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Abstract No. 301: Intra Arterial Autologous Implant of Adult Stem Cell for Patients with Parkinson’s Disease
of inferior vena caval filter is recommended. Previous study revealed slightly higher recurrence rate of pulmonary embolism after suprarenal implant of Greenfield filter as compared with conventional infrarenal implant. Thus we compared filtering efficiency among two different inferior vena caval filters depending on the filter position in an vitro model. MATERIALS AND METHODS: Guenther tulip filter (GTF) or Trapease filter (TEF) was positioned into an in vitro vena caval model (25 mm I.D.) below or above renal venous ostia (13 mm I.D.). Clot emboli made from 3.5% polyacrylamide gel of varying sizes (5⫻15, 5⫻10, 5⫻5 mm) were introduced into a constant flow (total 2L/min, 10% in each renal vein) of 44% glycerin solution, and the frequency of successful captures by the filters was recorded. RESULTS: Infrarenal GTF captured 65, 55, 60% of each 5⫻15, 5⫻10, 5⫻5 mm clot emboli, while suprarenal GTF 30, 25, 25% of each clot emboli. On the other hand, infrarenal TEF captured 65, 50, 65% and suprarenal TEF trapped 70, 55, 50% of each clot emboli. Suprarenal GTF diminished the filtering efficiency significantly (p ⬍ .05) as compared with infrarenal GTF, while TEF showed stable filtering effect independent of the filter postition. CONCLUSION: For suprarenal implant, TEF seems to be more suitable than GTF concerning filter efficiency in vitro. Abstract No. 299 Percutaneous Retrieval of Over-the-Wire Greenfield Filters: Two Recent Cases. J.J. McBride, A.A. Duncan, A.W. Stanson; Mayo Clinic, Rochester, MN PURPOSE: The purpose of this report is to present two recent cases of retrieval of Over-the-Wire Greenfield Filters.
RESULTS: The first patient had an uneventful post procedural course with resolution of her abdominal pain at one, two, and three-month follow up phone visits. The second patient’s post procedure course was also uneventful. One week follow up was available at time of submission, which revealed that she was asymptomatic and off anticoagulation. CONCLUSION: If clinically warranted, retrieval of the Over-The-Wire Greenfield filter is feasible. The Over-TheWire Greenfield is not FDA approved for retrieval. However, with device technology (Amplatz snare and coaxial sheaths), it was deemed worthy of attempting, which was accomplished successfully and safely.
IVC-SVC Filters. A Comprehensive Review of the Spectrum of Complications. J. Tisnado,1 M.K. Sydnor,1 D.J. Komorowski,1 D.A. Leung,1 J. Tisnado;2 1MCV Hospitals/VCU Medical Center, Richmond, VA; 2School of Medicine, VCU Medical Center, Richmond, VA PURPOSE: About 4000 filters (all kinds) have been placed by us in the IVC and SVC during the last three decades. Therefore, we have accumulated a vast experience in filter placement, and have seen or experienced all types of complications of the procedures. MATERIALS AND METHODS: We hereby classify the spectrum of complications of filter placement: (A) Vascular access: bleeding, hematoma, rupture, pneumothorax; (B) Placement: misplacement in different sites: renal veins, hepatic veins, aorta, iliac veins, extravascular in the retroperitoneum, failure to open, embolization into right atrium, right ventricle, PA; (C) Late complications: migration, rupture of prongs, “collapse” of filter, embolization; (D) Injuries to IVC-SVC: perforation, thrombosis, stenosis, rupture; (E) Multiple filter insertions: 1, 2, 3 because of misplacement, embolization, recurrent pulmonary embolism; (F) Iatrogenic: rupture of filter, extrusion, tilting, etc. TEACHING POINTS: We describe some of the ways or methods to correct complications once occurred. Filter placement in the IVC is now a “routine” procedure. Some operators with minimal experience are placing filters. We discuss ways to avoid complications and ways to solve complications.
Vascular Interventions: Other Abstract No. 301 Intra Arterial Autologous Implant of Adult Stem Cell for Patients with Parkinson’s Disease. A. Brazzini, R. Cantella, A. Gallardo, E. Orrillo, T. Chilon, M. Brazzini, T. Jorquiera, C. Leon, K. Verde; Brazzini Institute of Interventional Radiology, Lima, Peru PURPOSE: An innovative therapy for Parkinson’s Disease (PD) with autologous intra arterial implant of adult stem cells procedure is proposed. MATERIALS AND METHODS: A group of 47 patients are presented, 15 women and 32 men, who were 38 to 76 years of age and had PD (mean duration, 9 years). Patients were evaluated using a clinical exam, internationally recognized scales, MRI and SPECT. A bone marrow aspirate extracts stem cells, which are then processed using Rubinstein method. Three hours later they were intra arterially implanted in the posterior region of Circle of Willis using intra arterial interventional radiology procedures. Patients were evaluated in their progress using neurological evaluations, comparative scales, videos and MRI.
