surgical evacuation combined with Shirodkar cervical suture and selective uterine artery embolization: A fertility preserving treatment for 10-15 weeks' live cesarean scar ectopic pregnancies.

Cesarean scar ectopic pregnancies (CSEPs) are associated with significant maternal morbidity and termination is often recommended in the early first trimester. Management of more advanced cases is challenging due to higher risks of major intraoperative hemorrhage. Hysterectomy is currently the intervention of choice for advanced cases. This study aimed to investigate if advanced live CSEPs could be managed effectively conservatively using suction curettage and interventional radiology. A retrospective single-center cohort study was performed. A total of 371 women diagnosed with CSEP were identified between January 2008 and January 2023. A total of 6% (22/371) women had an advanced live CSEP with crown-rump length (CRL) of ≥40 mm (≥10 weeks' gestation). Of these, 77% (17/22) opted for surgical intervention, whilst the remaining five continued their pregnancies. A preoperative ultrasound was performed in each patient. All women underwent suction curettage under ultrasound guidance and insertion of Shirodkar cervical suture as a primary hemostatic measure combined with uterine artery embolization (UAE) if required. The primary outcome was rate of blood transfusion. Secondary outcomes were estimated intraoperative blood loss, UAE, intensive care unit admission, reintervention, hysterectomy, hospitalization duration and rate of retained products of conception. Descriptive statistics were used to describe these variables. Median CRL of the 17 patients included was 54.1 mm (range: 40.0-85.7) and median gestational age based on CRL was 12 + 3 weeks (range: 10 + 6-15 + 0). On preoperative ultrasound scan placental lacunae were recorded in 76% (13/17) of patients and color Doppler score was ≥3 in 67% (10/15) of patients. At surgery, Shirodkar cervical suture was used in all cases. It was successful in achieving hemostasis by tamponade in 76% (13/17) of patients. In the remaining 24% (4/17) patients tamponade failed to achieve complete hemostasis and UAE was performed to stop persistent arterial bleeding into the uterine cavity. Median intraoperative blood loss was 800 mL (range: 250-2500) and 41% (7/17) women lost >1000 mL. 35% (6/17) needed blood transfusion. No women required hysterectomy. Surgical evacuation with Shirodkar cervical suture and selective UAE is an effective treatment for advanced live CSEPs.

Selective aneurysmal sac neck-targeted embolization during endovascular repair of abdominal aortic aneurysm with hostile neck anatomy.

To evaluate the efficacy and safety of selective aneurysmal sac neck-targeted embolization in endovascular aneurysm repair (EVAR) in patients with a hostile neck anatomy (HNA). Between October 2020 and June 2022, patients with an abdominal aortic aneurysm (AAA) and HNA who underwent EVAR with a low-profile stent graft and a selective aneurysmal sac neck-targeted embolization technique were analysed. An HNA was defined by the presence of any of the following parameters: infrarenal neck angulation > 60°; neck length < 15mm; conical neck; circumferential calcification ≥ 50%; or thrombus ≥ 50%. Before occluding the entire aneurysm during the procedure, a buddy wire was loaded prophylactically into the sac through the contralateral limb side. If a type Ia endoleak (ELIa) occurred and persisted despite adjunctive treatment such as balloon moulding or cuff extension, this preloaded wire could be utilized to enable a catheter to reach the space between the stent graft and sac neck to perform coil embolization. In the absence of ELIa, the wire was simply retracted. The primary outcome of this study was freedom from sac expansion and endoleak-related reintervention during the follow-up period; secondary outcomes included technical success and intraoperative and in-hospital postoperative complications. Among the 28 patients with a hostile neck morphology, 11 (39.5%) who presented with ELIa underwent intraprocedural treatment involving sac neck-targeted detachable coil embolization. Seventeen individuals (60.7%) of the total patient population did not undergo coiling. All patients in the coiling group underwent balloon moulding, and 2 patients additionally underwent cuff extension. In the noncoiling group, 14 individuals underwent balloon moulding as a treatment for ELIa, while 3 patients did not exhibit ELIa during the procedure. The coiling group showed longer operating durations (81.27 ± 11.61 vs. 70.71 ± 7.17min, P < 0.01) and greater contrast utilization than the noncoiling group (177.45 ± 52.41 vs. 108.24 ± 17.49ml, P < 0.01). In the entire cohort, the technical success rate was 100%, and there were no procedure-related complications. At a mean follow-up of 18.6 ± 5.2months (range 12-31), there were no cases of sac expansion (19 cases of sac regression, 67.86%; 9 cases of stability, 32.14%) or endoleak-related reintervention. Selective aneurysmal sac neck-targeted embolization for the treatment of ELIa in AAA patients with an HNA undergoing EVAR is safe and may prevent type Ia endoleak and related sac expansion after EVAR.

