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Abstract No. 149: Geniculate artery embolization for synovial hypertrophy in the management of spontaneous recurrent hemarthrosis of the knee: a case series
JVIR 䡲 Scientific Session
Tuesday 䡲 S63
Results: Granulometric analysis showed that in vitro diameter was significantly different between group A (195m) and B (371m) (p⬍0.0001, MW). In vivo, mean diameter of MS was also significantly different between A (106⫾26 m) and B (218⫾55 m) (p⬍0.0001, MW). Vascular diameter of occluded vessels was significantly lower in group A (146⫾46 m) than B (260⫾63 m) (p⬍0.0001, MW) and was correlated to the size of MS (Rho⫽0.814, p⬍0.0001). The diameter of the occluded vessels was also correlated (Rho⫽0.677, p⬍0.0001) with the bile duct diameter in the same portal tract suggesting that small MS were situated in smaller portal tracts with a smaller bile duct. Vessels occluded by smaller MS were moreover located closer to hepatic capsule (3.3⫾2.4mm) compared to vessels occluded by larger MS (3.6⫾1.7mm) (p⫽0.0471, MW) suggesting a deeper penetration of smaller beads in hepatic vasculature. Distance between occluded vessels in group A (2.6⫾2.3mm) was significantly smaller than in group B (4.9⫾3.9mm) (p⫽0.0001, MW) showing a more dense distribution. The number of vessels occluded by MS on each section was higher in group A (10.0⫾8.3) than B (4.5⫾2.3), though NS (p⫽0.0885, MW). Conclusion: Small sized microspheres are associated with a more distal occlusion and a more dense coverage of the embolized tissue. In the case of drug loaded particles, the choice of small caliber may be accurate to obtain a more homogeneous and efficient drug coverage.
8:40 AM
Abstract No. 149
S. Bagla, A. van Breda, K.S. Rholl, A. van Breda; Cardiovascular & Interventional Radiology Department, Inova Alexandria Hospital, Alexandria, VA Purpose: Spontaneous late hemarthrosis after total knee arthroplasty occurrs in 0.3% to 1% of patients (1), with the most accepted etiology being secondary to hypertrophic vascular synovium. Hemarthrosis may resolve with conservative management, however accepted treatment for refractory cases is open synovectomy, which carries significant surgical morbidity. While isolated cases of arterial embolization for hemarthroses have been published (2), this is the largest series of geniculate artery embolization for recurrent hemarthrosis with long term followup. Materials and Methods: Five patients (3 male, 2 female), age range 57-77, who underwent previous knee replacement (time 8-18 yrs) were treated. All patients underwent repeated arthrocentesis documenting hemorrhagic effusion. Arterial embolization was performed using spherical embolic material (range 100-700 um). Patients were followed clinically and with ultrasound for resolution. Results: Angiography demonstrated synovial hypervascularity in all patients. No vascular malformations were identified. Average time to resolution of effusion was 2.6 weeks. Two patients experienced transient distal cutaneous ischemia. Complications resolved spontaneously in both patients within 3 weeks. One patient experienced post procedural pain requiring short term analgesic medication. Ischemic complications occurred when spherical particulate size was less than 300 um. No recurrence has occurred at followup (mean 16 m). Conclusion: Selective geniculate artery embolization with spherical embolic is an effective treatment for late recurrent hem-
References 1. Kindsfater K, Scott R. Recurrent haemarthrosis after total knee arthroplasty. The Journal of Arthroplasty. 1995;10:S52–S55. 2. Maheshwari R, Kelly SP, Langkamer VG, Loveday E. Spontaneous recurrent haemarthrosis following unicompartimental knee arthroplasty and its successful treatment by coil embolisation. The Knee. 2004;11:413– 415. 3. Dhondt, E et al. Angiographic findings and therapeutic embolization of late hemarthrosis after total joint arthroplasty. Skeletal Radiology. 2009;31–36.
