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Abstract No. 263: Endovascular treatment of pelvic congestion syndrome: A retrospective study in 202 patients
Poster Sessions 䡲 JVIR
S112
three main areas relating to periprocedural care, namely sign in, time out, and sign out, and requires participation from all members of the interventional radiology team. Based on analysis of our initial data, simple errors such as lack of appropriate preprocedural antibiotic prophylaxis have been easily identified and corrected and there has been an increase in the efficiency of periprocedural patient evaluation. Overall, there has been excellent adoption and utilization of the safety checklist by all team members in interventional radiology. Conclusion and/or Teaching Points: The use of a periprocedural safety checklist in interventional radiology enhances patient care and safety without degrading efficiency. Additionally, it provides one simple form that provides pertinent information that is currently scattered throughout many mandatory forms required for compliance with institutional standards, thus allowing for the potential to simplify and eliminate some of these forms. It is likely that given the rapid adoption of similar checklists in the surgical arena, it is a matter of time before hospitals and payers require interventional radiology departments to comply with similar requirements. Given interventional radiology’s track record of leadership and innovation at the forefront of medicine, we recommend implementation of a periprocedural safety checklist in interventional radiology.
Genitourinary Interventions
Stent deployment was successful in all cases. No significant differences in prostate size between groups were identified at any studied timepoints. At day 30 after deployment, partial vesical migration was seen in two animals of the paclitaxel group and 1 belonging to the finasteride group, and complete vesical migration in 2 animals from the finasteride group. At day 60, all partial migrations had progressed to complete. All animals voided normally through the study. Pathology showed varying degrees of chronic irritation, with inflammatory cell infiltration and fibrosis in the glandular parenchyma. Prostate glandular atrophy was seen in the stented areas in both groups (graded 2 in a 0 to 3 semiquantitative scale). Conclusion: Prostate DES may induce glandular atrophy after 60 days. No difference in effectiveness was seen between Finasteride or Paclitaxel drug-eluting stents in the hormone- induced benign prostatic hyperplasia (BPH) canine model. Stent migration remains an issue that needs to be addressed in prostatic urethral stenting using covered stents.
Abstract No. 263 Endovascular treatment of pelvic congestion syndrome: A retrospective study in 202 patients A. Laborda1, J. Medrano1,2, I. Urtiaga3, A. Mainar1,2, M. Sanchez Ballestin1,2, C. Serrano1, R. FernandezParra1, M.A. de Gregorio1,2; 1GITMI-Universidad de Zaragoza, Zaragoza, Spain; 2IR, Lozano Blesa Clinical Hospital, Zaragoza, Spain; 3Vascular Surgery, Lozano Blesa Clinical Hospital, Zaragoza, Spain
Abstract No. 262 Drug-eluting stents for the management of benign prostatic hyperplasia: An experimental study in a canine model
Poster Sessions
V. Crisostomo1, M. Maynar2,3, F. Sun1, H. Song4, J. Usón1, F.M. Sanchez-Margallo1; 1Jesus Uson Minimally Invasive Surgery Centre, Caceres, Spain; 2 Hospiten Rambla, Santa Cruz de Tenerife, Spain; 3Las Palmas de Gran Canaria University, Las Palmas de Gran Canaria, Spain; 4Dept of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea Purpose: To evaluate the use of paclitaxel or finasteride drugeluting stents in a canine model of hormone induced benign prostatic hyperplasia (BPH). Materials and Methods: A BPH model was created in 10 adult surgically castrated male beagles by the administration of a combination of steroid hormones during 5 months. Drug-eluting stents (DES) were prepared by dipping 15x20mm nitinol stents in a polyurethane solution including 10% paclitaxel or finasteride. Animals were randomly allocated to either paclitaxel (Group A, n⫽5) or finasteride- (Group B, n⫽5) eluting stents. Stents were deployed under fluoroscopic guidance 120 days after the beginning of the study. Transrectal ultrasound was performed by an operator blinded to the animals’ group to measure the prostate size before hormonal therapy, immediately before stenting, and at 30 and 60 days after stent deployment. Dogs were then euthanized and pathological study performed. Results: Prior to stents deployment, prostatic volumes increased significantly (p ⬍ 0.001) from 1.60 ⫾ 0.80cc to 44.94 ⫾ 10.62cc.