Diagnosis and Current Treatment of Aneurysmal Bone Cysts.

The purpose of this review is to increase awareness about the evolution and development of current trends in the diagnosis and treatment of aneurysmal bone cysts (ABCs). ABCs are benign, but locally aggressive bone tumors that mainly affect children. ABCs comprise 1% of all primary bone tumors and occur most frequently during the first two decades of life. The diagnosis is made using a variety of imaging modalities and has the characteristic features of an expansile, radiolucent lesion that is often seen in the metaphyseal region of the bone and has fluid-fluid levels that are apparent on MRI. In the pediatric population, telangiectatic osteosarcoma and unicameral bone cyst (UBC) are the main differential diagnoses of an ABC. Giant cell tumors (GCTs) also include in differential diagnosis, which often manifest in patients older than 15 and do not penetrate the open physis although they develop after the physeal closure. Imaging alone cannot rule out telangiectatic osteosarcoma; therefore, a biopsy is recommended. A variety of treatment options have been described; traditionally, most patients are treated with curettage and bone grafting. Curettage alone, however, usually results in tumor recurrence following excision. A variety of adjuvants have been utilized with varying degrees of effectiveness to reduce the risk of local recurrence. When a cyst is in the pelvis, its location and size are such that surgery is a very risky option. Selective arterial embolization has significantly contributed to the development of effective treatments for these situations. Embolization or radiation, as well as denosumab therapy, are widely used as therapies for ABCs in anatomic locations where surgery would significantly increase morbidity.

Minimally Invasive Treatment of Chyle Leak After Thyroidectomy and Cervical Lymph Node Dissection in Patients with Thyroid Carcinoma: Results of a Study Involving 36 Patients.

Chyle leak (CL) after head and neck surgery is a rare but well-known complication. In patients with high-output leakage, the treatment can be complicated. This study aims to report on a recent innovation in lymphatic intervention for treating such patients. A retrospective review of 36 patients with chyle leak after neck surgery for thyroid cancer was conducted to assess the efficacy of percutaneous lymphatic embolization and thoracic duct (TD) disruption. Antegrade catheterization of the thoracic duct was achieved in 31 of 36 patients (86.1%). Therefore, embolization of the thoracic duct and thoracic duct branches was performed in 26 and 5 patients, respectively. In 5 cases of unsuccessful antegrade catheterization into the thoracic duct, transcervical access embolization was performed in 2 patients, and TD disruption (TDD) was performed in 3 patients. The pooled overall technical success rate of lymphatic embolization was 33/36 patients (91.7%). One patient who underwent thoracic duct embolization (TDE) with technical success (1/33 patients) but clinical failure had additional treatment directly sclerosing the TD under computed tomography scan. Cervical fluid collection sclerotherapy was done in 7 patients as an additional treatment. Resolution of the chyle leak after procedures was observed in all patients (100%). The mean time to resolution was 3 days (1-7 days). There was no complication intra and after procedures. TDE, selective TD branches embolization and TDD are safe and effective minimally invasive treatments for CL post-surgery for thyroid carcinoma. Sclerosing cervical fluid collection contributes to clinical success.

Surgical management of pediatric spinal aneurysmal bone cysts: patient series.