POSTER SESSIONS
MATERIALS AND METHODS: Two patients were referred to our institution for consideration of percutaneous retrieval of their IVC filters which had been placed at other institutions. The first patient had the filter placed 6 years previously, but for the past 18 months had episodic disabling abdominal pain. A CT scan revealed penetration of the IVC by all 6 filter legs. The second patient, who had a filter placed 8 months previously, was told that she needed lifetime anticoagulation. This was a lifestyle issue not acceptable to her and she requested the filter be removed. From right internal jugular venous access, venacavograms revealed both patients had normal IVC anatomy. Using a multiple coaxial set of sheaths (12, 14, 18-Fr), an Amplatz snare was used to retrieve the filters.
Abstract No. 300 EE
RESULTS: At one week patients had improved 38% in the UPDRS (Unified Parkinson’s Disease Rating Scale) at one month 52%, at 3 months 59% and at 6 months patients had improved 76%. No relationship was found between age and duration of disease or with overall improvement. Other scales lwere also used. CONCLUSION: We consider this a highly recommended procedure because it has resulted beneficial and effective to all the treated patients, improving their symptoms, lowering drug use and obtaining independence. The role and training S111
of the interventional radiologist is crucial for the success of this procedure because stem cells need to be implanted intra arterially. Additionally, no complications due to treatment have been found. What is more, many of the patients have achieved reinsertion in their daily and labor activities. Abstract No. 302 H Ring Device: New Bioprosthetic Device for Patent Foramen Ovale Closure in a Swine Model. D. Pavcnik,1 K. Tekulve,2 B.T. Uchida,1 M. Pavcnik Arnol,3 F.S. Keller,1 J. Rosch;1 1Dotter Interventional Institute, Portland, OR; 2Cook Inc, Bloomington, IN; 3University Medical Center Ljubljana, Ljubljana, Slovenia PURPOSE: To evaluate the feasibility, effectiveness and safety of a porcine small intestinal submucosa (SIS) covered device for the closure of patent foramen ovale (PFO) in swine. MATERIALS AND METHODS: Twelve piglets with PFO, ranging in size from 6 mm to 12 mm were used for the in vivo testing. The closure device consisted of two basic components, a flexible nitinol ring covered with SIS and an anchor. The device was advanced through an 8 Fr sheath from the femoral vein. In nine acute animals the device was tested for deployment, stability, effectiveness of immediate shunt closure, and device repositioning and retrievability prior to or after its detachment. The efficacy of the device was recorded by angiography. ECG was recorded before and after PFO closure. Three of the 12 animals were followed for 6 weeks (n⫽1), 12 weeks (n⫽1) and 16 weeks (n⫽1). RESULTS: Successful device implantation was achieved in all animals, and no shunting of the contrast media was observed in 11 PFOs. In the nine animals used for acute studies the device was easily placed and retrieved in prior to detachment. After detachment the device was easily retrieved in all four attempts. Histologic evaluation of the 3 long-term animals showed that devices were well incorporated in the atrial septum with complete shunt closure. Devices were covered on each side by neointima with endothelial cells. SIS remodeling with host cells (endothelial cells, fibroblasts, fibrocytes) was nearly complete by 16 weeks. ECGs recorded at pretreatment and post treatment time points demonstrated no arrhythmias. CONCLUSION: PFO closure with the bioprosthetic H ring device is feasible, safe, and effective in swine.