Purpose: To present a retrospective series of 202 patients suffering from pelvic congestion syndrome (PCS) treated by embolotherapy. Materials and Methods: 202 patients were recruited in a single center (mean age 43.5 years; range 27–57). Inclusion criteria were: patients with chronic pelvic pain for more than 6 months without evidence of other causes, increased venous caliber (⬎6 mm) in US and 1 of the following criteria: venous ectasia, venous reflux or presence of communicating veins by transvaginal US Doppler. US findings were confirmed by angiography. Both ovarian and hypogastric veins were embolised in all cases using different size coils. Pain level of the patients was assessed pre and post embolotherapy and in follow-up using a visual analogue scale (VAS). The patients filled in our own questionnaire to evaluate the grade of satisfaction and changes that affect their quality of life. Clinical and US-Doppler studies were recorded in the follow-up (1, 3, 6 and 12 months. The patients were clinically reevaluated by phone each year for 5 years (pain, complications, new symptoms). Results: Technical success was achieved in 100% of the cases and clinical success (improvement or disappearance of symptoms at discharge) in all patients, with total disappearance symptoms in 29 patients (15%). Mean follow-up was of 44 months (range 3– 60 months) with total disappearance of symptoms at the end of follow-up in 68% of the patients (the other 32% showed slight pain, ⬍3 in VAS). Complications were: abdominal pain postembolization (23 cases), groin haematoma (6 cases), coil migration (4 cases), and reaction to contrast media (1 case). The degree of satisfaction recorded by the patients was over 7/10 in 89% of the patients. Conclusion: Embolisation of the ovarian and internal iliac veins is a feasible and technically easy procedure that improves the
JVIR 䡲 Poster Sessions
S113
clinical symptoms of pelvic congestion syndrome, which correlates with a high degree of satisfaction in the patients.
Abstract No. 264 How to perform every uterine fibroid embolization as an outpatient procedure J.M. Pisco, M. Duarte, T. Bilhim, H. Rio Tinto; Saint Louis Hospital, Lisbon, Portugal Purpose: To evaluate whether it is feasible and safe to perform every uterine fibroid embolization (UFE) as an outpatient procedure, with the use of a specific mediation protocol. Materials and Methods: Six hundred and fourteen patients (age range 23–59 years; mean age 40.9) with symptomatic fibroids underwent UFE with polyvinyl alcohol particles or Embozene microspheres between January 2007 and March 2010. Patients were given acid-suppressing drugs, non-steroidal, anti-inflammatory drugs and anti-histaminic drugs twice a day, for 2 days before UFE and once on the morning of UFE. Just before the procedure the same medication plus other anti-inflammatory and analgesic were given orally. During and after embolization anti-inflammatory, analgesic and anti-emetic drugs were given intravenously. At discharge the patients were medicated with anti- inflammatory and analgesic drugs given orally plus an anti-emetic as suppositories. Pain score rated from 0 to 10 was evaluated using a numeric pain scale during UFE, after the procedure, at discharge, at the night of discharge and on the following morning. The results of UFE were evaluated at 6 months by pelvic magnetic resonance imaging and questionnaires. Results: The mean pain score was 0.6 during embolization, 2.3 after embolization, 0.4 at discharge, 0.9 the first night after discharge and 0.4 the next morning. All patients were discharged from the hospital 3 to 8 hours after the procedure, without any overnight hospital admission or readmission. The volumes of the uterus and dominant fibroid decreased 36.8% and 48.2%, respectively, at 6 months. Conclusion: With acid-suppressing, anti-inflammatory, and antihistaminic drugs started two days before the procedure every UFE can be performed safely as an outpatient procedure.
Abstract No. 265 Transarterial prostatic embolization (TAPE) for benign prostatic hyperplasia and localized prostate cancer: Initial experience in a canine model
Purpose: To prospectively evaluate pathological responses to transarterial prostatic embolization (TAPE) and its technical safety in a canine model. Materials and Methods: The study was approved by the institutional ethics committee for animal research. Ten adult male beagles were surgically castrated and received hormonal therapy
Interventional Oncology Abstract No. 266 Antioxidants taken orally prior to radiation exposure can prevent DNA injury at CT doses of ionizing radiation J. Barfett, S. Spieth, K.J. Murphy, D. Mikulis; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada Purpose: We examine use of the free radical scavengers vitamin C (VC), glutathione (GL) and uric acid (UA) as a pre-medication strategy prior to radiation exposures typical of medical imaging studies. Our intent was to develop a simple cocktail of antioxidants to be taken orally prior to X-Ray exposures that can protect a patient’s DNA against free radical mediated radiation injury. Materials and Methods: In all experiments, blood was drawn from two study volunteers in duplicate, creating four individual tests per data point. Firstly, in vitro at 2Gy of gamma irradiation, DNA protection was tested after supplementation into blood tubes of an additional 0.02, 0.2 and 3.8 mM of VC and 0.05 mM GL. Secondly, an additional 0.16mM of VC supplementation was tested in vitro against controls at diagnostic doses of IR (15 min standardized fluoroscopy exposure). Finally, the volunteers were pre-medicated with an antioxidant cocktail (URAC, Summit HealthSciences) PO BID for 5 days to elevate circulating levels of UA, GL and VC. Blood tubes were drawn at day 0 and day 5 from each volunteer and subjected IR via volumetric CT perfusion (4650 DLP). DNA injury was assessed via the H2AX/53PB1 assay in lymphocytes through 3D optical microscopy and computational histologic analysis.
