- Email: [email protected]
Abstract No. 175: Pre-Allograft Nephrectomy Embolotherapy (PNE); A Retrospective Review of Blood Loss and Transfusion Requirements
a lower rate of tumor recurrence post-operatively. 3. Our findings suggest a highly specific occlusion of tumoral vasculature with the use of TM. 4:36 PM
Abstract No. 175
Pre-Allograft Nephrectomy Embolotherapy (PNE); A Retrospective Review of Blood Loss and Transfusion Requirements. J. Taussig1, J.A. Requarth1, M.A. Bettmann1, R. Stratta2, A. Farney2, J. Rogers2; 1Wake Forest Baptist Medical Center - Radiology, Winston-Salem, NC; 2Wake Forest Baptist Medical Center - Transplant Services, Winston-Salem, NC. PURPOSE: Allogaft nephrectomy (AN) is a common procedure which is performed in approximately 30% of patients with allograft failure. The most common indication is immunologic rejection, but other indications include post biopsy hemorrhage, infection, thrombosis, and urologic complications. AN is technically challenging and can be associated with significant hemorrhage. The resulting transfusion requirement may lead to increased sentization; thus, future HLA matching is made more difficult. The purpose of this review is to determine if PNE decreases operative blood loss estimates and transfusion requirements during AN. MATERIALS & METHODS: A retrospective review of all patients undergoing isolated AN at our institution between 1/30/01 and 6/13/08 was performed. The study was limited to those who underwent AN more than one month after transplantation,had a patent allograft artery, and underwent PNE less than 48 hours prior to AN. RESULTS: A total of 47 AN patients were identified; only 26 satisfied the study requirements. Fourteen had PNE and 12 had no embolotherapy. The mean ages at AN were 43.6 and 39.9 years respectively, and the number of months the allograft survived was 47 ⫾ 56 months and 45 ⫾ 41 months (ns), respectively. The blood loss estimates and the number of transfused PRBC units are summarized in the attached table. PNE resulted in significantly fewer PRBC units transfused on the day of surgery when compared to non-embolotherapy (NE) patients (p⬍.05). Although the mean estimated blood loss for the NE patients was higher than the PNE patients, it did not quite obtain significance. CONCLUSION: Approximately one-third of renal allograft recipients will undergo AN. PNE results in lower estimated blood loss and fewer units of PRBCs transfused. The reduced blood loss makes the surgical procedure technically easier for the surgeon, less risky for the patient, and may result in less sensitization. Estimated Blood Loss and Transfusion Requirements for Allograft Nephrectomy No Embolotherapy Embolotherapy p value Number of PRBC units 1.5 ⫾ 1.83 0.4 ⫾ 0.5 p⬍0.05 transfused* Estimated blood loss 446 ⫾ 548 148 ⫾ 119 p⬍0.1 (ml) Data are given as mean ⫾ standard deviation. * PRBC units given on the day of surgery.
4:48 PM
Abstract No. 176
Arterial Embolotherapy for Endoscopically Unmanageable Acute Hemorrhage from Gastroduodenal Ulcers: Predictors of Early Bleeding Recurrence. R. Loffroy, B. Guiu, A. Lambert, L. Mezzetta, J.P. Cercueil, D. Krause´; University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon, France. S68
PURPOSE: To identify predictors of early bleeding recurrence (⬍ 30 days) after transcatheter embolization for refractory hemorrhage from gastroduodenal ulcers. MATERIALS & METHODS: Retrospective study of 60 consecutive emergency embolization procedures in hemodynamically unstable patients (41 males, 19 females, mean age 69.4 ⫾ 15 years) referred from 1999 to 2008 for selective angiography after failed endoscopic treatment. The embolic agents used were metallic coils, microspheres, gelatine sponge particles, and glue, sole or in combination. Predictors of early rebleeding were tested with univariate analysis and multivariate logistic regression model, respectively. RESULTS: The technical success rate was 95%. The primary clinical success rate was 71.9% (41 of 57 patients). Secondary clinical success occurred in three additional patients (77.2%). No major complications related to catheterization occurred. The periprocedural mortality rate was 26.7% (16 of 60), mostly related to underlying conditions. Early recurrence of bleeding was associated with longer time to angiography (P⫽.0005), more units of packed red blood cells transfused prior to the procedure (P⫽.0009), number of co-morbidities ⱖ 2 (P⫽.005), and the use of coils as the only embolic agent (P⫽.003). Two factors were non confounding predictors of embolization failure: time to angiography ⬎ 2 days (odds ratio⫽70.94; P⬍.05) and comorbid diseases ⱖ 2 (odds ratio⫽45.06; P⬍.05). The use of anticoagulant and/or anti-inflammatory medications before procedure tended to predict failure treatment (odds ratio⫽11.83; .05⬍P⬍.1). CONCLUSION: Angiographic embolization for hemorrhage from gastroduodenal ulcers should be performed early in the course of bleeding and not with coils alone in otherwise critically ill patients. 