Non-vascular Interventions: Biliary/ Gallbladder Abstract No. 303 Percutaneous Retrograde Transjejunal Cholangiography and Biliary intervention for Beningn and Malignant Strictures. S.S. Bhatia, P. Grover, J.J. Guerra, E. Russell, J.Y. Yrizarry; University of Miami Miller School of Medicine, Miami, FL PURPOSE: The aim of this study is to assess the safety and efficacy of percutaneous retrograde transjejunal cholangiography and biliary dilation for benign and malignant biliary strictures and to evaluate the catheter free survival interval and impact on quality of life in this group of patients. MATERIALS AND METHODS: The clinical and Radiographic records of patients who underwent percutaneous S112
retrograde transjejunal biliary intervention over a period of 7 years were studied retrospectively at a single institution. Total number of patients studied was 37, age ranging between 3-85 years; 27 patients had underlying benign stricture and 10 patients had underlying malignant etiology of biliary stricture. Mean Age of patients selected was 51.3 years. RESULTS: A total of 175 procedures were done in 37 patients over a period of 7 years. Out of these, 173 were successful through transjejunal route. However, 32 procedures needed transhepatic approach. Two procedures were unsuccessful despite several attempts. Average number of procedures per patient with benign stricture was 4.7 and in patients with malignant stricture were 4.5. The biliary interventions performed were balloon dilation, stone retrieval, catheter placement, brush biopsy, retrieval of intrabiliary foreign body. Mean interval between biliary dilations for benign disease was 45.58 weeks and 22.36 weeks for malignant disease. Repeat interventions were based on symptomatology of patient. Out of 37 patients, 7 patients needed catheter placement through transhepatic route (average catheter duration was 8.75 weeks), and 2 patients through transjejunal route (average catheter duration was 9.7 weeks.). Notable periprocedural events were; rupture of CHD (n⫽3), contrast extravasation in peritoneal cavity (n⫽1). However these patients had benign course with no intervention required. No procedure related mortality occurred. CONCLUSION: Percutaneous transjejunal biliary access allows repeated interventions over without significant morbidity or mortality. Subfascial fixation of Roux-n-Y loop (in patients who have undergone biliary-enteric anastomosis) facilitates repeated biliary interventions and provide a catheter free survival significantly improving quality of life. Abstract No. 304 ePTFE/FEP Covered Versus Uncovered Metallic Stents for Malignant Biliary Disease Palliation. Results in 200 Patients. M. Krokidis,1 F. Fanelli,2 A. Hatzidakis,1 G. Orgera,2 M. Bezzi,2 R. Pasariello,2 N. Gourtsoyiannis;1 1Department of Radiology, University Hospital of Heraklion, Heraklion, Greece; 2Department of Radiological Sciences, University of Rome “La Sappienza”, Rome, Italy PURPOSE: To study the clinical effectiveness, patency and complication rates of ePTFE/FEP covered-metallic stents compared with uncovered Wallstents, in the palliative treatment of malignant biliary disease. MATERIALS AND METHODS: We used 107 Wallstents in 100 patients with malignant biliary obstruction (Group A) and 104 Viabil covered stents with (n⫽51) or without (n⫽53) side holes in another 100 patients with malignant jaundice (Group B). Obstruction was caused by Pancreatic-Ca (n⫽98), Cholangiocarcinoma (n⫽51), Gastric-Ca (n⫽19), Lymph-node enlargement (n⫽17), Papillary–Ca (n⫽9), and Gallbladder-Ca (n⫽6). Bare stents were used to treat all kind of strictures (Bismuth type I- IV) and covered stents lower strictures (Bismuth I-II). All patients were followed-up until death. RESULTS: Technical success was 97.5% in Group A and 98.7% in Group B. Procedure related complication rate was 8% and 5% in the two groups, respectively. Mean survival was 142.8 days for the Mesh- and 147.3 days for the Covered-group patients. Primary patency in 6 and 12
RESULTS: The first patient had an uneventful post procedural course with resolution of her abdominal pain at one, two, and three-month follow up phone visits. The second patient’s post procedure course was also uneventful. One week follow up was available at time of submission, which revealed that she was asymptomatic and off anticoagulation. CONCLUSION: If clinically warranted, retrieval of the Over-The-Wire Greenfield filter is feasible. The Over-TheWire Greenfield is not FDA approved for retrieval. However, with device technology (Amplatz snare and coaxial sheaths), it was deemed worthy of attempting, which was accomplished successfully and safely.
IVC-SVC Filters. A Comprehensive Review of the Spectrum of Complications. J. Tisnado,1 M.K. Sydnor,1 D.J. Komorowski,1 D.A. Leung,1 J. Tisnado;2 1MCV Hospitals/VCU Medical Center, Richmond, VA; 2School of Medicine, VCU Medical Center, Richmond, VA PURPOSE: About 4000 filters (all kinds) have been placed by us in the IVC and SVC during the last three decades. Therefore, we have accumulated a vast experience in filter placement, and have seen or experienced all types of complications of the procedures. MATERIALS AND METHODS: We hereby classify the spectrum of complications of filter placement: (A) Vascular access: bleeding, hematoma, rupture, pneumothorax; (B) Placement: misplacement in different sites: renal veins, hepatic veins, aorta, iliac veins, extravascular in the retroperitoneum, failure to open, embolization into right atrium, right ventricle, PA; (C) Late complications: migration, rupture of prongs, “collapse” of filter, embolization; (D) Injuries to IVC-SVC: perforation, thrombosis, stenosis, rupture; (E) Multiple filter insertions: 1, 2, 3 because of misplacement, embolization, recurrent pulmonary embolism; (F) Iatrogenic: rupture of filter, extrusion, tilting, etc. TEACHING POINTS: We describe some of the ways or methods to correct complications once occurred. Filter placement in the IVC is now a “routine” procedure. Some operators with minimal experience are placing filters. We discuss ways to avoid complications and ways to solve complications.