Poster Sessions
F. Sun1, F.M. Sanchez-Margallo1, V. Crisostomo1, J.R. Lima1, L. Luis2, I. Díaz-Gu¨emes1, C. Baez1, V. GarciaMartinez3, C. Lopez-Sanchez3, J. Usón1, M. Maynar4; 1 Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain; 2Biopharma Division, Neuron BPh, S.A., Granada, Spain; 3Faculty of Medicine, University of Extremadura, Badajoz, Spain; 4HOSPITEN, Santa Cruz de Tenerife, Spain
for 4 months to induce prostatic hyperplasia. At month 3, the beagles were randomly assigned to TAPE group (n⫽7) and control group (n⫽3). Animals in the TAPE group underwent embolization using microspheres 300-500 m in diameter. At month 4, all animals were sacrificed for pathological study. Transrectal ultrasound (TRUS) scan and MRI examination were performed to evaluate pathological responses. The data of prostate size acquired by TRUS was processed for statistical analysis using Paired Student t test. Results: The canine prostatic hyperplasia model was successfully created in 10 beagles with increase of mean prostate size up to 572% at the 3rd month of hormonal therapy Intraprostatic cavity was noted 1month after TAPE in all 7 beagles. Four beagles showed significant shrinkage of the prostate, whereas the other 3 beagles showed increase of the prostate size. Imaging examinations and necropsy demonstrated a huge cavity occupying almost the entire prostate in the 3 beagles with increased prostate size. No complications associated with TAPE were encountered. Conclusion: TAPE is a safe procedure that may induce prostatic infarction and ablate prostate gland, suggesting its potential clinical applications in patients with benign prostatic hyperplasia (BPH) and localized prostate cancer (PCa).
S112
three main areas relating to periprocedural care, namely sign in, time out, and sign out, and requires participation from all members of the interventional radiology team. Based on analysis of our initial data, simple errors such as lack of appropriate preprocedural antibiotic prophylaxis have been easily identified and corrected and there has been an increase in the efficiency of periprocedural patient evaluation. Overall, there has been excellent adoption and utilization of the safety checklist by all team members in interventional radiology. Conclusion and/or Teaching Points: The use of a periprocedural safety checklist in interventional radiology enhances patient care and safety without degrading efficiency. Additionally, it provides one simple form that provides pertinent information that is currently scattered throughout many mandatory forms required for compliance with institutional standards, thus allowing for the potential to simplify and eliminate some of these forms. It is likely that given the rapid adoption of similar checklists in the surgical arena, it is a matter of time before hospitals and payers require interventional radiology departments to comply with similar requirements. Given interventional radiology’s track record of leadership and innovation at the forefront of medicine, we recommend implementation of a periprocedural safety checklist in interventional radiology.
Genitourinary Interventions
Stent deployment was successful in all cases. No significant differences in prostate size between groups were identified at any studied timepoints. At day 30 after deployment, partial vesical migration was seen in two animals of the paclitaxel group and 1 belonging to the finasteride group, and complete vesical migration in 2 animals from the finasteride group. At day 60, all partial migrations had progressed to complete. All animals voided normally through the study. Pathology showed varying degrees of chronic irritation, with inflammatory cell infiltration and fibrosis in the glandular parenchyma. Prostate glandular atrophy was seen in the stented areas in both groups (graded 2 in a 0 to 3 semiquantitative scale). Conclusion: Prostate DES may induce glandular atrophy after 60 days. No difference in effectiveness was seen between Finasteride or Paclitaxel drug-eluting stents in the hormone- induced benign prostatic hyperplasia (BPH) canine model. Stent migration remains an issue that needs to be addressed in prostatic urethral stenting using covered stents.