8:48 AM
Abstract No. 150
Transarterial bland embolization of focal nodular hyperplasia J. Birn1, S. Allgeier2, D.L. Croteau1,2, S. Sturza1,2, T.M. Getzen1,2; 1Radiology, Henry Ford Hospital, Detroit, MI; 2 Wayne State University, Detroit, MI Purpose: Focal nodular hyperplasia, a benign tumor, is the second most common liver neoplasm. The majority of FNH lesions are discovered incidentally, without clinical symptoms. Due to a lack of malignant potential, they are typically not treated. Occasional patients with FNH will present with nonspecific abdominal pain, often if the lesion abuts or places pressure upon the liver capsule. In these cases, surgical resection has traditionally been favored. However, depending on the number and location of the lesions, and their proximity to adjacent structures such as the IVC, resection may be difficult or carry significant morbidity. Transarterial bland embolization provides an alternative to surgery in the management of patients who cannot, or prefer not to, undergo surgery, or for lesions which are technically difficult to resect. In addition, embolization can potentially be used as an adjunct to surgical resection, especially in large or unresectable lesions. Materials and Methods: We reviewed our experience of 13 symptomatic patients with FNH who underwent transarterial embolization either as primary treatment or as an adjunct to surgical resection. All patients were embolized with 100-300 micron microspheres, followed by 300-500 micron spheres if necessary. We compared lesion size and contrast enhancement before and after treatment to determine procedural success. Clinical response was determined by review of the electronic medical record. Results: Overall, patients showed symptomatic improvement after embolization. Follow up imaging demonstrated measurable decrease in lesion size in all patients. Based on maximum axial diameter measurement, lesion size decreased up to 92%, with most shrinking more than 47%. Diminished contrast enhancement was universally noted, with a few showing near complete lack of residual enhancement. Conclusion: Transarterial bland embolization of FNH in the symptomatic patient is an excellent alternative to surgical resection and can also be used as an adjunct to surgery, especially in the treatment of large lesions. Our experience of 13 such patients represents the largest series of this treatment to date.
8:56 AM
Abstract No. 151
Spontaneous, anticoagulation-induced haemorrhage in the soft tissues: mid-term outcome after transcatheter embolotherapy
TUESDAY: Scientific Sessions
Geniculate artery embolization for synovial hypertrophy in the management of spontaneous recurrent hemarthrosis of the knee: a case series
arthrosis of the knee. It is suggested that spherical particulate size greater than 300 micron may be less likely to cause cutaneous ischemia.
Tuesday 䡲 S63
Results: Granulometric analysis showed that in vitro diameter was significantly different between group A (195m) and B (371m) (p⬍0.0001, MW). In vivo, mean diameter of MS was also significantly different between A (106⫾26 m) and B (218⫾55 m) (p⬍0.0001, MW). Vascular diameter of occluded vessels was significantly lower in group A (146⫾46 m) than B (260⫾63 m) (p⬍0.0001, MW) and was correlated to the size of MS (Rho⫽0.814, p⬍0.0001). The diameter of the occluded vessels was also correlated (Rho⫽0.677, p⬍0.0001) with the bile duct diameter in the same portal tract suggesting that small MS were situated in smaller portal tracts with a smaller bile duct. Vessels occluded by smaller MS were moreover located closer to hepatic capsule (3.3⫾2.4mm) compared to vessels occluded by larger MS (3.6⫾1.7mm) (p⫽0.0471, MW) suggesting a deeper penetration of smaller beads in hepatic vasculature. Distance between occluded vessels in group A (2.6⫾2.3mm) was significantly smaller than in group B (4.9⫾3.9mm) (p⫽0.0001, MW) showing a more dense distribution. The number of vessels occluded by MS on each section was higher in group A (10.0⫾8.3) than B (4.5⫾2.3), though NS (p⫽0.0885, MW). Conclusion: Small sized microspheres are associated with a more distal occlusion and a more dense coverage of the embolized tissue. In the case of drug loaded particles, the choice of small caliber may be accurate to obtain a more homogeneous and efficient drug coverage.
