- Email: [email protected]
Streamlining a vascular referral service line through the use of a portable vascular laboratory
JVIR
’
Posters and Exhibits
S159
Materials and Methods: Review of our procedural database revealed 44 patients treated with radioembolization for HCC between 9/2007 and 2/2012. From 9/05 to 2/2009, 84 patients were treated with bland embolization for HCC. Patients with unifocal disease, portal vein thrombosis, extrahepatic disease, or Okuda stage III disease were excluded from subsequent analysis. The final study population consisted of 29 patients who underwent bland embolization (24 males, mean age 63 years) and 29 patients who underwent radioembolization (20 males, mean age 69 years). Clinical records were retrospectively reviewed. Survival rates were estimated using the Kaplan-Meier method and compared using the log rank test. Results: A total of 31 bland embolization procedures were performed in 29 patients. Thirty-seven radioembolization procedures were performed in 29 patients. The 6 and 12 month survival rates for patients undergoing bland embolization were 86% and 71% respectively, compared to 83% and 60% for patients undergoing radioembolization (p¼0.057). Analysis of Okuda staging revealed that 31% of patients undergoing bland embolization were stage I compared to 86% of patients undergoing radioembolization (po0.01). Conclusion: In this retrospective study, bland embolization and radioembolization demonstrated comparable overall survival rates for patients with multifocal HCC and without portal vein thrombus. However, the patients treated with bland embolization in this study had a higher Okuda disease stage than those treated with radioembolization.
Educational Exhibit
Abstract No. 371
Streamlining a vascular referral service line through the use of a portable vascular laboratory J. Cannell, M. Montgomery; Texas AandM HSC - Scott and White Memorial Hospital, Temple, TX
Educational Exhibit
Abstract No. 372
Intraoperative major trauma embolization: initial experience and TIPS for success in establish a hemorrhage control team D.A. Valenti1, T. Razek2, V. Demers1, S. Kaduri1, A. Bessissow1, R.W. Lindsay1, C. Torres1, T. Cabrera1, L.N. Boucher1; 1Radiology, McGill University, Montreal, QC, Canada; 2Surgery, McGill University, Montreal, QC, Canada Learning Objectives: To outline basic selection criteria for intra-operative vs IR suite embolization. To review some pitfalls and roadblocks to success. Discuss keys for prompt response time and short procedural times. Background: A subset of severe poly-trauma patients are too unstable to be successfully imaged by CT and transferred to the IR suite. These patients require urgent transfer to the OR for stabilization and support. Nonetheless, some of these patients can benefit from embolization intra-operatively, as certain pelvic and parenchymal organ hemorrhage may be easier to control angiographically than surgically. Clinical Findings/Procedure Details: Basic materials required required for intra-operative angiography will be outlined as well as strategies to reduce response and procedure time. Conclusion and/or Teaching Points: Intra-operative angiographic hemorrhage control has become an essential part of our Trauma team. It is especially useful in those patients with such massive hemorrhage and severe hemodynamic instability that transfer to an OR setting is required just to maintain a minimum blood pressure. High clinical success rates are achievable despite challenging technical conditions.
Educational Exhibit
Abstract No. 373
Splenic artery embolization as treatment for splenic artery steal syndrome after liver transplantation D.V. Strain1, P. Brady1, T. Matalon1, M. Horrow1, J. Ortiz2, A. Parsikia2; 1Radiology, Albert Einstein Medical Center, Philadelphia, PA; 2Transplant Surgery, Albert Einstein Medical Center, Philadelphia, PA Learning Objectives: Splenic artery steal syndrome is an underdiagnosed entity first described in 1991 and occurring in 3-8% of patients after orthotopic liver transplantation (OLTX). The purpose of this article is to describe five cases of splenic artery steal syndrome in a single institution. Background: An imaging search engine was used to search for liver transplant patients with a diagnosis of splenic artery steal syndrome. Further chart review to evaluate for what treatment was performed, and the post treatment changes.
Posters and Exhibits
Learning Objectives: 1)The reader will learn strategies to increase efficiency in the evaluation of vascular referrals through the use of electronic medical records and a portable vascular laboratory.2)Methods and strategies utilizing a portable vascular laboratory to improve patient care, reduce healthcare costs, and increase access to care in Interventional Radiology will be discussed. Background: Noninvasive vascular testing including Doppler ultrasound, segmental pressures, pulse volume recordings, and ankle brachial indices are regularly used for evaluation of peripheral vascular disease. Ultrasound is also used in evaluation of venous reflux and venous mapping. Testing can be used to screen, diagnose, and plan for vascular therapy. With the development of compact mobile noninvasive diagnostic devices, noninvasive testing has become portable. Portable vascular laboratories allow for rapid evaluation when patients are initially seen with primary care providers in office-based clinics. This technology has been utilized to increase referrals to Interventional Radiology. Clinical Findings/Procedure Details: This exhibit will demonstrate how to incorporate a portable vascular laboratory into an existing vascular service line. A practical guide will be proposed which can be used to prioritize referrals based on this portable testing and the information available in the electronic medical record. Strategies to improve communication with referring clinicians and optimize treatments will be presented. Also exhibited will be the possible benefits of improving efficiency including potential cost-reduction. Methods utilizing
portable devices to appropriately screen patients for referral to Interventional Radiology will be highlighted. Conclusion and/or Teaching Points: Through the use of a portable noninvasive vascular laboratory and a supporting EMR, vascular referrals can be more efficiently evaluated. The potential benefits of portability and increased efficiency include costreduction and increased patient volume to Interventional Radiology.
