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The safety and efficacy of prostatic arteries embolization with polyzene-coated microspheres (Embozene) for benign prostatic hyperplasia - preliminary results
JVIR
’
Posters and Exhibits
S155
imaging technique of TR-MRA and practical steps in obtaining high-quality angiography of the pulmonary artery adequate for detecting recanalization of PAVM. Case examples are provided demonstrating the utility of this technique in evaluating the patency of PAVMs treated with embolotherapy with platinum coils in comparison with transcatheter digital subtraction pulmonary angiography as a reference. Advantages of this method are that lesion hemodynamics can be observed and it is less sensitive to metal artifact compared to CT. On the other hand, motion artifact is one of the factors affecting image quality. Conclusion and/or Teaching Points: TR-MRA is a relatively new imaging technology available on most modern MR systems. It will become a standard, non-invasive method for follow up PAVMs after treatment with embolotherapy.
Conclusion and/or Teaching Points: Splenic injuries due to blunt force trauma are being increasingly treated with endovascular embolization forgoing the need for operative management. Appropriate utilization of proximal and distal embolization techniques performed with a variety of embolic agents is essential to achieve safe and effective patient outcomes.
References
N.V. Costa3,1, J.M. Pisco3, T. Bilhim3, L. Pinheiro2, L. Fernandes3, J.A. Pereira3, M. Duarte3, A. Oliveira3; 1 Centro Hospitalar Lisboa Central, Estoril, Portugal; 2 Hospital St Louis, Lisboa, Portugal; 3Radiology, Saint Louis Hospital, Lisbon, Portugal
1. Remy-Jardin M et al. Pulmonary arteriovenous malformations treated with embolotherapy: helical CT evaluation of long-term effectiveness after 2-21-year follow-up. Radiology 2006; 239:576–585. 2. Hayashi S et al. Efficacy of venous sac embolization for pulmonary arteriovenous malformations: comparison with feeding artery embolization. J Vasc Interv Radiol 2012; 23:1566–1577. 3. Kawai T et al. Feasibility of Time-Resolved MR Angiography for Detecting Recanalization of Pulmonary Arteriovenous Malformations Treated with Embolization with Platinum Coils. J Vasc Interv Radiol. 2014; 25:1339–1347.
Educational Exhibit
Abstract No. 345
Endovascular management of splenic trauma: a review of principles and techniques K.C. Ching, C.J. Friend, E. Santos, K.M. McCluskey; Interventional Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
The safety and efficacy of prostatic arteries embolization with polyzene-coated microspheres (Embozene) for benign prostatic hyperplasia preliminary results
Purpose: To evaluate the short term clinical outcome of prostate artery embolization (PAE) with polyzene-coated microspheres (Embozene) in 20 patients with Benign Prostatic Hyperplasia (BPH). Materials and Methods: Between June 2011 and July 2013, 20 patients with BPH and moderate to severe lower urinary tract symptoms (LUTS) refractory to medical therapy for at least 6 months, underwent PAE with Embozene 400mm. This prospective study was approved by the institutional review board and an Informed consent for PAE was signed by all participants. The clinical success was evaluated by clinical improvement of International Prostate Symptoms Score (IPSS), Quality of Life (Qol), International Index Erectile Function (IIEF) and by changes of Prostate Volume (PV), Prostatic Specific Antigen (PSA), Peak Urinary Flow rate (Qmax) and post-void Residual Volume (PVR) changes from baseline at 1 and 6 months after PAE. There was technical failure when none of the prostatic arteries was embolized. Clinical success was considered when there was reduction of the total IPSS score of at least 25% and r 15, Qol reduction of at least one point or r 3 and no need of medical therapy or any other treatment. Results: There was not any technical failure. Three patients were lost to follow up, therefore 17 patients were controlled. There were 3 (17.6%) initial clinical failures and clinical success in 14 (14 (83.4%) patients. At 6 months there was another clinical failure, thus the clinical success at 6 months was 76.5%. There was not any case of sexual dysfunction or any other major complication. There was 1 case of slight hematospermia and 1 case of rectorragia. Both adverse advents were self-controlled. Conclusion: PAE for BPH with Embozene is a safe and efficient outpatient procedure, with low morbidity, no sexual dysfunction and good preliminary outcome at short term.