8:40 AM
Abstract No. 149
S. Bagla, A. van Breda, K.S. Rholl, A. van Breda; Cardiovascular & Interventional Radiology Department, Inova Alexandria Hospital, Alexandria, VA Purpose: Spontaneous late hemarthrosis after total knee arthroplasty occurrs in 0.3% to 1% of patients (1), with the most accepted etiology being secondary to hypertrophic vascular synovium. Hemarthrosis may resolve with conservative management, however accepted treatment for refractory cases is open synovectomy, which carries significant surgical morbidity. While isolated cases of arterial embolization for hemarthroses have been published (2), this is the largest series of geniculate artery embolization for recurrent hemarthrosis with long term followup. Materials and Methods: Five patients (3 male, 2 female), age range 57-77, who underwent previous knee replacement (time 8-18 yrs) were treated. All patients underwent repeated arthrocentesis documenting hemorrhagic effusion. Arterial embolization was performed using spherical embolic material (range 100-700 um). Patients were followed clinically and with ultrasound for resolution. Results: Angiography demonstrated synovial hypervascularity in all patients. No vascular malformations were identified. Average time to resolution of effusion was 2.6 weeks. Two patients experienced transient distal cutaneous ischemia. Complications resolved spontaneously in both patients within 3 weeks. One patient experienced post procedural pain requiring short term analgesic medication. Ischemic complications occurred when spherical particulate size was less than 300 um. No recurrence has occurred at followup (mean 16 m). Conclusion: Selective geniculate artery embolization with spherical embolic is an effective treatment for late recurrent hem-
References 1. Kindsfater K, Scott R. Recurrent haemarthrosis after total knee arthroplasty. The Journal of Arthroplasty. 1995;10:S52–S55. 2. Maheshwari R, Kelly SP, Langkamer VG, Loveday E. Spontaneous recurrent haemarthrosis following unicompartimental knee arthroplasty and its successful treatment by coil embolisation. The Knee. 2004;11:413– 415. 3. Dhondt, E et al. Angiographic findings and therapeutic embolization of late hemarthrosis after total joint arthroplasty. Skeletal Radiology. 2009;31–36.
8:48 AM
Abstract No. 150
Transarterial bland embolization of focal nodular hyperplasia J. Birn1, S. Allgeier2, D.L. Croteau1,2, S. Sturza1,2, T.M. Getzen1,2; 1Radiology, Henry Ford Hospital, Detroit, MI; 2 Wayne State University, Detroit, MI Purpose: Focal nodular hyperplasia, a benign tumor, is the second most common liver neoplasm. The majority of FNH lesions are discovered incidentally, without clinical symptoms. Due to a lack of malignant potential, they are typically not treated. Occasional patients with FNH will present with nonspecific abdominal pain, often if the lesion abuts or places pressure upon the liver capsule. In these cases, surgical resection has traditionally been favored. However, depending on the number and location of the lesions, and their proximity to adjacent structures such as the IVC, resection may be difficult or carry significant morbidity. Transarterial bland embolization provides an alternative to surgery in the management of patients who cannot, or prefer not to, undergo surgery, or for lesions which are technically difficult to resect. In addition, embolization can potentially be used as an adjunct to surgical resection, especially in large or unresectable lesions. Materials and Methods: We reviewed our experience of 13 symptomatic patients with FNH who underwent transarterial embolization either as primary treatment or as an adjunct to surgical resection. All patients were embolized with 100-300 micron microspheres, followed by 300-500 micron spheres if necessary. We compared lesion size and contrast enhancement before and after treatment to determine procedural success. Clinical response was determined by review of the electronic medical record. Results: Overall, patients showed symptomatic improvement after embolization. Follow up imaging demonstrated measurable decrease in lesion size in all patients. Based on maximum axial diameter measurement, lesion size decreased up to 92%, with most shrinking more than 47%. Diminished contrast enhancement was universally noted, with a few showing near complete lack of residual enhancement. Conclusion: Transarterial bland embolization of FNH in the symptomatic patient is an excellent alternative to surgical resection and can also be used as an adjunct to surgery, especially in the treatment of large lesions. Our experience of 13 such patients represents the largest series of this treatment to date.
8:56 AM
Abstract No. 151
Spontaneous, anticoagulation-induced haemorrhage in the soft tissues: mid-term outcome after transcatheter embolotherapy
TUESDAY: Scientific Sessions
Geniculate artery embolization for synovial hypertrophy in the management of spontaneous recurrent hemarthrosis of the knee: a case series
arthrosis of the knee. It is suggested that spherical particulate size greater than 300 micron may be less likely to cause cutaneous ischemia.