Aneurysmal bone cysts (ABCs) are rare, highly vascular osteolytic bone lesions that predominantly affect pediatric populations. This report evaluates the clinicopathological data of pediatric patients with spinal ABCs. The medical records for all patients at Children's Hospital Los Angeles with biopsy-proven ABCs of the spine between 1998 and 2018 were evaluated. Seventeen patients, 6 males and 11 females, were identified. The mean age at surgery was 10.4 years (range, 3.5-20 years). The most common presenting complaint was pain at the lesion site 16/17 (94%), followed by lower-extremity weakness 8/17 (47%). Resection and intralesional curettage were performed in all patients. Three (18%) of 17 patients underwent selective arterial embolization prior to resection. Spinal stability was compromised in 15 of 17 patients (88%), requiring instrumented fusion. Five (29%) of the 17 patients received additional therapy including radiation, calcitonin-methylprednisolone, or phenol. Four (23.5%) of 17 patients experienced a recurrence, and the mean time to recurrence was 15 months. The postoperative follow-up ranged from 6 to 108 months (median, 28 months). Reoperation occurred after an average of 35 months. At the recent follow-up, patients were free of disease. Gross-total resection by intralesional curettage with case-dependent instrumented spinal fusion for instability remains an effective strategy for managing pediatric spinal ABCs. Long-term follow-up is necessary to detect tumor recurrence.

Arteriovenous malformation of quadriceps tendon

Abstract Objective: There have been few reported cases of muscle arteriovenous malformations in the literature to date. Case Report: We present the case of a 24-year-old male with an arteriovenous malformation involving the quadriceps tendon, presenting with recurrent episodes of pain and swelling in the right knee. The patient was treated with selective embolization of feeding arteries to the tumor, followed by surgical excision of the mass, and showed resolution of symptoms at 1 month follow-up. Conclusion: Selective embolization of the feeding artery results in the reduction of the tumor mass, and excision of the tumor becomes bloodless, easy, and safe.

Treatment of a Patient With Closed Liver Injury Using Interventional Methods:&#x0D; a Case Study

Background. Mechanical injury occupies a leading position among the causes of mortality in the working-age population. Diagnosis and treatment of isolated and combined abdominal traumas accompanied by bleeding appear to be a specific challenge. Due to difficulties in diagnosis and treatment, they are characterized by frequent complications and an increased mortality rate.Currently, there is no uniform tactics for diagnosing and treating patients with liver damage. In Russia and globally, new approaches are being actively introduced for the treatment of patients with closed liver traumas using minimally invasive techniques.The aim of study was to present a clinical case of a patient with a closed liver injury treated using interventional methods, such as angiography and embolization.Materials and methods. According to conventional techniques, the patient had to undergo laparotomy with complex manipulations to stop intra-abdominal bleeding from a ruptured liver, which would inevitably worsen her condition in the context of a presenting severe injury.Multiple studies reported that the number of postoperative complications after laparotomy is up to 41%, and in case of combined trauma 10-35% of complications can be one of the causes of death [6, 7, 8]. In order to avoid more traumatic treatment approaches, we applied tactics using minimally invasive high-tech diagnostic and treatment options.Results. To stop intra-abdominal bleeding from a liver rupture, which was previously diagnosed during multislice computed tomography (MSCT) with intravenous contrast, using interventional options, selective embolization of the segmental branch of the right hepatic artery was performed with an adhesive composition. The post-traumatic period proceeded without complications; in 14 days after the injury, the patient was discharged in satisfactory condition.Conclusion. Minimally invasive and conservative treatment of patients with closed abdominal traumas using interventional radiology can be successfully applied in specialized trauma centers.

Internal Iliac Artery Ligation in Obstetrics and Gynecology: Surgical Anatomy and Surgical Considerations.

The internal iliac artery (IIA) is the main arterial vessel of the pelvis. It supplies the pelvic viscera, pelvic walls, perineum, and gluteal region. In cases of severe obstetrical or gynecologic hemorrhage, IIA ligation can be a lifesaving procedure. Regrettably, IIA ligation has not gained widespread popularity, primarily due to limited surgical training and concerns regarding possible complications, including buttock claudication, impotence, and urinary bladder and rectum necroses. Nowadays, selective arterial embolization or temporary balloon occlusion are increasingly utilized alternatives, which can be applied preoperatively or intraoperatively for threatening severe genital or pelvic bleeding. However, IIA ligation retains its relevance, as the previously described procedures are not always available and have limitations. This article provides a step-by-step guide to the IIA ligation procedure and its possible complications. It also includes a detailed description of the anatomy of the IIA and pelvic arterial anastomoses. This review highlights the importance of a thorough understanding of pelvic anatomy as a prerequisite for safe IIA ligation and posits that training in this procedure should be an integral part of obstetrics and gynecology curricula.

