- Email: [email protected]
First experiences with superselective TANDEM® TACE in Heidelberg
S150
Posters and Exhibits
po0.0001). Patients with stage 3B/4 CKD were significantly more likely to undergo amputation (N ¼ 17/66, RR ¼ 1.8, p ¼ 0.04). In those with TASC C/D lesions and stage 5 CKD, there was a statistically significant risk of amputation and a trend toward major amputation (N ¼ 4/6 and 3/6, RR ¼ 5.9 and 3.0, p ¼ 0.002 and 0.09). In both TASC subgroups, mortality increased with CKD severity. There were no differences in restenosis in either group. Conclusion: Chronic kidney disease has a negative effect on amputation free survival. The negative correlation of CKD with amputation free survival was more consistent in the TASC A/B subgroup, although stage 5 CKD correlated with worse outcomes in both subgroups.
Abstract No. 331 Instituting a hospital central venous access policy for peripheral vein preservation in chronic kidney disease (CKD) patients: a 12-year experience
Posters and Exhibits
B.L. Yam, S. Trerotola; Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA Purpose: PICC are associated with a high thrombosis rate in peripheral arm veins and are thus contraindicated in the CKD population due to future hemodialysis access needs. We describe a single institutional experience with implementation of nursing-based venous access team (VAT) and IR standardized protocols in accordance with K/DOQI guidelines to provide central venous access while preserving peripheral veins in patients with CKD. Materials and Methods: Retrospective review of PICC and small bore central catheter (SBCC, identical device to PICC placed via IJ, tunneled subcutaneously) referral and placement data from VAT and IR QA databases and radiology reports was conducted. Total number of PICC requested and VAT referrals to IR for SBCC placement between September 2001 and April 2013 were identified. SBCC referral was automatic for patients with creatinine Z3 or renal transplant regardless of creatinine, unless dialysis was not planned (eg, hospice care). All IR SBCC insertions (regardless of referral source) during the study period were identified and reviewed. Of these, SBCC placement resulting from K/DOQI PICC contraindication were identified. Technical success, immediate complications, indications, and access sites were ascertained. Infection and thrombosis rates were outside the scope of this study. Results: During the 12-year period 35,781 requests for PICC placement were made to the VAT. 1,889 of these were referred to IR for SBCC per institutional policy. 2,201 SBCC were newly placed during this period, 1,879 resulting from K/DOQI contraindication. Technical success rate of SBCC placement was 98%. 7 minor (0.3%) and 3 major (0.1%) immediate complications occurred. The main indication for SBCC was antibiotics (59%). Other common indications included TPN, fluids, inotropes, and chemotherapy. Access sites included right IJV (70%), left IJV (24%), right EJV (3%), left EJV (2%), right CFV (0.3%) and left CFV (0.2%). Conclusion: Automatic referral for SBCC in CKD patients via VAT and IR protocols can eliminate PICC placement and thereby protect peripheral veins needed for hemodialysis. SBCC placement has a high technical success rate and a low immediate complication rate.
’
JVIR
Abstract No. 332 Carbon dioxide digital subtraction angiography: an alternative for detection endoleaks at endovascular abdominal aortic aneurysm repairs procedure E. Sueyoshi, H. Nagayama, I. Sakamoto, M. Uetani; Nagasaki University, Nagasaki, Japan Purpose: The purpose of this study is to evaluate CO2- digital subtraction angiography (CO2-DSA) as an alternative for detection endoleak (EL) at EVAR procedure, comparing with iodinated conventional DSA (C-DSA). Materials and Methods: Thirty-seven patients with infrarenal AAA who were scheduled to undergo EVAR were enrolled in the study. All patients had both C-DSA and CO2-DSA immediately after EVAR. All patients were followed by CT over 6 months after EVAR. We evaluated the C-DSA and CO2DSA results for the presence or absence of an EL. Identified ELs were classified by types. The sensitivity and specificity were calculated for the ability of CO2-DSA to detect ELs. We also correlated with CT findings at 6 months after EVAR. Results: C-DSA showed that 26 of the 37 patients (70%) were identified to have a total of 27 ELs (type I;4, type II;20, type III;3, type IV;0). On the other hands, CO2-DSA showed that 16 of the 37 patients (43%) were identified to have a total of 17 EL (type I;4, type II;10, type III;3, type IV;0). For the detection of high flow type ELs (type I and III) using C-DSA as the criterion standard, CO2-DSA has a sensitivity of 100% and a specificity of 100%. For the detection of type II ELs, CO2-DSA has a sensitivity of 45% and a specificity of 100%.Based on CT findings after 6 months from EVAR, 9 of 20 type II ELs identified by C-DSA (45%) progressed to persistent type II ELs. For the detection of progressed persistent type II ELs, CO2-DSA has a sensitivity of 100% and a specificity of 96%. On the other hand, C-DSA has a sensitivity of 100% and a specificity of 61%. Conclusion: CO2-DSA is reliable for prediction of persistent type II endoleaks in EVAR. CO2-DSA is alternative to C-DSA to detect the ELs at EVAR procedure.
