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Abstract No. 320: Pediatric external carotid artery angiography: Current status
JVIR 䡲 Poster Sessions
S133
Pediatric Interventions Educational Exhibit
Abstract No. 320
Pediatric external carotid artery angiography: Current status L.E. Braswell1,2, N. Phulwani1,2, C. James1,2, E. Erdem1,2; 1Radiology, University of Arkansas for Medical Sciences, Little Rock, AR; 2Radiology, Arkansas Children’s Hospital, Little Rock, AR Learning Objectives: 1) Identify indications for therapeutic interventions and diagnostic catheter angiography in the external carotid artery (ECA) in pediatric patients. 2) Review pertinent anatomy of ECA branch supply and ECA-intracranial connections. 3) Provide a pictorial review of representative angiographic cases. Background: Common indications for embolization include presence of vascular malformations, vascular masses, and epistaxis. Indications for diagnostic studies are less frequent and include preoperative planning for intracranial vascular abnormality such as Moyamoya disase, in which ECA-intracranial collateral flow is beneficial. When embolization is performed in the ECA, knowledge of the potential communications between the ECA and intracranial supply is crucial in order to avoid complications. Clinical Findings/Procedure Details: In the recent 7 years at our institution, we have performed 48 patient encounters in the external carotid artery. Therapeutic indications included extracranial arteriovenous malformation (n⫽18), juvenile nasal angiofibroma (n⫽10), other hypervascular tumors (n⫽7), and epistaxis (n⫽1). Diagnostic indications included preoperative evaluation for extracranial to intracranial anastamoses in Moyamoya disase (n⫽8) or for other intracranial vascular abnormalities (n⫽4). Embolization was performed with PVA particles, dehydrated ethanol, or Onyx. Before proceeding with embolization, diagnostic angiography was performed to demonstrate extracranial to intracranial communications. Dangerous pathways were delineated in 2 patients. Partial visual field defect was encountered in 2 patients following vascular tumor embolization; the ophthalmic artery was not visualized in 1 of these. Other complications included soft tissue injury (n⫽1) and groin hematoma (n⫽1). Conclusion and/or Teaching Points: 1) ECA angiography in the pediatric patient is currently performed for embolization of vascular lesions or, less commonly, for presurgical planning. 2) Delineation of ophthalmic artery patency and of extracranial/ intracranial pathways is required.
Abstract No. 321
F. Gulsen, M. Cantasdemir, S. Solak, F. Numan; Interventional Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey Purpose: Priapism is defined as continuous penile erection which is not associated with sexual stimulation, and is classified as
Abstract No. 322 Percutaneous transluminal renal angioplasty for renovascular hypertension in pediatric patients with moyamoya disease H. Jae, S. Kang, H. Kim, J. Chung, J. Park; Radiology, Seoul Nationl University Hospital, Seoul, Republic of Korea Purpose: To evaluate the feasibility and efficacy of percutaneous transluminal renal angioplasty (PTRA) for renovascular hypertension in pediatric patients with moyamoya disease. Materials and Methods: Between January 1999 and December 2008, we performed PTRA for 8 renal artery stenoses in 6 pediatric patients (M:F ⫽ 5:1; Mean age ⫽ 9.6 years; Age range: 3–16 years) with moyamoya disease to manage the intractable renovascular hypertension. Medical records and imaging findings of the patients were retrospectively reviewed to evaluate the technical and clinical outcomes. Results: The mean renal artery stenosis was decreased from 66.8 ⫾ 15.3% to 33 ⫾ 16.2% and technical success (residual stenosis ⬍ 30%) was obtained in 4(50%) of the 8 lesions. The systolic blood pressure decreased from 164.7 ⫾ 14.3 to 121.7 ⫾ 18.0 and diastolic blood pressure decreased from 94.1 ⫾ 10.9 to 71.3 ⫾ 18.0mmHg. In short-term (1 month) follow up, all patients had lower diastolic blood pressure or reduced number of antihypertensive medications after PTRA. In long-term follow up (mean 38.8 month, range: 8 –72 month), 4 patients (67%) maintained stable status and the number of antihypertensive medications was increased again in 1 patients (17%). Conclusion: In pediatric patients with moyamoya disease, PTRA for renovascular hypertension showed favorable clinical outcomes in spite of low initial technical success rate.
Poster Sessions
Posttraumatic high-flow priapism in pediatric patients treated with autologous blood clot embolization: Long-term results
either low-flow (ischemic) or high-flow (non-ischemic). Priapism can occur at any age, ranging from newborn to older adulthood, but is a rare occurrence in children. Selective embolization is an accepted form of therapy in patients with high-flow priapism. The purpose of our study is to retrospectively evaluate the long-term results of transcatheter arterial embolization for high-flow priapism in children. Materials and Methods: Between 2002 and 2005, 7 pediatric patients underwent superselective transcatheter embolization of high-flow priapism with blunt trauma to the penis or perineum. All patients underwent diagnostic evaluation with color-flow Doppler ultrasound and superselective pudendal arteriography, revealing unilateral arteriocorporal fistula and/or pseudoaneurysm in all patients. Autologous blood clot was used as an embolization agent in all patients combined with microcatheter guidance. Results: Superselective arteriography showed intracavernosal arteriovenous fistulas and/or pseudoaneurysms in 7 pediatric patients. By using superselective microcatheterization and autologous blod clot embolization, detumescence was achieved in all of the patients. Color-flow Doppler ultrasonography follow-ups showed no signs of high flow. Conclusion: For the treatment of high flow priapism among the pediatric population, superselective transcatheter embolization and transient occlusion of the fistula with autologous blood clot is an effective therapy that preserves future erectile function.
