We present the case of a 63-year-old man diagnosed with clear cell renal cell cancer (RCC) with multiple osteolytic bone metastases who was treated at our hospital. The patient underwent a pathological fracture of the left femur, surgically stabilized with a titanium plate in August of 2023. Due to the risk of spinal compression syndrome and pain, the patient underwent a palliative sacrum and Th8 radiotherapy. In October 2023, due to the destabilization of a surgical anastomosis of the femur, the patient was qualified for embolization, followed by orthopaedic surgery (Fig. 1A, B). The procedure involved puncturing the right femoral artery under local anaesthesia using the Seldinger method. A guidewire catheter was inserted on the left side. Pathological vessels supplying the richly vascularized tumour of the left thigh from the deep femoral artery were visualized. Embolization was performed using Embozene 700 μm microspheres for small pathological vessels (Fig. 1C). In the end, coils were used to close the bigger vessels. Control arteriography showed effective devascularization of the tumour (Fig. 1D). After two days, the patient underwent the removal of destabilized material from the femur with internal repositioning and stabilization with an intramedullary nail. No intraoperative complications occurred. Post-surgery, the patient was qualified for systemic therapy with ipilimumab and nivolumab as he belongs to the intermediate-risk group, according to the International Metastatic RCC Database Consortium [1].

Figure 1. Computed tomography — pathological fracture and a broken stabilizing plate; A. 3D multiplanar reconstruction; B. 3D volumetric reconstruction. Digital subtraction arteriography; C. Metastatic tumour. Vascular supply from the deep femoral artery; D. Shadow of the embolization coil and effective occlusion of the tumour blood supply. Absence of flow in the distal segment of the deep femoral artery

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