Safety and Efficacy of Selective Renal Artery Embolization in the Management of Postprocedural Acute Renal Bleeding: Experience of A Tertiary Care Center

Safety and Efficacy of Selective Renal Artery Embolization in the Management of Postprocedural Acute Renal Bleeding: Experience of A Tertiary Care Center

Primary hyperaldosteronism: the choice in favor of conservative surgery

Primary hyperaldosteronism (PHA) is the most common cause of secondary arterial hypertension among endocrine disorders. Given that patients with this pathology are at a higher risk of developing fatal and non-fatal cardiovascular events, early diagnosis and timely treatment are of great importance. Currently, the two main forms of PHA are aldosterone-producing adenoma and bilateral adrenal hyperplasia, which are treated with laparoscopic adrenalectomy or pharmacotherapy with mineralocorticoid receptor antagonists. Although most patients experience restoration of their functional and metabolic status after surgical intervention, some may develop postoperative adrenal insuffi ciency, which requires long-term hormone replacement therapy. This review examines the options for organ-preserving surgeries, such as partial adrenalectomy and selective embolization of the adrenal artery.

Morphological changes in the abdominal organs after left gastric artery embolization in an experiment

Objective – to experimentally evaluate the morphological changes of internal organs (liver, spleen, duodenum, pancreas) after embolization of gastric arteries.Material and methods. To conduct the experiment, 10 Vietnamese pigs aged 4-5 months, female, were selected and fed a high-fat diet for 2 months to simulate obesity. Aorta contrast and celiacography with "Vazipak" solution (5-10 ml per injection) were performed on animals under general anesthesia. Superselective bariatric embolization of the left gastric artery was performed with a 3F microcatheter. After 3 weeks, a morphological (hematoxylin-eosin staining) examination of such organs as liver, duodenum, spleen, pancreas was performed. Photofixation of the histopreparations of the relevant organs was carried out using a trinocular microscope of laboratory class Nikon Eclipse Ci-E with 10x, 20x and 40x plan achromat objectives.Results. In general, no macroscopic signs of ischemia of adjacent organs were noted against the background of the performed selective embolization of the left gastric artery. Blood filling of the liver was uneven, the perisinusoidal spaces were expanded, which indicated its edema. In the duodenum, reactive disturbances of microcirculation were manifested by expansion and congestion of venous vessels and blood stasis. Microscopic changes in the spleen were characterized by congestion of the sinusoids, while the vessels of the pancreas were unevenly filled with blood, and at the same time, venous congestion prevailed.Conclusion. Microcirculation disorders, dystrophic changes, and signs of a shock reaction, which can be considered transient, occur in the examined organs after embolization of the gastric arteries. These data indicate the safety of performing selective embolization of gastric arteries and the absence of signs of critical redistribution of blood flow or ischemia "robbing".

Selective Arterial Embolization of Ruptured Hepatocellular Carcinoma with N-Butyl Cyanoacrylate and Lipiodol: Safety, Efficacy, and Short-Term Outcomes.

The rupture of hepatocellular carcinoma (rHCC) is uncommon but causes sudden life-threatening bleeding. Selective transarterial embolization (STAE) is an effective bleeding-control option. The optimal embolic agent is unknown, and data on the use of cyanoacrylate glue are lacking. The objective of this study was to report the outcomes of cyanoacrylate-lipiodol embolization for rHCC. We retrospectively reviewed the files of the 16 patients (14 males; mean age, 72 years) who underwent emergency cyanoacrylate-lipiodol STAE at a single center in 2012-2023 for spontaneous rHCC. All 16 patients had subcapsular HCC and abundant hemoperitoneum. The technical success rate was 94% (15/16). Day 30 mortality was 19%; the three patients who died had severe hemodynamic instability at admission; one death was due to rebleeding. Liver enzyme levels returned to baseline by day 30. No rebleeding was recorded during the median follow-up of 454 days in the 10 patients who were alive with available data after day 30. Larger prospective studies with the collection of longer-term outcomes are needed to assess our results supporting the safety and effectiveness of cyanoacrylate-lipiodol STAE for rHCC. Randomized trials comparing this mixture to other embolic agents should be performed.