Vascular Interventions: Other Abstract No. 301 Intra Arterial Autologous Implant of Adult Stem Cell for Patients with Parkinson’s Disease. A. Brazzini, R. Cantella, A. Gallardo, E. Orrillo, T. Chilon, M. Brazzini, T. Jorquiera, C. Leon, K. Verde; Brazzini Institute of Interventional Radiology, Lima, Peru PURPOSE: An innovative therapy for Parkinson’s Disease (PD) with autologous intra arterial implant of adult stem cells procedure is proposed. MATERIALS AND METHODS: A group of 47 patients are presented, 15 women and 32 men, who were 38 to 76 years of age and had PD (mean duration, 9 years). Patients were evaluated using a clinical exam, internationally recognized scales, MRI and SPECT. A bone marrow aspirate extracts stem cells, which are then processed using Rubinstein method. Three hours later they were intra arterially implanted in the posterior region of Circle of Willis using intra arterial interventional radiology procedures. Patients were evaluated in their progress using neurological evaluations, comparative scales, videos and MRI.
POSTER SESSIONS
MATERIALS AND METHODS: Two patients were referred to our institution for consideration of percutaneous retrieval of their IVC filters which had been placed at other institutions. The first patient had the filter placed 6 years previously, but for the past 18 months had episodic disabling abdominal pain. A CT scan revealed penetration of the IVC by all 6 filter legs. The second patient, who had a filter placed 8 months previously, was told that she needed lifetime anticoagulation. This was a lifestyle issue not acceptable to her and she requested the filter be removed. From right internal jugular venous access, venacavograms revealed both patients had normal IVC anatomy. Using a multiple coaxial set of sheaths (12, 14, 18-Fr), an Amplatz snare was used to retrieve the filters.
Abstract No. 300 EE
RESULTS: At one week patients had improved 38% in the UPDRS (Unified Parkinson’s Disease Rating Scale) at one month 52%, at 3 months 59% and at 6 months patients had improved 76%. No relationship was found between age and duration of disease or with overall improvement. Other scales lwere also used. CONCLUSION: We consider this a highly recommended procedure because it has resulted beneficial and effective to all the treated patients, improving their symptoms, lowering drug use and obtaining independence. The role and training S111
of the interventional radiologist is crucial for the success of this procedure because stem cells need to be implanted intra arterially. Additionally, no complications due to treatment have been found. What is more, many of the patients have achieved reinsertion in their daily and labor activities. Abstract No. 302 H Ring Device: New Bioprosthetic Device for Patent Foramen Ovale Closure in a Swine Model. D. Pavcnik,1 K. Tekulve,2 B.T. Uchida,1 M. Pavcnik Arnol,3 F.S. Keller,1 J. Rosch;1 1Dotter Interventional Institute, Portland, OR; 2Cook Inc, Bloomington, IN; 3University Medical Center Ljubljana, Ljubljana, Slovenia PURPOSE: To evaluate the feasibility, effectiveness and safety of a porcine small intestinal submucosa (SIS) covered device for the closure of patent foramen ovale (PFO) in swine. MATERIALS AND METHODS: Twelve piglets with PFO, ranging in size from 6 mm to 12 mm were used for the in vivo testing. The closure device consisted of two basic components, a flexible nitinol ring covered with SIS and an anchor. The device was advanced through an 8 Fr sheath from the femoral vein. In nine acute animals the device was tested for deployment, stability, effectiveness of immediate shunt closure, and device repositioning and retrievability prior to or after its detachment. The efficacy of the device was recorded by angiography. ECG was recorded before and after PFO closure. Three of the 12 animals were followed for 6 weeks (n⫽1), 12 weeks (n⫽1) and 16 weeks (n⫽1). RESULTS: Successful device implantation was achieved in all animals, and no shunting of the contrast media was observed in 11 PFOs. In the nine animals used for acute studies the device was easily placed and retrieved in prior to detachment. After detachment the device was easily retrieved in all four attempts. Histologic evaluation of the 3 long-term animals showed that devices were well incorporated in the atrial septum with complete shunt closure. Devices were covered on each side by neointima with endothelial cells. SIS remodeling with host cells (endothelial cells, fibroblasts, fibrocytes) was nearly complete by 16 weeks. ECGs recorded at pretreatment and post treatment time points demonstrated no arrhythmias. CONCLUSION: PFO closure with the bioprosthetic H ring device is feasible, safe, and effective in swine.