Abstract No. 263 Endovascular treatment of pelvic congestion syndrome: A retrospective study in 202 patients A. Laborda1, J. Medrano1,2, I. Urtiaga3, A. Mainar1,2, M. Sanchez Ballestin1,2, C. Serrano1, R. FernandezParra1, M.A. de Gregorio1,2; 1GITMI-Universidad de Zaragoza, Zaragoza, Spain; 2IR, Lozano Blesa Clinical Hospital, Zaragoza, Spain; 3Vascular Surgery, Lozano Blesa Clinical Hospital, Zaragoza, Spain
Abstract No. 262 Drug-eluting stents for the management of benign prostatic hyperplasia: An experimental study in a canine model
Poster Sessions
V. Crisostomo1, M. Maynar2,3, F. Sun1, H. Song4, J. Usón1, F.M. Sanchez-Margallo1; 1Jesus Uson Minimally Invasive Surgery Centre, Caceres, Spain; 2 Hospiten Rambla, Santa Cruz de Tenerife, Spain; 3Las Palmas de Gran Canaria University, Las Palmas de Gran Canaria, Spain; 4Dept of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea Purpose: To evaluate the use of paclitaxel or finasteride drugeluting stents in a canine model of hormone induced benign prostatic hyperplasia (BPH). Materials and Methods: A BPH model was created in 10 adult surgically castrated male beagles by the administration of a combination of steroid hormones during 5 months. Drug-eluting stents (DES) were prepared by dipping 15x20mm nitinol stents in a polyurethane solution including 10% paclitaxel or finasteride. Animals were randomly allocated to either paclitaxel (Group A, n⫽5) or finasteride- (Group B, n⫽5) eluting stents. Stents were deployed under fluoroscopic guidance 120 days after the beginning of the study. Transrectal ultrasound was performed by an operator blinded to the animals’ group to measure the prostate size before hormonal therapy, immediately before stenting, and at 30 and 60 days after stent deployment. Dogs were then euthanized and pathological study performed. Results: Prior to stents deployment, prostatic volumes increased significantly (p ⬍ 0.001) from 1.60 ⫾ 0.80cc to 44.94 ⫾ 10.62cc.
Purpose: To present a retrospective series of 202 patients suffering from pelvic congestion syndrome (PCS) treated by embolotherapy. Materials and Methods: 202 patients were recruited in a single center (mean age 43.5 years; range 27–57). Inclusion criteria were: patients with chronic pelvic pain for more than 6 months without evidence of other causes, increased venous caliber (⬎6 mm) in US and 1 of the following criteria: venous ectasia, venous reflux or presence of communicating veins by transvaginal US Doppler. US findings were confirmed by angiography. Both ovarian and hypogastric veins were embolised in all cases using different size coils. Pain level of the patients was assessed pre and post embolotherapy and in follow-up using a visual analogue scale (VAS). The patients filled in our own questionnaire to evaluate the grade of satisfaction and changes that affect their quality of life. Clinical and US-Doppler studies were recorded in the follow-up (1, 3, 6 and 12 months. The patients were clinically reevaluated by phone each year for 5 years (pain, complications, new symptoms). Results: Technical success was achieved in 100% of the cases and clinical success (improvement or disappearance of symptoms at discharge) in all patients, with total disappearance symptoms in 29 patients (15%). Mean follow-up was of 44 months (range 3– 60 months) with total disappearance of symptoms at the end of follow-up in 68% of the patients (the other 32% showed slight pain, ⬍3 in VAS). Complications were: abdominal pain postembolization (23 cases), groin haematoma (6 cases), coil migration (4 cases), and reaction to contrast media (1 case). The degree of satisfaction recorded by the patients was over 7/10 in 89% of the patients. Conclusion: Embolisation of the ovarian and internal iliac veins is a feasible and technically easy procedure that improves the
JVIR 䡲 Poster Sessions
S113
clinical symptoms of pelvic congestion syndrome, which correlates with a high degree of satisfaction in the patients.