Educational Exhibit
Abstract No. 347
Direct puncture approach for embolization of visceral aneurysms A.K. Dik, P. Vanlangenhove, E. Dhondt, L. Defreyne; Vascular and Interventional Radiology, University Hospital Gent, Ghent, Belgium
Posters and Exhibits
Learning Objectives: 1) Discuss the epidemiology and mechanisms of splenic trauma. 2) Review pertinent imaging findings on CT and the American Association for the Surgery of Trauma (AAST) grading scale for splenic injuries. 3) Highlight techniques and principles for endovascular embolization of acute splenic trauma. 4) Discuss follow-up care, postembolization imaging, and potential complications. Background: Splenic injuries most commonly occur due to blunt force trauma following motor vehicle accidents. While splenic trauma has been historically managed with splenectomy or splenorrhaphy, splenic arterial embolization has become the principal treatment in hemodynamically stable patients. Because of an extensive network of collateral vessels supplying the spleen, proximal or distal embolization maybe employed for endovascular management of splenic injuries. Clinical Findings/Procedure Details: This exhibit reviews the pertinent anatomy and angiographic evaluation of splenic artery embolization. Depending on the initial angiographic findings, proximal or distal embolization maybe performed each with differing techniques and underlying principles. A variety of factors should be considered when choosing the site of embolization as well as the embolic agent utilized. Case based examples of active extravasation, pseudoaneurysms, and splenic artery aneurysms managed with coiling, microparticle, vascular plug, and gel foam embolization will be highlighted using quality images. Close postprocedure care is essential as delayed splenic rupture, splenic abscess, and other complications may occur. Guidelines for vaccination and timing of follow-up CT will be included.
Abstract No. 346
’
Posters and Exhibits
S155
imaging technique of TR-MRA and practical steps in obtaining high-quality angiography of the pulmonary artery adequate for detecting recanalization of PAVM. Case examples are provided demonstrating the utility of this technique in evaluating the patency of PAVMs treated with embolotherapy with platinum coils in comparison with transcatheter digital subtraction pulmonary angiography as a reference. Advantages of this method are that lesion hemodynamics can be observed and it is less sensitive to metal artifact compared to CT. On the other hand, motion artifact is one of the factors affecting image quality. Conclusion and/or Teaching Points: TR-MRA is a relatively new imaging technology available on most modern MR systems. It will become a standard, non-invasive method for follow up PAVMs after treatment with embolotherapy.
Conclusion and/or Teaching Points: Splenic injuries due to blunt force trauma are being increasingly treated with endovascular embolization forgoing the need for operative management. Appropriate utilization of proximal and distal embolization techniques performed with a variety of embolic agents is essential to achieve safe and effective patient outcomes.
References
N.V. Costa3,1, J.M. Pisco3, T. Bilhim3, L. Pinheiro2, L. Fernandes3, J.A. Pereira3, M. Duarte3, A. Oliveira3; 1 Centro Hospitalar Lisboa Central, Estoril, Portugal; 2 Hospital St Louis, Lisboa, Portugal; 3Radiology, Saint Louis Hospital, Lisbon, Portugal
1. Remy-Jardin M et al. Pulmonary arteriovenous malformations treated with embolotherapy: helical CT evaluation of long-term effectiveness after 2-21-year follow-up. Radiology 2006; 239:576–585. 2. Hayashi S et al. Efficacy of venous sac embolization for pulmonary arteriovenous malformations: comparison with feeding artery embolization. J Vasc Interv Radiol 2012; 23:1566–1577. 3. Kawai T et al. Feasibility of Time-Resolved MR Angiography for Detecting Recanalization of Pulmonary Arteriovenous Malformations Treated with Embolization with Platinum Coils. J Vasc Interv Radiol. 2014; 25:1339–1347.
