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Abstract No. 340: An update and review of bronchial artery embolization techniques and complications
JVIR 䡲 Poster Sessions
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recovery time. Post-procedure improvement in semen quality is variable with both treatment modalities. Conclusion and/or Teaching Points: TV are dilated veins of the pampiniform plexus adjacent to the testicles which may be due to incompetent venous valves. These are seen on physical examination mainly on the left side in adolescent males. Ultrasound can help in further characterizing TV and assessing for complications. There is an association between TV and infertility which is the driving force behind treatment of this abnormality. Treatment options include surgical interventions and percutaneous embolization. Variable improvement in semenalysis is seen with both treatment options.
Educational Exhibit
Abstract No. 340
An update and review of bronchial artery embolization techniques and complications D. Sarkar1,2, D. Tsai1, S. Franciosa1; 1Interventional Radiology, Cooper University Hospital, Camden, NJ; 2 Diagnostic Radiology, Cooper University Hospital, Camden, NJ Learning Objectives: To provide an update and review of techniques for performing bronchial artery embolization as well as various technical considerations and potential complications in the treatment of major hemoptysis. Background: Bronchial artery embolization can often be a life saving procedure for the treatment of major hemoptysis. Bronchial artery embolization can be challenging due to anatomy and various anatomical variants. As a result, several different types of catheters and guide wires may be necessary and there are a wide array of risks and/or complications involved in the procedure. Prompt recognition of anatomical appearances of structures and their relative relationships is critical. Successfully treating major hemoptysis in the appropriate patient population, with BAE requires an understanding of the vascular anatomy of the bronchial tree and pulmonary vasculature as well as the anatomical appearance of variant anatomy and prompt recognition of complications. Clinical Findings/Procedure Details: This review provides an update and procedural review of bronchial artery embolization. We have included images displaying various angiographic techniques as well as anatomical variants, and complications such as vessel perforation or free extravasation. Digital subtraction angiography, CT and MR images are used. Treatments for complications are discussed. Conclusion and/or Teaching Points: This presentation provides an update on bronchial artery embolization techniques. Specifically bronchial artery anatomy, pathology, newer and updated treatment techniques, as well as techniques to prevent and treat complications.
Educational Exhibit
Abstract No. 341
R. Sharma1, R. Sharma2, V. Vadlamudi1, M.B. Shah1, P. Shetty3; 1Michigan State University, Flint, MI; 2 Radiology, Henry Ford Hospital, Detroit, MI; 3 Radiology, Hurley Medical Center, Flint, MI Learning Objectives: We report seven cases of non-common femoral artery lower extremity pseudoaneurysms secondary to
Abstract No. 342 Splenic salvage rate and radiation dose of proximal embolization compared to distal embolization in the blunt trauma patient M.K. Sydnor, Jr, B.J. Strife, L. Thacker; Radiology, MCV/VCU, Richmond, VA Purpose: The purpose is to compare Proximal Splenic Embolization (PSE) to Distal Splenic Embolization (DSE) in terms of fluoroscopy time and splenic salvage rate to determine if either technique is advantageous in terms of radiation safety and/or outcome. Materials and Methods: The Trauma Registry and Interventional Radiology log books were cross-referenced from May 2002 until May 2011 to identify all trauma patients who underwent splenic arterial embolization. Patients were entered into a secure spreadsheet and the following information was recorded: medical record number, date of procedure, and fluoroscopy time. All cases were reviewed with an attending interventional radiologist and divided into one of two subgroups: PSE or DSE. The electronic medical record was then reviewed as far out as available to determine if the patient’s spleen was subsequently removed. Results: During the nine year interval of this retrospective cohort study, 35 patients were identified: 25 underwent PSE and 10 underwent DSE. The splenic salvage rate was 84% in the PSE group (21 of 25 patients) and 80% in the DSE group (2 of 10 patients). Fisher’s Exact T-test was used to demonstrate a P value of 0.54 between the two groups. The average fluoroscopy time for the PSE group was 13 minutes 18 seconds. The average fluoroscopy time for the DSE group was 50 minutes 24 seconds. Nonparametric Kruskall-Wallis test (chi-square⫽11.3095) was used to demonstrate a P value of 0.008. Conclusion: These results demonstrate a statistically significant difference in fluoroscopy time between the two groups with no significant difference in splenic salvage rate, suggest-
Poster Sessions
Endovascular treatment of lower extremity noncommon femoral artery pseudoaneurysms
penetrating trauma and iatrogenic causes with subsequent endovascular management. Background: Pseudoaneurysms arise from a disruption in one or more of the arterial wall layers and can occur from inflammation, infection, connective tissue disorders, trauma, or iatrogenic causes. Involvement of the peripheral arteries is rare and most commonly a result of traumatic penetrating or blunt injuries, such as gunshot or stab wounds, and iatrogenic arterial injuries. Surgery has been the traditional treatment of choice for pseudoaneurysms and, depending on the location, surgical management may include resection with a bypass procedure or arterial ligation. Over the past few years, minimally invasive and endovascular techniques have proven to be a viable alternative to the surgical approach. These include transcatheter coil embolization, stent-graft placement, and ultrasound guided percutaneous thrombin injection. Clinical Findings/Procedure Details: Of the seven cases reviewed from our institutions, all were successfully treated utilizing endovascular techniques, with post-embolization images demonstrating cessation of sac filling and resolution of the arteriovenous fistulas in those select cases. Conclusion and/or Teaching Points: Endovascular management of non-common femoral artery lower extremity pseudoaneurysms is a successful, minimally invasive, and cost-effective therapeutic option in comparison to the traditional surgical option, with a marked decrease in morbidity and mortality.
