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ABSTRACT |
Tuesday, May 8, 11:20 AM–12:30 PM
Abstracts 112-118
Moderator(s): Nilesh Patel and Robert Hieb
11:20 AM
112. Role of Transcatheter Embolization in Life-Threatening Hemoptysis
Sheorain V. K.*; Rathod J.; Taori K. Government Medical College, Nagpur, India
Address correspondence to V. Sheorain (veeru5{at}rediffmail.com)
Objective: To assess the role of transcatheteral embolization in the life-threatening hemoptysis.
Materials and Methods: 101 patients (86 men and 15 women) underwent transcatheteral embolization as a treatment for life-threatening hemoptysis. All patients with life-threatening hemoptysis were included in the study. In our study leading cause of life-threatening hemoptysis was pulmonary tuberculosis seen in 96 patients, aspergilloma in 4 patients, and bronchial carcinoma in one patient. Embolization procedure was carried out under C-arm DSA machine. Check angiography of bronchial and nonbronchial arteries (intercostals, branches of subclavian artery) was performed in all the patients and the abnormal vessels responsible for hemoptysis were embolized using gelfoam particles mixed with nonionic contrast material using 4F/5F cobra and/or shepherd crook catheters.
Results: Procedure was technically successful in all patients. Hemoptysis was controlled immediately postprocedure in all the patients. However 12 patients developed recurrent hemoptysis after a period of 1 month. Eight patients underwent re-embolization. Two patients had complication in the form of paraplegia.
Conclusion: Transcather embolization of the bronchial and nonbronchial arteries responsible for hemoptysis is a life-saving procedure in the hands of experienced interventional radiologist.
113. Efficacy of Uterine Artery Embolization with Spherical Poly-Vinyl Alcohol (PVA)
Rasuli P.*; Badr A.; French G.; Jolly E. The Ottawa Hospital, Ottawa, Canada
Address correspondence to P. Rasuli (prasuli{at}rogers.com)
Objective: To compare the efficacy uterine artery embolization (UAE) with the newly introduced spherical PVA compared to conventional PVA.
Materials and Methods: UAE was carried out in 203 women with symptomatic fibroids at the Ottawa Hospital between 1998–2006. One-year follow-up data was available in 149 women of whom 96 had received conventional PVA (Group A), and 53 had been embolized using spherical PVA (Group B). All patients were interviewed by a research nurse prior to and in 9–12 months post UAE in regards to their symptoms related to menometrorrhagia, dysmenorrhea, pressure symptoms, and frequency. The severity of the symptoms was ranked using an 11-point scale (0–10). The magnitude of change in the symptoms, serum hemoglobin level and the size of the dominant fibroid as depicted on abdominal ultrasound 9–12 months following UAE in each group were used to assess the efficacy of the two types of embolizing particles. The number of partial/total hysterectomies or myomectomies in each group was also recorded as evidence of UAE failure. We used Mann-Whitney U test and the Chi square test to assess the statistical significance of the findings.
Results: Patients embolized with conventional PVA showed an average of 4.6 score improvement in menometrorrhagia 2.9 in dysmenorrhea, 3.7 in pressure, 3.4 in frequency while patients embolized with Spherical PVA showed improvement of 3 score in menometrorrhagia, 2.4 in dysmenorrhea, 3.1 in pressure, 2.0 in frequency. The degree of improvement in menometrorrhagia, pressure feeling and frequency was significantly better (p < 0.001) in patients embolized with conventional PVA. There was no statistical difference in the two groups related to dysmenorrhea. Patients embolized with conventional PVA showed 8 g/dl improvement in serum hemoglobin versus 3 g/dl in patients who were embolized with spherical PVA (p < 0.05). Finally patients who were embolized with conventional PVA showed an average reduction of 28 mm in the diameter of their dominant fibroid while patients who were embolized with spherical PVA showed an average of 15.7-mm reduction (p = 0.01). There were 5 instances of hysterectomy and one myomectomy in the patients embolized with conventional PVA vs. 8 in patients embolized with spherical PVA. This difference was not statistically significant (p = 0.06)
Conclusion: In comparison with conventional PVA, UAE using spherical PVA results in lesser tumor shrinkage and lesser improvement in fibroid symptoms.