Abstract No. 333 First experiences with superselective TANDEMs TACE in Heidelberg A. Schmitz1, D.M. Gnutzmann1, N. Bellemann1, T. Mokry1, N. Kortes1, C. Sommer1, D. Gotthard2, K. Weiss2, U. Stampfl1, B.A. Radeleff1, H. Kauczor1; 1 Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; 2Department of Internal Medicine IV, Gastroenterology, Hepatology, Infectious Diseases, Intoxications, University Hospital Heidelberg, Heidelberg, Germany Purpose: We evaluated prospectively the morphological and clinical outcome after DEB-TACE with TANDEMs particles (tightly calibrated, drug elutable microspheres) in irresectable patients suffering from HCCs. Materials and Methods: From 05/2012 - 09/13 28 patients (23 male; 5 female) with a mean age of 59.5 years (range of 46-74) and HCC underwent TANDEMs TACE (100 and 75 μm
JVIR
’
Posters and Exhibits
S151
particle size) in obligative superselective technique until stasis of 2nd order branches. If necessary additional Embozene (100μm in HCC o6 cm diameter or 250μm in HCC 46 cm) used until stasis was reached. Primary study endpoints were time to progression and overall survival. Secondary study endpoints were the evaluation of tumor control, safety, the appearance of PES (post-embolization syndrome) and quality of life. Results: In all patients (n¼26), who underwent the first control MRI tumor control was achieved: n¼3 stable disease (SD); n¼9 partial response (PR); n¼14 complete remission (CR) according to the EASL criteria. Until today a 6 month follow up MRI was accomplished in twelve patients with a high tumor control rate (67%): n¼0 SD, n¼1 PR, n¼7 CR and 4 progressive disease (PD). N¼§§ Patients with PD underwent again a TACE procedure into SD. PES occurred in o50% with pain and nausea. Average of patients discharge was 3 days after TACE. Conclusion: TANDEMs TACE is feasible and efficient with a high rate of tumor control after 6 month (67%). Just low postembolisation-syndrom and low adverse events peri- and postinterventionel appeared under standard i.v. medication.
Abstract No. 334 Importance of variance in operator technique towards reducing the radiation dose during fluoroscopic procedures N.G. Miller, L.V. Leite, S. Laroia; Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
Abstract No. 335 Initial clinical experience with a novel microcatheter-deliverable vascular plug A. Moin, M. Kirk, G. Jindal, J.W. Mitchell, B. Swehla, F.M. Moeslein; Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, MD Purpose: To discuss and evaluate the efficacy of the MVP™ Micro Vascular Plug system, a self-expanding vessel occlusion device, in peripheral and neurovascular applications. Materials and Methods: A retrospective review was conducted of six cases from August to September 2013, two cases of neurotrauma and four cases of hepatic arterial mapping prior to Y90 radioembolization. All six cases utilized the MVP-3 Micro Vascular Plug system for embolization, a self-expanding occlusion device comprised of nitinol and a partial PTFE cover intended for vessels ranging from 1.5 to 3.0 mm in diameter deliverable through a 0.021 inch inner diameter microcatheter. Results: Prompt and complete occlusion of the target vessels was observed in all six cases without a necessity for a secondary embolization agent. Target vessels included vertebral, lingual, segmental hepatic, gastroduodenal, and supraduodenal arteries. Two vascular plugs were required in one of the neurointerventions given the complexity of the traumatic injury. No significant migration of the plugs was observed. Conclusion: The MVP™ Micro Vascular Plug system, currently available in the United States in a 3-mm system and deliverable through a 0.021 inch microcatheter, was effective in prompt occlusion of target vessels in both peripheral and neurovascular applications.