5:00 PM Abstract No. 177 FEATURED ABSTRACT Thyroid Arterial Embolization to Treat Graves’ Disease: 9-Year Experience. J. Yang; Second Military Medical University, Shanghai, China. PURPOSE: To estimate the values and limitations of thyroid arterial embolization(TAE) in treating Graves’ disease. MATERIALS & METHODS: 76 cases of Graves’ disease were fallen into group A(25 cases) and B(51 cases). Patients from group A were embolized with gelfoam particles and stainless coils after infusion of 24mg blemycin. Patients from group B were embolized with PVA particles. The first 9 patients had DSA of upper bilateral thyroid arteries only, the rest had DSA of all thyroid arteries. The diameters of thyroid arteries were measured on DSA. The relationship between complications, relapse and embolizing materials, arteries embolized was analysed. Serum TSH, FT3 and FT4 were tested before, at 4 day and 1 month after emboliation and afterward every 2 months. RESULTS: Mean diameters of right superior and inferior thyroid arteries were 3.8mm(2.2-6.0mm) and 3.5mm(1.75.6mm) respectively( P⬎0.05). Diameters of left superior and inferior thyroid arteries were 3.7mm(2.4-6.0mm)and 2.9mm( 1.0-5.2mm)respectively(P⬍0.01). It was effective in all patients in 2-3 months post TAE. 3 patients had subsequent partial thyroidectomy and 3 had 131I radiation therapy 2 weeks after TAE. 54 patients(77.1%) became euthyroid. The relapse rate was 29.2% and 19.6% for group A and B respectively(P⬎0.05) and was 46.7%, 20% and
Abstract No. 175
Pre-Allograft Nephrectomy Embolotherapy (PNE); A Retrospective Review of Blood Loss and Transfusion Requirements. J. Taussig1, J.A. Requarth1, M.A. Bettmann1, R. Stratta2, A. Farney2, J. Rogers2; 1Wake Forest Baptist Medical Center - Radiology, Winston-Salem, NC; 2Wake Forest Baptist Medical Center - Transplant Services, Winston-Salem, NC. PURPOSE: Allogaft nephrectomy (AN) is a common procedure which is performed in approximately 30% of patients with allograft failure. The most common indication is immunologic rejection, but other indications include post biopsy hemorrhage, infection, thrombosis, and urologic complications. AN is technically challenging and can be associated with significant hemorrhage. The resulting transfusion requirement may lead to increased sentization; thus, future HLA matching is made more difficult. The purpose of this review is to determine if PNE decreases operative blood loss estimates and transfusion requirements during AN. MATERIALS & METHODS: A retrospective review of all patients undergoing isolated AN at our institution between 1/30/01 and 6/13/08 was performed. The study was limited to those who underwent AN more than one month after transplantation,had a patent allograft artery, and underwent PNE less than 48 hours prior to AN. RESULTS: A total of 47 AN patients were identified; only 26 satisfied the study requirements. Fourteen had PNE and 12 had no embolotherapy. The mean ages at AN were 43.6 and 39.9 years respectively, and the number of months the allograft survived was 47 ⫾ 56 months and 45 ⫾ 41 months (ns), respectively. The blood loss estimates and the number of transfused PRBC units are summarized in the attached table. PNE resulted in significantly fewer PRBC units transfused on the day of surgery when compared to non-embolotherapy (NE) patients (p⬍.05). Although the mean estimated blood loss for the NE patients was higher than the PNE patients, it did not quite obtain significance. CONCLUSION: Approximately one-third of renal allograft recipients will undergo AN. PNE results in lower estimated blood loss and fewer units of PRBCs transfused. The reduced blood loss makes the surgical procedure technically easier for the surgeon, less risky for the patient, and may result in less sensitization. Estimated Blood Loss and Transfusion Requirements for Allograft Nephrectomy No Embolotherapy Embolotherapy p value Number of PRBC units 1.5 ⫾ 1.83 0.4 ⫾ 0.5 p⬍0.05 transfused* Estimated blood loss 446 ⫾ 548 148 ⫾ 119 p⬍0.1 (ml) Data are given as mean ⫾ standard deviation. * PRBC units given on the day of surgery.