114. IVUS-guided Transmembrane Puncture Re-entry Device to Facilitate Subintimal Recanalization of Chronically Occluded Iliac Arteries–Technique and Short Term Follow-up
Krishnamurthy V. N.1,2*; Venkatram M.3 1. University of Michigan Hospital, Ann Arbor, MI; 2. VA Medical Center, Ann Arbor, MI; 3. Wayne State University/Sinai Grace, Detroit, MI
Address correspondence to V. Krishnamurthy (venkkris{at}med.umich.edu)
Objective: Successful subintimal recanalization of chronically occluded iliac arteries is often difficult due to inability to re-enter the true lumen with guide wire. This study details the technical feasibility and short term follow-up with the Pioneer crossing device (Medtronic, Santa Rosa, CA) to facilitate accurate re-entry after subintimal recanalization of chronically occluded iliac arteries.
Materials and Methods: Four male patients with symptomatic chronically occluded iliac arteries (moderate to severe limb ischemia by ABIs) were recanalized using the Pioneer crossing device after failed recanalization attempts using standard technique. Occlusion length varied from 3 to 15 cm. The Pioneer crossing device is a 6.2F rapid exchange catheter, which tracks over a 0.014" wire. A 20-MHz phased array IVUS transducer is integrated into the tip of the catheter allowing imaging guidance for re-entry needle. Using the guidance of the IVUS cross-sectional image supported by color flow imaging, the true lumen is punctured with an integrated 24-G needle allowing delivery of a second 0.014" wire.
Results: Re-entry into the true lumen was technically successful in all four cases without complications. Re-entry was achieved with a single attempt in 3 patients and two attempts were required one patient. The intimal re-entry site was then dilated with 3-mm balloon to allow passage of 4F catheter and 0.035" guide wire. Balloon expandable stents were deployed in 2 patients and self-expanding Nitinol stents were used in remaining 2 patients to open the subintimal channel. No procedure-related complications were noted. At 3–6 months (mean 3 months) follow-up, all patients became asymptomatic with normalization of ABIs.
Conclusion: The Pioneer crossing device is an effective and safe tool to facilitate true lumen re-entry during subintimal recanalization of chronically occluded iliac arteries. Technical success rate approaches 100% with this IVUS-guided re-entry technique.
115. Isolated Inferior Mesenteric Artery (IMA) Intervention in Management of Chronic Mesenteric Ischemia (CMI)
Turba U. C.*; Arslan B.; Bozlar U.; Angle J. F.; Hagspiel K. D.; Matsumoto A. H. University of Virginia, Charlottesville, VA
Address correspondence to U. Turba (uct5d{at}virginia.edu)
Objective: Endovascular treatment for patients, who develop CMI symptoms, requiring only IMA intervention is not well defined, and only a few case reports are available. We report our interventional therapy experience to treat IMA lesions in CMI patient population.
Materials and Methods: IRB approval was obtained for this retrospective review. Cases were performed between 1996 and 2006. We excluded patients with CMI symptoms requiring celiac artery (CA) and/or superior mesenteric artery (SMA) interventions, such as percutaneous transluminal angioplasty (PTA) and/or stent placement. Our inclusion criteria were, CA or SMA occlusion or no evidence of hemodynamically significant stenosis involving CA and/or SMA. We identified 12 patients, in whom 12 procedures were performed. Only IMA intervention was performed to treat these patient's CMI symptoms.
Results: Twelve patients (n = 12), age range 47–90 were reviewed. SMA and CA were occluded in 5 patients, with IMA stenosis between 65–99%. Three patients had SMA occlusion and less than 40% stenosis of CA, with IMA stenosis of 80-99%. Four patients had normal SMA and CA, with IMA stenosis of 80-95%. PTA was performed in 3 patients with good result. Primary stenting was utilized in 1 patient. PTA was performed with suboptimal results in 8 patients, and then stenting was performed successfully. Following PTA, 1 patient experienced embolic complication, which was successfully managed with mechanical thrombectomy. One PTA procedure was complicated with dissection, which was successfully managed with stent deployment. All procedures were technically successful. Only 1 patient's CMI symptoms did not improve clinically immediately after the procedure.
