Twenty-five patients with primary metastatic adenocarcinoma renis were treated by embolization and delayed nephrectomy. The objective of the study was to examine whether the natural history of the disease is influenced by this combined treatment. Most patients (19/25) had measurable metastatic lesions. No patient received additional therapy unless progression occurred. Embolization was mainly performed with Gelfoam and Gianturco coils. Complete remission of metastases was observed in 1 patient (still in remission after 36 months); stable disease in 6 patients (lasting between 14 and 31 months). Eighteen patients died after a median survival of 5.7 months (range 14 days to 11 months). No major complication related to the embolization procedure occurred. Angio-infarction followed by nephrectomy cannot be recommended for widespread use in patients with primary metastatic kidney carcinoma. The procedure may be tested in controlled clinical trials together with other treatment protocols, such as immunotherapy, infarction with radioactive particles, or chemoembolization. These approaches are experimental and therefore limited to institutions with sufficient experience.