’
Posters and Exhibits
S159
Materials and Methods: Review of our procedural database revealed 44 patients treated with radioembolization for HCC between 9/2007 and 2/2012. From 9/05 to 2/2009, 84 patients were treated with bland embolization for HCC. Patients with unifocal disease, portal vein thrombosis, extrahepatic disease, or Okuda stage III disease were excluded from subsequent analysis. The final study population consisted of 29 patients who underwent bland embolization (24 males, mean age 63 years) and 29 patients who underwent radioembolization (20 males, mean age 69 years). Clinical records were retrospectively reviewed. Survival rates were estimated using the Kaplan-Meier method and compared using the log rank test. Results: A total of 31 bland embolization procedures were performed in 29 patients. Thirty-seven radioembolization procedures were performed in 29 patients. The 6 and 12 month survival rates for patients undergoing bland embolization were 86% and 71% respectively, compared to 83% and 60% for patients undergoing radioembolization (p¼0.057). Analysis of Okuda staging revealed that 31% of patients undergoing bland embolization were stage I compared to 86% of patients undergoing radioembolization (po0.01). Conclusion: In this retrospective study, bland embolization and radioembolization demonstrated comparable overall survival rates for patients with multifocal HCC and without portal vein thrombus. However, the patients treated with bland embolization in this study had a higher Okuda disease stage than those treated with radioembolization.
Educational Exhibit
Abstract No. 371
Streamlining a vascular referral service line through the use of a portable vascular laboratory J. Cannell, M. Montgomery; Texas AandM HSC - Scott and White Memorial Hospital, Temple, TX
Educational Exhibit
Abstract No. 372
Intraoperative major trauma embolization: initial experience and TIPS for success in establish a hemorrhage control team D.A. Valenti1, T. Razek2, V. Demers1, S. Kaduri1, A. Bessissow1, R.W. Lindsay1, C. Torres1, T. Cabrera1, L.N. Boucher1; 1Radiology, McGill University, Montreal, QC, Canada; 2Surgery, McGill University, Montreal, QC, Canada Learning Objectives: To outline basic selection criteria for intra-operative vs IR suite embolization. To review some pitfalls and roadblocks to success. Discuss keys for prompt response time and short procedural times. Background: A subset of severe poly-trauma patients are too unstable to be successfully imaged by CT and transferred to the IR suite. These patients require urgent transfer to the OR for stabilization and support. Nonetheless, some of these patients can benefit from embolization intra-operatively, as certain pelvic and parenchymal organ hemorrhage may be easier to control angiographically than surgically. Clinical Findings/Procedure Details: Basic materials required required for intra-operative angiography will be outlined as well as strategies to reduce response and procedure time. Conclusion and/or Teaching Points: Intra-operative angiographic hemorrhage control has become an essential part of our Trauma team. It is especially useful in those patients with such massive hemorrhage and severe hemodynamic instability that transfer to an OR setting is required just to maintain a minimum blood pressure. High clinical success rates are achievable despite challenging technical conditions.
Educational Exhibit
Abstract No. 373
Splenic artery embolization as treatment for splenic artery steal syndrome after liver transplantation D.V. Strain1, P. Brady1, T. Matalon1, M. Horrow1, J. Ortiz2, A. Parsikia2; 1Radiology, Albert Einstein Medical Center, Philadelphia, PA; 2Transplant Surgery, Albert Einstein Medical Center, Philadelphia, PA Learning Objectives: Splenic artery steal syndrome is an underdiagnosed entity first described in 1991 and occurring in 3-8% of patients after orthotopic liver transplantation (OLTX). The purpose of this article is to describe five cases of splenic artery steal syndrome in a single institution. Background: An imaging search engine was used to search for liver transplant patients with a diagnosis of splenic artery steal syndrome. Further chart review to evaluate for what treatment was performed, and the post treatment changes.
Posters and Exhibits
Learning Objectives: 1)The reader will learn strategies to increase efficiency in the evaluation of vascular referrals through the use of electronic medical records and a portable vascular laboratory.2)Methods and strategies utilizing a portable vascular laboratory to improve patient care, reduce healthcare costs, and increase access to care in Interventional Radiology will be discussed. Background: Noninvasive vascular testing including Doppler ultrasound, segmental pressures, pulse volume recordings, and ankle brachial indices are regularly used for evaluation of peripheral vascular disease. Ultrasound is also used in evaluation of venous reflux and venous mapping. Testing can be used to screen, diagnose, and plan for vascular therapy. With the development of compact mobile noninvasive diagnostic devices, noninvasive testing has become portable. Portable vascular laboratories allow for rapid evaluation when patients are initially seen with primary care providers in office-based clinics. This technology has been utilized to increase referrals to Interventional Radiology. Clinical Findings/Procedure Details: This exhibit will demonstrate how to incorporate a portable vascular laboratory into an existing vascular service line. A practical guide will be proposed which can be used to prioritize referrals based on this portable testing and the information available in the electronic medical record. Strategies to improve communication with referring clinicians and optimize treatments will be presented. Also exhibited will be the possible benefits of improving efficiency including potential cost-reduction. Methods utilizing
portable devices to appropriately screen patients for referral to Interventional Radiology will be highlighted. Conclusion and/or Teaching Points: Through the use of a portable noninvasive vascular laboratory and a supporting EMR, vascular referrals can be more efficiently evaluated. The potential benefits of portability and increased efficiency include costreduction and increased patient volume to Interventional Radiology.