Conclusion: Although long term follow-up suffers from co-morbid conditions in patients with CMI, endovascular intervention is probably a valuable treatment option. Inferior mesenteric artery alone may be responsible for CMI symptoms, and/or IMA treatment alone could provide enough mesenteric blood supply to relieve CMI symptoms. Prospective, and due to rarity of the condition multicentric studies are needed to confirm our findings.
116. A New Twist to the Uterine Artery Embolization Paradigm
Knuttinen M.*; Van Ha T. University of Chicago Hospitals, Chicago, IL
Address correspondence to M. Knuttinen (mgk600{at}hotmail.com)
Objective: Success rates of up to 98% have been reported in the literature for uterine artery embolization (UAE) in the treatment of uterine fibroids. Failure of UAE has been defined as subsequent hysterectomy, definitive myomectomy, repeat embolization, or failure of symptom improvement. To our knowledge, there have been no studies which have looked at the performance or success rates of UAE AFTER prior uterine surgeries. Only Zorlu et al. (2005) have addressed using UAE as a means to control bleeding after myomectomy. We broaden this concept by suggesting that UAE can be a beneficial therapeutic option in the treatment of uterine fibroids, even after having undergone prior uterine intervention.
Materials and Methods: We analyzed the outcomes of 36 patients over the course of two years who underwent previous uterine surgeries, including prior myomectomies, endometrial polypectomies, or prior Caesarean sections. The mean age was 42 years. A questionnaire and review of medical and surgical records was performed and assessed prior to their UAE procedure. This questionnaire also addressed changes in symptoms and any procedure-related complications. Additionally, the symptoms and procedure conditions from the UAE were compared to their prior myomectomy or surgical experience. The type, location and size of the fibroids was also documented in the surgical report and reviewed prior to their UAE procedure.
Results: Patients with previous uterine surgery appeared to fare as well as reported in the literature for the overall patient population. No additional risks were identified. The majority of the patients reviewed demonstrated positive responses and did not undergo additional treatment in an average of a 23-month follow-up (range 8 months–36 months). Positive responses were defined as symptom improvement and no need for repeat embolization or other surgical procedure. Additionally, patients who had undergone a prior myomectomy for treatment of symptomatic fibroids had significant improvement in symptoms.
Conclusion: Much of the literature has addressed the UAE benefits of being a less invasive and safer treatment option than standard surgical techniques. However, to our knowledge, our study is the first report to suggest that UAE may also be a safe and therapeutic option in women who underwent prior uterine surgeries.
117. Accuracy of Gadobenate Dimeglumine-enhanced MR Angiography in the Evaluation of Renal Artery Stenosis: Comparison with Digital Subtraction Angiography (DSA)
Soulez G.4; Douek P.8; Benea G.6,7; Grazioli L.9; Pasowicz M.3; Morana G.12; Vanzulli A.10; Ballarati C.11; Schneider G.5*; Kirchin M.; Pirovano G.1 1. Bracco Diagnostics Inc, Milano, Italy; 2. Center for Diagnosis and Rehabilitation of Heart and Lung Diseases, John Paul II Hospital, Krakow, Poland; 3. Centre Hospitalier De L'Universite De Montreal, Montreal, Canada; 4. Department of Diagnostic Radiology, Building 49, University Hospital, Homburg, Germany; 5. Facolta' di Medicina e Chirurgia, Ferrara, Italy; 6. Facolta' di Medicina e Chirurgia, Ferrara, Italy; 7. Hôpital Louis Pradel, Service de Radiologie, Lyon, France; 8. II Servizio di Radiologia, Ospedali Civili, Brescia, Italy; 9. Radiologia sUD, Ospedale Niguarda Ca' Granda, Milan, Italy; 10. Radiological and Imaging Department, Ospedale Valduce, Como, Italy; 12. Servizio di Diagnostica per Immagini, Como, Italy
Address correspondence to G. Schneider (ragsne{at}uniklinik-saarland.de)
Objective: To determine the diagnostic accuracy of contrast-enhanced MR angiography (CE-MRA) with gadobenate dimeglumine for detection of significant steno-occlusive disease of the renal arteries using digital subtraction angiography (DSA) as reference standard, and to compare findings for CE-MRA with those for unenhanced time-of-flight [TOF] MRA.