Non-vascular Interventions: Biliary/ Gallbladder Abstract No. 303 Percutaneous Retrograde Transjejunal Cholangiography and Biliary intervention for Beningn and Malignant Strictures. S.S. Bhatia, P. Grover, J.J. Guerra, E. Russell, J.Y. Yrizarry; University of Miami Miller School of Medicine, Miami, FL PURPOSE: The aim of this study is to assess the safety and efficacy of percutaneous retrograde transjejunal cholangiography and biliary dilation for benign and malignant biliary strictures and to evaluate the catheter free survival interval and impact on quality of life in this group of patients. MATERIALS AND METHODS: The clinical and Radiographic records of patients who underwent percutaneous S112
retrograde transjejunal biliary intervention over a period of 7 years were studied retrospectively at a single institution. Total number of patients studied was 37, age ranging between 3-85 years; 27 patients had underlying benign stricture and 10 patients had underlying malignant etiology of biliary stricture. Mean Age of patients selected was 51.3 years. RESULTS: A total of 175 procedures were done in 37 patients over a period of 7 years. Out of these, 173 were successful through transjejunal route. However, 32 procedures needed transhepatic approach. Two procedures were unsuccessful despite several attempts. Average number of procedures per patient with benign stricture was 4.7 and in patients with malignant stricture were 4.5. The biliary interventions performed were balloon dilation, stone retrieval, catheter placement, brush biopsy, retrieval of intrabiliary foreign body. Mean interval between biliary dilations for benign disease was 45.58 weeks and 22.36 weeks for malignant disease. Repeat interventions were based on symptomatology of patient. Out of 37 patients, 7 patients needed catheter placement through transhepatic route (average catheter duration was 8.75 weeks), and 2 patients through transjejunal route (average catheter duration was 9.7 weeks.). Notable periprocedural events were; rupture of CHD (n⫽3), contrast extravasation in peritoneal cavity (n⫽1). However these patients had benign course with no intervention required. No procedure related mortality occurred. CONCLUSION: Percutaneous transjejunal biliary access allows repeated interventions over without significant morbidity or mortality. Subfascial fixation of Roux-n-Y loop (in patients who have undergone biliary-enteric anastomosis) facilitates repeated biliary interventions and provide a catheter free survival significantly improving quality of life. Abstract No. 304 ePTFE/FEP Covered Versus Uncovered Metallic Stents for Malignant Biliary Disease Palliation. Results in 200 Patients. M. Krokidis,1 F. Fanelli,2 A. Hatzidakis,1 G. Orgera,2 M. Bezzi,2 R. Pasariello,2 N. Gourtsoyiannis;1 1Department of Radiology, University Hospital of Heraklion, Heraklion, Greece; 2Department of Radiological Sciences, University of Rome “La Sappienza”, Rome, Italy PURPOSE: To study the clinical effectiveness, patency and complication rates of ePTFE/FEP covered-metallic stents compared with uncovered Wallstents, in the palliative treatment of malignant biliary disease. MATERIALS AND METHODS: We used 107 Wallstents in 100 patients with malignant biliary obstruction (Group A) and 104 Viabil covered stents with (n⫽51) or without (n⫽53) side holes in another 100 patients with malignant jaundice (Group B). Obstruction was caused by Pancreatic-Ca (n⫽98), Cholangiocarcinoma (n⫽51), Gastric-Ca (n⫽19), Lymph-node enlargement (n⫽17), Papillary–Ca (n⫽9), and Gallbladder-Ca (n⫽6). Bare stents were used to treat all kind of strictures (Bismuth type I- IV) and covered stents lower strictures (Bismuth I-II). All patients were followed-up until death. RESULTS: Technical success was 97.5% in Group A and 98.7% in Group B. Procedure related complication rate was 8% and 5% in the two groups, respectively. Mean survival was 142.8 days for the Mesh- and 147.3 days for the Covered-group patients. Primary patency in 6 and 12