Abstract 16011: Lymphatic Intervention Following Superior Cavo-Pulmonary Anastomosis Potentially Allows for Successful Fontan Completion

Introduction: Superior cavopulmonary anastomosis (SCPC) inevitably exposes the thoracic duct to higher venous pressure, potentially triggering disordered lymphatic perfusion manifesting as chylothorax (CT) and/or plastic bronchitis (PB) . Though outcomes following lymphatic interventions after Fontan completion (FC) are well described, they are not well described in patients after SCPC. Methods: A single-center retrospective study of patients who underwent lymphatic intervention for PB or CT following SCPC 1/1/2011-12/31/2021 was performed, excluding those with planned two ventricle or 1.5 ventricle repair, patients who underwent thoracic duct ligation, and those in whom interventions were performed either prior to SCPC or following FC. Results: In total, 27 patients (56% male) were studied, of which 22% had PB and 78% with CT, 7% with Noonan’s syndrome and 19% with heterotaxy syndrome. Median age at intervention was 11.3 months (IQR 7.4 - 33.5). Median time following SCPC was 3.5 months (IQR 2.1 - 24.2). In terms of interventions, 41% (n=11) underwent selective lymphatic channel embolization. Of these 36% (4/11) underwent subsequent thoracic duct embolization (TDE). The remaining 59% (n=16) patients underwent TDE. The thoracic duct was able to be accessed in 23 patients (85.2%). Twenty-four patients (19/21 with CT, 5/6 with PB) had resolution of symptoms following transcatheter intervention at our center. Following intervention, seven patients (all of whom were of the type IV lymphatic subtype) were successfully referred for FC, ten are currently awaiting FC, five are not Fontan candidates and five passed away from non-procedural comorbidities. Median duration of post-operative chest tubes following FC was 7 days (IQR 6-8) and median follow up is 39.1 months (IQR 15.1 - 45.1). Conclusions: Selective lymphatic embolization and TDE are feasible in SCPC recipients with CT and PB, with most patients experiencing symptomatic improvement. Subsequent FC has been achieved in some patients with type IV lymphatic abnormalities, suggesting that these interventions may alter the unnatural history of lymphatic dysfunction in single ventricle patients. Future research is needed to define longer term outcomes of this high-risk cohort.

Massive hemoptysis. Selective embolization of bronchial artery-left pulmonary artery fistula. How would I approach it?

Massive hemoptysis. Selective embolization of bronchial artery-left pulmonary artery fistula. How would I approach it?

Long-term outcomes of deep pediatric arteriovenous malformations.

Multimodality treatment has been shown to be the optimal management strategy for pediatric arteriovenous malformations (AVMs). Deep AVMs represent a subset of AVMs for which optimal management may be achieved with a combination of radiosurgery and highly selective embolization, in the absence of compelling features requiring operative intervention. The objective of this study was to identify predictors of good functional outcomes in pediatric patients with deep AVMs. A retrospective cohort study of the outcomes of 79 patients with deep AVMs from January 1988 through December 2021 was performed. Deep AVMs were defined as those with the majority of the nidus centered in the basal ganglia, thalamus, or brainstem. Collected data included patient demographics and presenting symptoms, presenting modified Rankin Scale (mRS) score, radiographic findings and outcomes, management strategy, complications, and clinical outcomes as indicated by follow-up mRS score. A good outcome was defined as a follow-up mRS score ≤ 2, while a poor outcome was defined as a follow-up mRS score ≥ 3. Statistical analysis was performed to identify factors associated with functional outcomes. With a mean follow-up duration of 85.6 months, there was a 72.2% angiographic obliteration rate, with 75.9% of patients having a good clinical outcome (mRS score ≤ 2). Presenting symptoms and radiographic characteristics were not significantly associated with long-term functional outcomes. There was a significantly higher rate of posttreatment hemorrhage in patients with a poor versus good outcome (11.8% vs 0%, p = 0.010). On multivariate logistic regression analysis, poor long-term functional outcome was only associated with poor presenting mRS score (p = 0.002). Satisfactory angiographic obliteration rates and good long-term functional outcomes can be achieved for deep AVMs, with stereotactic radiosurgery as the cornerstone of multimodality treatment.