Materials and Methods: A total of 293 patients with severe hypertension (82.2%), progressive renal failure (11.3%), or suspected RAS were enrolled. MR angiography was performed before (2D TOF-MRA) and after (3D spoiled gradient-echo MRA) administration of 0.1 mmol/kg gadobenate dimeglumine at 2 mL/sec. DSA (anteroposterior and oblique projections) was performed in 270 subjects. MRA images were evaluated by three blinded reviewers in terms of sensitivity, specificity, accuracy and inter-observer agreement for detection of significant (=50%) steno-occlusive disease using DSA as reference standard.
Results: Overall, 190/268 subjects evaluated with both MRA and DSA had significant steno-occlusive disease on DSA. Significantly (p < 0.001) greater sensitivity, specificity and accuracy for detection of =50% stenosis/occlusion was noted for CE-MRA (60%–84%, 89%–95%, 80%–87%, respectively) compared to TOF-MRA (28–42%, 68–87%, 53–66%, respectively) relative to DSA. Very few CE-MRA examinations were inadequate for technical reasons (2–3% vs. 14–29% for TOF-MRA; p < 0.001). Significantly (p < 0.0001) better inter-observer agreement was determined for CE-MRA (87.9% agreement; kappa = 0.69) compared to TOF-MRA (57.0%; kappa = 0.43).
Conclusion: CE-MRA performed with 0.1 mmol/kg gadobenate dimeglumine provides high sensitivity, specificity and accuracy for detection of significant renal artery steno-occlusive disease compared to DSA and is significantly superior to TOF-MRA in terms of diagnostic performance and reproducibility.
118. 16-detector Row Multislice CT Angiography of Aortoiliac and Lower Extremity Arteries–Comparison with Digital Subtraction Angiography
Meyer B.*; Albrecht T. Charite, Campus Benjamin Franklin, Berlin, Germany
Address correspondence to B. Meyer (bernhard.meyer{at}charite.de)
Objective: To compare 16-detector row CT angiography (CTA) and digital subtraction angiography (DSA) in patients with steno-occlusive disease of the peripheral arteries with regards to image quality, grading of steno-occlusive lesions, visualization of collaterals, impact on patient management and time required for image analysis.
Materials and Methods: The study was conducted with IRB approval. Fifty consecutive patients (34 men, 16 women; mean age 65.1 ± 10.9 years) referred for pre-interventional or confirmatory DSA out of 203 patients undergoing CTA of the peripheral arteries between March 2003 and March 2005 were evaluated. CTA images were independently evaluated by two blinded readers. DSA was similarly evaluated independently by two additional blinded readers in consensus. Consensus DSA served as reference standard for comparisons with CTA in terms of diagnostic quality, grading of steno-occlusive lesions, visualization of collaterals, impact on patient management and time required for image analysis.
Results: No significant differences in diagnostic quality were observed between CTA and DSA at arterial levels in the legs. CTA readers 1 and 2 noted significantly (p < 0.001 and p < 0.01, respectively) more diagnostic images of pedal arteries (70 and 72 segments, respectively) than shown on DSA (57 segments). Of 958 steno-occlusive lesions on DSA, CTA readers 1 and 2 detected 933 and 929 lesions, respectively. Sensitivity and specificity for detection of hemodynamically-relevant (>50%) lesions was 93.3% (292/313) and 96.5% (598/620) for reader 1 and 90.1% (281/312) and 95.6% (590/617) for reader 2. Agreement between CTA and DSA was good for both readers (kappa = 0.75 and kappa = 0.64, respectively). Collaterals were seen at 150 arterial levels on DSA compared with 97 and 92 levels at 16D-MDCT (p < 0.05; both readers). Patient management decisions based on CTA were equivalent to those after DSA in 49/50 patients. Analysis of DSA images required an average of 11.8 ± 5 minutes for reader 1 and 9.9 ± 4.4 minutes for reader 2, while CTA images required 18.0 ± 10.9 minutes and 18.7 ± 9.1 minutes, respectively (p < 0.01).
Conclusion: CTA is an effective noninvasive alternative to DSA for the detection of peripheral vascular disease. Collaterals are less well visualized on CTA than on DSA.
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