4:48 PM
Abstract No. 176
Arterial Embolotherapy for Endoscopically Unmanageable Acute Hemorrhage from Gastroduodenal Ulcers: Predictors of Early Bleeding Recurrence. R. Loffroy, B. Guiu, A. Lambert, L. Mezzetta, J.P. Cercueil, D. Krause´; University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon, France. S68
PURPOSE: To identify predictors of early bleeding recurrence (⬍ 30 days) after transcatheter embolization for refractory hemorrhage from gastroduodenal ulcers. MATERIALS & METHODS: Retrospective study of 60 consecutive emergency embolization procedures in hemodynamically unstable patients (41 males, 19 females, mean age 69.4 ⫾ 15 years) referred from 1999 to 2008 for selective angiography after failed endoscopic treatment. The embolic agents used were metallic coils, microspheres, gelatine sponge particles, and glue, sole or in combination. Predictors of early rebleeding were tested with univariate analysis and multivariate logistic regression model, respectively. RESULTS: The technical success rate was 95%. The primary clinical success rate was 71.9% (41 of 57 patients). Secondary clinical success occurred in three additional patients (77.2%). No major complications related to catheterization occurred. The periprocedural mortality rate was 26.7% (16 of 60), mostly related to underlying conditions. Early recurrence of bleeding was associated with longer time to angiography (P⫽.0005), more units of packed red blood cells transfused prior to the procedure (P⫽.0009), number of co-morbidities ⱖ 2 (P⫽.005), and the use of coils as the only embolic agent (P⫽.003). Two factors were non confounding predictors of embolization failure: time to angiography ⬎ 2 days (odds ratio⫽70.94; P⬍.05) and comorbid diseases ⱖ 2 (odds ratio⫽45.06; P⬍.05). The use of anticoagulant and/or anti-inflammatory medications before procedure tended to predict failure treatment (odds ratio⫽11.83; .05⬍P⬍.1). CONCLUSION: Angiographic embolization for hemorrhage from gastroduodenal ulcers should be performed early in the course of bleeding and not with coils alone in otherwise critically ill patients. 5:00 PM Abstract No. 177 FEATURED ABSTRACT Thyroid Arterial Embolization to Treat Graves’ Disease: 9-Year Experience. J. Yang; Second Military Medical University, Shanghai, China. PURPOSE: To estimate the values and limitations of thyroid arterial embolization(TAE) in treating Graves’ disease. MATERIALS & METHODS: 76 cases of Graves’ disease were fallen into group A(25 cases) and B(51 cases). Patients from group A were embolized with gelfoam particles and stainless coils after infusion of 24mg blemycin. Patients from group B were embolized with PVA particles. The first 9 patients had DSA of upper bilateral thyroid arteries only, the rest had DSA of all thyroid arteries. The diameters of thyroid arteries were measured on DSA. The relationship between complications, relapse and embolizing materials, arteries embolized was analysed. Serum TSH, FT3 and FT4 were tested before, at 4 day and 1 month after emboliation and afterward every 2 months. RESULTS: Mean diameters of right superior and inferior thyroid arteries were 3.8mm(2.2-6.0mm) and 3.5mm(1.75.6mm) respectively( P⬎0.05). Diameters of left superior and inferior thyroid arteries were 3.7mm(2.4-6.0mm)and 2.9mm( 1.0-5.2mm)respectively(P⬍0.01). It was effective in all patients in 2-3 months post TAE. 3 patients had subsequent partial thyroidectomy and 3 had 131I radiation therapy 2 weeks after TAE. 54 patients(77.1%) became euthyroid. The relapse rate was 29.2% and 19.6% for group A and B respectively(P⬎0.05) and was 46.7%, 20% and