Abstract No. 336 Risk of rebleeding and death following bronchial artery embolization among patients with sarcoidosis L. Tom1, H.I. Palevsky2, D.S. Holsclaw2, T.W. Clark1; 1 Interventional Radiology, University of Pennsylvania, Philadelphia, PA; 2Medicine (Pulmonology), University of Pennsylvania, Philadelphia, PA Purpose: Bronchial artery embolization (BAE) is used to arrest hemoptysis in patients with inflammatory, infectious and neoplastic conditions. We compared rebleeding and mortality among patients undergoing BAE according to underlying pulmonary disease. Materials and Methods: A prospective QA database was used to identify a study cohort of 72 patients (45 males: 27 females) who underwent 100 consecutive BAE sessions at a tertiary academic medical center over 11 years. Patients each underwent 1 to 7 BAE sessions. 26 BAE were done in 13 patients with sarcoidosis (26% of BAE; 18% of patients). 74 BAE were done in 59 patients with other etiologies of hemoptysis, including cystic fibrosis (n¼12), lung cancer (n¼8), and bronchiectasis (n¼ 11). Rebleeding risk and survival was compared between sarcoid and non-sarcoid patients using the Kaplan-Meier technique.
Posters and Exhibits
Purpose: Due to well-known immediate and chronic effects of radiation dose administration to patients, are appropriately invested in using radiation safety techniques. Although several studies have measured the average dose rate received by patients per procedure type, there has not yet (to our knowledge) been a study to assess the effect of operator technique and patient radiation dose. The purpose of our study is to evaluate three fluoroscopy techniques at our facility in order to ascertain if the variations in these techniques results in a significant impact on the patient’s received radiology dose. Materials and Methods: We extracted the data from reports of temporary and permanent dialysis catheter placements by three different interventionalists in our facility from January 1, 2012 and December 31, 2012. It was assumed that there would be relative intra-operator consistency in techniques used between cases during these fairly-standardized procedures. Thus, a significant difference in dose received in patient groups as designated by operator would likely be related to each operator’s difference in technique. A total of 257 records were pulled in this way. Outliers (significant alteration in procedure course, missing data, or 4 2 standard deviations from the mean per operator) were discarded. An analysis of variance (ANOVA) test was performed on the remaining 229 cases to assess for a significant variance in radiation dose received by operator technique. Results: ANOVA analyses showed that there was a significant relationship between the variance in radiation dose received for both permanent catheter placements - F(2,111) ¼ 4.64, po.05 and temporary catheter placements, F(2,112) ¼ 3.58, po.05. Conclusion: These results show that differences in fluoroscopy technique make a significant difference in radiation dose received by patients during standardized procedures. In other words, efforts to use radiation-saving techniques (i.e. pulse
sequence instead of continuous, collimation, “screen capture” techniques, etc. would likely result in a meaningful reduction in radiation dose received).
Posters and Exhibits
po0.0001). Patients with stage 3B/4 CKD were significantly more likely to undergo amputation (N ¼ 17/66, RR ¼ 1.8, p ¼ 0.04). In those with TASC C/D lesions and stage 5 CKD, there was a statistically significant risk of amputation and a trend toward major amputation (N ¼ 4/6 and 3/6, RR ¼ 5.9 and 3.0, p ¼ 0.002 and 0.09). In both TASC subgroups, mortality increased with CKD severity. There were no differences in restenosis in either group. Conclusion: Chronic kidney disease has a negative effect on amputation free survival. The negative correlation of CKD with amputation free survival was more consistent in the TASC A/B subgroup, although stage 5 CKD correlated with worse outcomes in both subgroups.
Abstract No. 331 Instituting a hospital central venous access policy for peripheral vein preservation in chronic kidney disease (CKD) patients: a 12-year experience
Posters and Exhibits
B.L. Yam, S. Trerotola; Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA Purpose: PICC are associated with a high thrombosis rate in peripheral arm veins and are thus contraindicated in the CKD population due to future hemodialysis access needs. We describe a single institutional experience with implementation of nursing-based venous access team (VAT) and IR standardized protocols in accordance with K/DOQI guidelines to provide central venous access while preserving peripheral veins in patients with CKD. Materials and Methods: Retrospective review of PICC and small bore central catheter (SBCC, identical device to PICC placed via IJ, tunneled subcutaneously) referral and placement data from VAT and IR QA databases and radiology reports was conducted. Total number of PICC requested and VAT referrals to IR for SBCC placement between September 2001 and April 2013 were identified. SBCC referral was automatic for patients with creatinine Z3 or renal transplant regardless of creatinine, unless dialysis was not planned (eg, hospice care). All IR SBCC insertions (regardless of referral source) during the study period were identified and reviewed. Of these, SBCC placement resulting from K/DOQI PICC contraindication were identified. Technical success, immediate complications, indications, and access sites were ascertained. Infection and thrombosis rates were outside the scope of this study. Results: During the 12-year period 35,781 requests for PICC placement were made to the VAT. 1,889 of these were referred to IR for SBCC per institutional policy. 2,201 SBCC were newly placed during this period, 1,879 resulting from K/DOQI contraindication. Technical success rate of SBCC placement was 98%. 7 minor (0.3%) and 3 major (0.1%) immediate complications occurred. The main indication for SBCC was antibiotics (59%). Other common indications included TPN, fluids, inotropes, and chemotherapy. Access sites included right IJV (70%), left IJV (24%), right EJV (3%), left EJV (2%), right CFV (0.3%) and left CFV (0.2%). Conclusion: Automatic referral for SBCC in CKD patients via VAT and IR protocols can eliminate PICC placement and thereby protect peripheral veins needed for hemodialysis. SBCC placement has a high technical success rate and a low immediate complication rate.