Educational Exhibit
Abstract No. 345
Endovascular management of splenic trauma: a review of principles and techniques K.C. Ching, C.J. Friend, E. Santos, K.M. McCluskey; Interventional Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
The safety and efficacy of prostatic arteries embolization with polyzene-coated microspheres (Embozene) for benign prostatic hyperplasia preliminary results
Purpose: To evaluate the short term clinical outcome of prostate artery embolization (PAE) with polyzene-coated microspheres (Embozene) in 20 patients with Benign Prostatic Hyperplasia (BPH). Materials and Methods: Between June 2011 and July 2013, 20 patients with BPH and moderate to severe lower urinary tract symptoms (LUTS) refractory to medical therapy for at least 6 months, underwent PAE with Embozene 400mm. This prospective study was approved by the institutional review board and an Informed consent for PAE was signed by all participants. The clinical success was evaluated by clinical improvement of International Prostate Symptoms Score (IPSS), Quality of Life (Qol), International Index Erectile Function (IIEF) and by changes of Prostate Volume (PV), Prostatic Specific Antigen (PSA), Peak Urinary Flow rate (Qmax) and post-void Residual Volume (PVR) changes from baseline at 1 and 6 months after PAE. There was technical failure when none of the prostatic arteries was embolized. Clinical success was considered when there was reduction of the total IPSS score of at least 25% and r 15, Qol reduction of at least one point or r 3 and no need of medical therapy or any other treatment. Results: There was not any technical failure. Three patients were lost to follow up, therefore 17 patients were controlled. There were 3 (17.6%) initial clinical failures and clinical success in 14 (14 (83.4%) patients. At 6 months there was another clinical failure, thus the clinical success at 6 months was 76.5%. There was not any case of sexual dysfunction or any other major complication. There was 1 case of slight hematospermia and 1 case of rectorragia. Both adverse advents were self-controlled. Conclusion: PAE for BPH with Embozene is a safe and efficient outpatient procedure, with low morbidity, no sexual dysfunction and good preliminary outcome at short term.
Educational Exhibit
Abstract No. 347
Direct puncture approach for embolization of visceral aneurysms A.K. Dik, P. Vanlangenhove, E. Dhondt, L. Defreyne; Vascular and Interventional Radiology, University Hospital Gent, Ghent, Belgium
Posters and Exhibits
Learning Objectives: 1) Discuss the epidemiology and mechanisms of splenic trauma. 2) Review pertinent imaging findings on CT and the American Association for the Surgery of Trauma (AAST) grading scale for splenic injuries. 3) Highlight techniques and principles for endovascular embolization of acute splenic trauma. 4) Discuss follow-up care, postembolization imaging, and potential complications. Background: Splenic injuries most commonly occur due to blunt force trauma following motor vehicle accidents. While splenic trauma has been historically managed with splenectomy or splenorrhaphy, splenic arterial embolization has become the principal treatment in hemodynamically stable patients. Because of an extensive network of collateral vessels supplying the spleen, proximal or distal embolization maybe employed for endovascular management of splenic injuries. Clinical Findings/Procedure Details: This exhibit reviews the pertinent anatomy and angiographic evaluation of splenic artery embolization. Depending on the initial angiographic findings, proximal or distal embolization maybe performed each with differing techniques and underlying principles. A variety of factors should be considered when choosing the site of embolization as well as the embolic agent utilized. Case based examples of active extravasation, pseudoaneurysms, and splenic artery aneurysms managed with coiling, microparticle, vascular plug, and gel foam embolization will be highlighted using quality images. Close postprocedure care is essential as delayed splenic rupture, splenic abscess, and other complications may occur. Guidelines for vaccination and timing of follow-up CT will be included.
Abstract No. 346