Radiological Vascular Anatomy of the Caudate Lobe of the Liver Required for Transarterial Chemoembolization of Hepatocellular Carcinoma.

The caudate lobe is located between the bilateral hepatic lobes and is divided into three subsegments: the Spiegel lobe, paracaval portion, and caudate process. The caudate artery arises from various sites of the bilateral hepatic arteries as an independent branch, common trunk, or arcade. Extrahepatic arteries can enter the caudate lobe mainly by the right inferior phrenic artery. The caudate artery also supplies the main bile duct and posterior aspect of segment IV. Although catheterization into the caudate artery is occasionally difficult because of its small size and sharp angulation, selective embolization of a tumor feeder is a significant prognostic factor in patients with hepatocellular carcinoma originating there. Therefore, we should recognize the peculiarity of its vascular anatomy and should be familiar with catheterization and embolization techniques.

Long-term efficacy of selective arterial embolisation of renal angiomyolipoma.

To evaluate the long-term efficacy of selective arterial embolisation in renal angiomyolipoma (AML), with emphasis on tumour shrinkage, potential regrowth and the necessity of supplementary procedures. Material and methods: A retrospective review of all 58 consecutive embolisations at two institutions, between 1999 and 2018, was performed. Clinical notes, laboratory data and imaging were reviewed. The overall complication rate was 6.8%, with no Clavien-Dindo grades III-V complications. Kidney function was unaffected by embolisation as measured by creatinine. Median radiological follow-up was 4.8 years (interquartile range [IQR]: 2.8-7.8), and median clinical follow-up was 7.5 years (IQR: 4.7-14.0). Decreasing AML size was observed in 96% of procedures. Maximal shrinkage (30% median diameter decrease; IQR: 15-44) was reached after median 2.2 years (IQR: 0.6-4.8). During follow-up, regrowth occurred in 38% of patients, and four bleeding episodes occurred in three patients with tuberous sclerosis. Growing size and/or rebleeding prompted a redo embolisation in 9% of spontaneous AML and 50% of tuberous sclerosis-associated AML. Being a well-tolerated treatment with few complications, selective arterial embolisation renders a pronounced size-reduction in most patients with AML, and kidney function is preserved. Regrowth is common, and a radiological follow-up is necessary. Tuberous sclerosis is a risk factor for the need of reintervention.

Indocyanine green-marked fluorescence-guided off-clamp versus intraoperative ultrasound-guided on-clamp robotic partial nephrectomy: Outcomes on surgical procedure.

To compare surgical and functional outcomes between off-clamp robot-assisted partial nephrectomy with indocyanine-green tumour marking through preliminary superselective embolization and on-clamp robot-assisted partial nephrectomy with intraoperative ultrasound identification of the renal mass. One hundred and forty patients with a single renal mass underwent indocyanine-green fluorescence-guided off-clamp robot-assisted partial nephrectomy with preoperative superselective embolization (Group A, 70 patients) versus intraoperative ultrasound-guided on-clamp robot-assisted partial nephrectomy without embolization (Group B, 70 patients). We assessed operative time, intraoperative blood loss, complications, length of stay, renal function, need for ancillary procedures and blood transfusions. Mean tumour size was 24 versus 25 mm in Group A versus Group B (p= 0.19). Mean operative time was 86.5 versus 121.8 min (p= 0.02), mean blood loss was 72.8 versus 214.2 mL (p= 0.02), and mean haemoglobin drop on postoperative day 1 was 1.1 versus 2.6 g/dL (p= 0.04) in Group A versus Group B. One-month creatinine, hospital stay and enucleated tumour volume were comparable. Ten postoperative complications occurred in Group A (13.3%) and 11 in Group B (15.3%). Following superselective embolization, no patients required blood transfusions versus two patients in Group B. Postoperative selective renal embolization was needed in one case per group. Preoperative superselective embolization of a renal mass with indocyanine-green before off-clamp robot-assisted partial nephrectomy significantly reduces operative time and intraoperative blood loss compared to on-clamp intraoperative ultrasound-guided robot-assisted partial nephrectomy. A longer follow-up is needed to establish the effect on renal function.