’
JVIR
Abstract No. 332 Carbon dioxide digital subtraction angiography: an alternative for detection endoleaks at endovascular abdominal aortic aneurysm repairs procedure E. Sueyoshi, H. Nagayama, I. Sakamoto, M. Uetani; Nagasaki University, Nagasaki, Japan Purpose: The purpose of this study is to evaluate CO2- digital subtraction angiography (CO2-DSA) as an alternative for detection endoleak (EL) at EVAR procedure, comparing with iodinated conventional DSA (C-DSA). Materials and Methods: Thirty-seven patients with infrarenal AAA who were scheduled to undergo EVAR were enrolled in the study. All patients had both C-DSA and CO2-DSA immediately after EVAR. All patients were followed by CT over 6 months after EVAR. We evaluated the C-DSA and CO2DSA results for the presence or absence of an EL. Identified ELs were classified by types. The sensitivity and specificity were calculated for the ability of CO2-DSA to detect ELs. We also correlated with CT findings at 6 months after EVAR. Results: C-DSA showed that 26 of the 37 patients (70%) were identified to have a total of 27 ELs (type I;4, type II;20, type III;3, type IV;0). On the other hands, CO2-DSA showed that 16 of the 37 patients (43%) were identified to have a total of 17 EL (type I;4, type II;10, type III;3, type IV;0). For the detection of high flow type ELs (type I and III) using C-DSA as the criterion standard, CO2-DSA has a sensitivity of 100% and a specificity of 100%. For the detection of type II ELs, CO2-DSA has a sensitivity of 45% and a specificity of 100%.Based on CT findings after 6 months from EVAR, 9 of 20 type II ELs identified by C-DSA (45%) progressed to persistent type II ELs. For the detection of progressed persistent type II ELs, CO2-DSA has a sensitivity of 100% and a specificity of 96%. On the other hand, C-DSA has a sensitivity of 100% and a specificity of 61%. Conclusion: CO2-DSA is reliable for prediction of persistent type II endoleaks in EVAR. CO2-DSA is alternative to C-DSA to detect the ELs at EVAR procedure.
Abstract No. 333 First experiences with superselective TANDEMs TACE in Heidelberg A. Schmitz1, D.M. Gnutzmann1, N. Bellemann1, T. Mokry1, N. Kortes1, C. Sommer1, D. Gotthard2, K. Weiss2, U. Stampfl1, B.A. Radeleff1, H. Kauczor1; 1 Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; 2Department of Internal Medicine IV, Gastroenterology, Hepatology, Infectious Diseases, Intoxications, University Hospital Heidelberg, Heidelberg, Germany Purpose: We evaluated prospectively the morphological and clinical outcome after DEB-TACE with TANDEMs particles (tightly calibrated, drug elutable microspheres) in irresectable patients suffering from HCCs. Materials and Methods: From 05/2012 - 09/13 28 patients (23 male; 5 female) with a mean age of 59.5 years (range of 46-74) and HCC underwent TANDEMs TACE (100 and 75 μm
JVIR
’
Posters and Exhibits
S151
particle size) in obligative superselective technique until stasis of 2nd order branches. If necessary additional Embozene (100μm in HCC o6 cm diameter or 250μm in HCC 46 cm) used until stasis was reached. Primary study endpoints were time to progression and overall survival. Secondary study endpoints were the evaluation of tumor control, safety, the appearance of PES (post-embolization syndrome) and quality of life. Results: In all patients (n¼26), who underwent the first control MRI tumor control was achieved: n¼3 stable disease (SD); n¼9 partial response (PR); n¼14 complete remission (CR) according to the EASL criteria. Until today a 6 month follow up MRI was accomplished in twelve patients with a high tumor control rate (67%): n¼0 SD, n¼1 PR, n¼7 CR and 4 progressive disease (PD). N¼§§ Patients with PD underwent again a TACE procedure into SD. PES occurred in o50% with pain and nausea. Average of patients discharge was 3 days after TACE. Conclusion: TANDEMs TACE is feasible and efficient with a high rate of tumor control after 6 month (67%). Just low postembolisation-syndrom and low adverse events peri- and postinterventionel appeared under standard i.v. medication.