Abstract No. 264 How to perform every uterine fibroid embolization as an outpatient procedure J.M. Pisco, M. Duarte, T. Bilhim, H. Rio Tinto; Saint Louis Hospital, Lisbon, Portugal Purpose: To evaluate whether it is feasible and safe to perform every uterine fibroid embolization (UFE) as an outpatient procedure, with the use of a specific mediation protocol. Materials and Methods: Six hundred and fourteen patients (age range 23–59 years; mean age 40.9) with symptomatic fibroids underwent UFE with polyvinyl alcohol particles or Embozene microspheres between January 2007 and March 2010. Patients were given acid-suppressing drugs, non-steroidal, anti-inflammatory drugs and anti-histaminic drugs twice a day, for 2 days before UFE and once on the morning of UFE. Just before the procedure the same medication plus other anti-inflammatory and analgesic were given orally. During and after embolization anti-inflammatory, analgesic and anti-emetic drugs were given intravenously. At discharge the patients were medicated with anti- inflammatory and analgesic drugs given orally plus an anti-emetic as suppositories. Pain score rated from 0 to 10 was evaluated using a numeric pain scale during UFE, after the procedure, at discharge, at the night of discharge and on the following morning. The results of UFE were evaluated at 6 months by pelvic magnetic resonance imaging and questionnaires. Results: The mean pain score was 0.6 during embolization, 2.3 after embolization, 0.4 at discharge, 0.9 the first night after discharge and 0.4 the next morning. All patients were discharged from the hospital 3 to 8 hours after the procedure, without any overnight hospital admission or readmission. The volumes of the uterus and dominant fibroid decreased 36.8% and 48.2%, respectively, at 6 months. Conclusion: With acid-suppressing, anti-inflammatory, and antihistaminic drugs started two days before the procedure every UFE can be performed safely as an outpatient procedure.
Abstract No. 265 Transarterial prostatic embolization (TAPE) for benign prostatic hyperplasia and localized prostate cancer: Initial experience in a canine model
Purpose: To prospectively evaluate pathological responses to transarterial prostatic embolization (TAPE) and its technical safety in a canine model. Materials and Methods: The study was approved by the institutional ethics committee for animal research. Ten adult male beagles were surgically castrated and received hormonal therapy
Interventional Oncology Abstract No. 266 Antioxidants taken orally prior to radiation exposure can prevent DNA injury at CT doses of ionizing radiation J. Barfett, S. Spieth, K.J. Murphy, D. Mikulis; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada Purpose: We examine use of the free radical scavengers vitamin C (VC), glutathione (GL) and uric acid (UA) as a pre-medication strategy prior to radiation exposures typical of medical imaging studies. Our intent was to develop a simple cocktail of antioxidants to be taken orally prior to X-Ray exposures that can protect a patient’s DNA against free radical mediated radiation injury. Materials and Methods: In all experiments, blood was drawn from two study volunteers in duplicate, creating four individual tests per data point. Firstly, in vitro at 2Gy of gamma irradiation, DNA protection was tested after supplementation into blood tubes of an additional 0.02, 0.2 and 3.8 mM of VC and 0.05 mM GL. Secondly, an additional 0.16mM of VC supplementation was tested in vitro against controls at diagnostic doses of IR (15 min standardized fluoroscopy exposure). Finally, the volunteers were pre-medicated with an antioxidant cocktail (URAC, Summit HealthSciences) PO BID for 5 days to elevate circulating levels of UA, GL and VC. Blood tubes were drawn at day 0 and day 5 from each volunteer and subjected IR via volumetric CT perfusion (4650 DLP). DNA injury was assessed via the H2AX/53PB1 assay in lymphocytes through 3D optical microscopy and computational histologic analysis.
Poster Sessions
F. Sun1, F.M. Sanchez-Margallo1, V. Crisostomo1, J.R. Lima1, L. Luis2, I. Díaz-Gu¨emes1, C. Baez1, V. GarciaMartinez3, C. Lopez-Sanchez3, J. Usón1, M. Maynar4; 1 Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain; 2Biopharma Division, Neuron BPh, S.A., Granada, Spain; 3Faculty of Medicine, University of Extremadura, Badajoz, Spain; 4HOSPITEN, Santa Cruz de Tenerife, Spain
for 4 months to induce prostatic hyperplasia. At month 3, the beagles were randomly assigned to TAPE group (n⫽7) and control group (n⫽3). Animals in the TAPE group underwent embolization using microspheres 300-500 m in diameter. At month 4, all animals were sacrificed for pathological study. Transrectal ultrasound (TRUS) scan and MRI examination were performed to evaluate pathological responses. The data of prostate size acquired by TRUS was processed for statistical analysis using Paired Student t test. Results: The canine prostatic hyperplasia model was successfully created in 10 beagles with increase of mean prostate size up to 572% at the 3rd month of hormonal therapy Intraprostatic cavity was noted 1month after TAPE in all 7 beagles. Four beagles showed significant shrinkage of the prostate, whereas the other 3 beagles showed increase of the prostate size. Imaging examinations and necropsy demonstrated a huge cavity occupying almost the entire prostate in the 3 beagles with increased prostate size. No complications associated with TAPE were encountered. Conclusion: TAPE is a safe procedure that may induce prostatic infarction and ablate prostate gland, suggesting its potential clinical applications in patients with benign prostatic hyperplasia (BPH) and localized prostate cancer (PCa).