S133
Pediatric Interventions Educational Exhibit
Abstract No. 320
Pediatric external carotid artery angiography: Current status L.E. Braswell1,2, N. Phulwani1,2, C. James1,2, E. Erdem1,2; 1Radiology, University of Arkansas for Medical Sciences, Little Rock, AR; 2Radiology, Arkansas Children’s Hospital, Little Rock, AR Learning Objectives: 1) Identify indications for therapeutic interventions and diagnostic catheter angiography in the external carotid artery (ECA) in pediatric patients. 2) Review pertinent anatomy of ECA branch supply and ECA-intracranial connections. 3) Provide a pictorial review of representative angiographic cases. Background: Common indications for embolization include presence of vascular malformations, vascular masses, and epistaxis. Indications for diagnostic studies are less frequent and include preoperative planning for intracranial vascular abnormality such as Moyamoya disase, in which ECA-intracranial collateral flow is beneficial. When embolization is performed in the ECA, knowledge of the potential communications between the ECA and intracranial supply is crucial in order to avoid complications. Clinical Findings/Procedure Details: In the recent 7 years at our institution, we have performed 48 patient encounters in the external carotid artery. Therapeutic indications included extracranial arteriovenous malformation (n⫽18), juvenile nasal angiofibroma (n⫽10), other hypervascular tumors (n⫽7), and epistaxis (n⫽1). Diagnostic indications included preoperative evaluation for extracranial to intracranial anastamoses in Moyamoya disase (n⫽8) or for other intracranial vascular abnormalities (n⫽4). Embolization was performed with PVA particles, dehydrated ethanol, or Onyx. Before proceeding with embolization, diagnostic angiography was performed to demonstrate extracranial to intracranial communications. Dangerous pathways were delineated in 2 patients. Partial visual field defect was encountered in 2 patients following vascular tumor embolization; the ophthalmic artery was not visualized in 1 of these. Other complications included soft tissue injury (n⫽1) and groin hematoma (n⫽1). Conclusion and/or Teaching Points: 1) ECA angiography in the pediatric patient is currently performed for embolization of vascular lesions or, less commonly, for presurgical planning. 2) Delineation of ophthalmic artery patency and of extracranial/ intracranial pathways is required.
Abstract No. 321
F. Gulsen, M. Cantasdemir, S. Solak, F. Numan; Interventional Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey Purpose: Priapism is defined as continuous penile erection which is not associated with sexual stimulation, and is classified as
Abstract No. 322 Percutaneous transluminal renal angioplasty for renovascular hypertension in pediatric patients with moyamoya disease H. Jae, S. Kang, H. Kim, J. Chung, J. Park; Radiology, Seoul Nationl University Hospital, Seoul, Republic of Korea Purpose: To evaluate the feasibility and efficacy of percutaneous transluminal renal angioplasty (PTRA) for renovascular hypertension in pediatric patients with moyamoya disease. Materials and Methods: Between January 1999 and December 2008, we performed PTRA for 8 renal artery stenoses in 6 pediatric patients (M:F ⫽ 5:1; Mean age ⫽ 9.6 years; Age range: 3–16 years) with moyamoya disease to manage the intractable renovascular hypertension. Medical records and imaging findings of the patients were retrospectively reviewed to evaluate the technical and clinical outcomes. Results: The mean renal artery stenosis was decreased from 66.8 ⫾ 15.3% to 33 ⫾ 16.2% and technical success (residual stenosis ⬍ 30%) was obtained in 4(50%) of the 8 lesions. The systolic blood pressure decreased from 164.7 ⫾ 14.3 to 121.7 ⫾ 18.0 and diastolic blood pressure decreased from 94.1 ⫾ 10.9 to 71.3 ⫾ 18.0mmHg. In short-term (1 month) follow up, all patients had lower diastolic blood pressure or reduced number of antihypertensive medications after PTRA. In long-term follow up (mean 38.8 month, range: 8 –72 month), 4 patients (67%) maintained stable status and the number of antihypertensive medications was increased again in 1 patients (17%). Conclusion: In pediatric patients with moyamoya disease, PTRA for renovascular hypertension showed favorable clinical outcomes in spite of low initial technical success rate.
Poster Sessions
Posttraumatic high-flow priapism in pediatric patients treated with autologous blood clot embolization: Long-term results
either low-flow (ischemic) or high-flow (non-ischemic). Priapism can occur at any age, ranging from newborn to older adulthood, but is a rare occurrence in children. Selective embolization is an accepted form of therapy in patients with high-flow priapism. The purpose of our study is to retrospectively evaluate the long-term results of transcatheter arterial embolization for high-flow priapism in children. Materials and Methods: Between 2002 and 2005, 7 pediatric patients underwent superselective transcatheter embolization of high-flow priapism with blunt trauma to the penis or perineum. All patients underwent diagnostic evaluation with color-flow Doppler ultrasound and superselective pudendal arteriography, revealing unilateral arteriocorporal fistula and/or pseudoaneurysm in all patients. Autologous blood clot was used as an embolization agent in all patients combined with microcatheter guidance. Results: Superselective arteriography showed intracavernosal arteriovenous fistulas and/or pseudoaneurysms in 7 pediatric patients. By using superselective microcatheterization and autologous blod clot embolization, detumescence was achieved in all of the patients. Color-flow Doppler ultrasonography follow-ups showed no signs of high flow. Conclusion: For the treatment of high flow priapism among the pediatric population, superselective transcatheter embolization and transient occlusion of the fistula with autologous blood clot is an effective therapy that preserves future erectile function.