Abstract No. 334 Importance of variance in operator technique towards reducing the radiation dose during fluoroscopic procedures N.G. Miller, L.V. Leite, S. Laroia; Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
Abstract No. 335 Initial clinical experience with a novel microcatheter-deliverable vascular plug A. Moin, M. Kirk, G. Jindal, J.W. Mitchell, B. Swehla, F.M. Moeslein; Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, MD Purpose: To discuss and evaluate the efficacy of the MVP™ Micro Vascular Plug system, a self-expanding vessel occlusion device, in peripheral and neurovascular applications. Materials and Methods: A retrospective review was conducted of six cases from August to September 2013, two cases of neurotrauma and four cases of hepatic arterial mapping prior to Y90 radioembolization. All six cases utilized the MVP-3 Micro Vascular Plug system for embolization, a self-expanding occlusion device comprised of nitinol and a partial PTFE cover intended for vessels ranging from 1.5 to 3.0 mm in diameter deliverable through a 0.021 inch inner diameter microcatheter. Results: Prompt and complete occlusion of the target vessels was observed in all six cases without a necessity for a secondary embolization agent. Target vessels included vertebral, lingual, segmental hepatic, gastroduodenal, and supraduodenal arteries. Two vascular plugs were required in one of the neurointerventions given the complexity of the traumatic injury. No significant migration of the plugs was observed. Conclusion: The MVP™ Micro Vascular Plug system, currently available in the United States in a 3-mm system and deliverable through a 0.021 inch microcatheter, was effective in prompt occlusion of target vessels in both peripheral and neurovascular applications.
Abstract No. 336 Risk of rebleeding and death following bronchial artery embolization among patients with sarcoidosis L. Tom1, H.I. Palevsky2, D.S. Holsclaw2, T.W. Clark1; 1 Interventional Radiology, University of Pennsylvania, Philadelphia, PA; 2Medicine (Pulmonology), University of Pennsylvania, Philadelphia, PA Purpose: Bronchial artery embolization (BAE) is used to arrest hemoptysis in patients with inflammatory, infectious and neoplastic conditions. We compared rebleeding and mortality among patients undergoing BAE according to underlying pulmonary disease. Materials and Methods: A prospective QA database was used to identify a study cohort of 72 patients (45 males: 27 females) who underwent 100 consecutive BAE sessions at a tertiary academic medical center over 11 years. Patients each underwent 1 to 7 BAE sessions. 26 BAE were done in 13 patients with sarcoidosis (26% of BAE; 18% of patients). 74 BAE were done in 59 patients with other etiologies of hemoptysis, including cystic fibrosis (n¼12), lung cancer (n¼8), and bronchiectasis (n¼ 11). Rebleeding risk and survival was compared between sarcoid and non-sarcoid patients using the Kaplan-Meier technique.
Posters and Exhibits
Purpose: Due to well-known immediate and chronic effects of radiation dose administration to patients, are appropriately invested in using radiation safety techniques. Although several studies have measured the average dose rate received by patients per procedure type, there has not yet (to our knowledge) been a study to assess the effect of operator technique and patient radiation dose. The purpose of our study is to evaluate three fluoroscopy techniques at our facility in order to ascertain if the variations in these techniques results in a significant impact on the patient’s received radiology dose. Materials and Methods: We extracted the data from reports of temporary and permanent dialysis catheter placements by three different interventionalists in our facility from January 1, 2012 and December 31, 2012. It was assumed that there would be relative intra-operator consistency in techniques used between cases during these fairly-standardized procedures. Thus, a significant difference in dose received in patient groups as designated by operator would likely be related to each operator’s difference in technique. A total of 257 records were pulled in this way. Outliers (significant alteration in procedure course, missing data, or 4 2 standard deviations from the mean per operator) were discarded. An analysis of variance (ANOVA) test was performed on the remaining 229 cases to assess for a significant variance in radiation dose received by operator technique. Results: ANOVA analyses showed that there was a significant relationship between the variance in radiation dose received for both permanent catheter placements - F(2,111) ¼ 4.64, po.05 and temporary catheter placements, F(2,112) ¼ 3.58, po.05. Conclusion: These results show that differences in fluoroscopy technique make a significant difference in radiation dose received by patients during standardized procedures. In other words, efforts to use radiation-saving techniques (i.e. pulse
sequence instead of continuous, collimation, “screen capture” techniques, etc. would likely result in a meaningful reduction in radiation dose received).