S137
recovery time. Post-procedure improvement in semen quality is variable with both treatment modalities. Conclusion and/or Teaching Points: TV are dilated veins of the pampiniform plexus adjacent to the testicles which may be due to incompetent venous valves. These are seen on physical examination mainly on the left side in adolescent males. Ultrasound can help in further characterizing TV and assessing for complications. There is an association between TV and infertility which is the driving force behind treatment of this abnormality. Treatment options include surgical interventions and percutaneous embolization. Variable improvement in semenalysis is seen with both treatment options.
Educational Exhibit
Abstract No. 340
An update and review of bronchial artery embolization techniques and complications D. Sarkar1,2, D. Tsai1, S. Franciosa1; 1Interventional Radiology, Cooper University Hospital, Camden, NJ; 2 Diagnostic Radiology, Cooper University Hospital, Camden, NJ Learning Objectives: To provide an update and review of techniques for performing bronchial artery embolization as well as various technical considerations and potential complications in the treatment of major hemoptysis. Background: Bronchial artery embolization can often be a life saving procedure for the treatment of major hemoptysis. Bronchial artery embolization can be challenging due to anatomy and various anatomical variants. As a result, several different types of catheters and guide wires may be necessary and there are a wide array of risks and/or complications involved in the procedure. Prompt recognition of anatomical appearances of structures and their relative relationships is critical. Successfully treating major hemoptysis in the appropriate patient population, with BAE requires an understanding of the vascular anatomy of the bronchial tree and pulmonary vasculature as well as the anatomical appearance of variant anatomy and prompt recognition of complications. Clinical Findings/Procedure Details: This review provides an update and procedural review of bronchial artery embolization. We have included images displaying various angiographic techniques as well as anatomical variants, and complications such as vessel perforation or free extravasation. Digital subtraction angiography, CT and MR images are used. Treatments for complications are discussed. Conclusion and/or Teaching Points: This presentation provides an update on bronchial artery embolization techniques. Specifically bronchial artery anatomy, pathology, newer and updated treatment techniques, as well as techniques to prevent and treat complications.
Educational Exhibit
Abstract No. 341
R. Sharma1, R. Sharma2, V. Vadlamudi1, M.B. Shah1, P. Shetty3; 1Michigan State University, Flint, MI; 2 Radiology, Henry Ford Hospital, Detroit, MI; 3 Radiology, Hurley Medical Center, Flint, MI Learning Objectives: We report seven cases of non-common femoral artery lower extremity pseudoaneurysms secondary to
Abstract No. 342 Splenic salvage rate and radiation dose of proximal embolization compared to distal embolization in the blunt trauma patient M.K. Sydnor, Jr, B.J. Strife, L. Thacker; Radiology, MCV/VCU, Richmond, VA Purpose: The purpose is to compare Proximal Splenic Embolization (PSE) to Distal Splenic Embolization (DSE) in terms of fluoroscopy time and splenic salvage rate to determine if either technique is advantageous in terms of radiation safety and/or outcome. Materials and Methods: The Trauma Registry and Interventional Radiology log books were cross-referenced from May 2002 until May 2011 to identify all trauma patients who underwent splenic arterial embolization. Patients were entered into a secure spreadsheet and the following information was recorded: medical record number, date of procedure, and fluoroscopy time. All cases were reviewed with an attending interventional radiologist and divided into one of two subgroups: PSE or DSE. The electronic medical record was then reviewed as far out as available to determine if the patient’s spleen was subsequently removed. Results: During the nine year interval of this retrospective cohort study, 35 patients were identified: 25 underwent PSE and 10 underwent DSE. The splenic salvage rate was 84% in the PSE group (21 of 25 patients) and 80% in the DSE group (2 of 10 patients). Fisher’s Exact T-test was used to demonstrate a P value of 0.54 between the two groups. The average fluoroscopy time for the PSE group was 13 minutes 18 seconds. The average fluoroscopy time for the DSE group was 50 minutes 24 seconds. Nonparametric Kruskall-Wallis test (chi-square⫽11.3095) was used to demonstrate a P value of 0.008. Conclusion: These results demonstrate a statistically significant difference in fluoroscopy time between the two groups with no significant difference in splenic salvage rate, suggest-
Poster Sessions
Endovascular treatment of lower extremity noncommon femoral artery pseudoaneurysms
penetrating trauma and iatrogenic causes with subsequent endovascular management. Background: Pseudoaneurysms arise from a disruption in one or more of the arterial wall layers and can occur from inflammation, infection, connective tissue disorders, trauma, or iatrogenic causes. Involvement of the peripheral arteries is rare and most commonly a result of traumatic penetrating or blunt injuries, such as gunshot or stab wounds, and iatrogenic arterial injuries. Surgery has been the traditional treatment of choice for pseudoaneurysms and, depending on the location, surgical management may include resection with a bypass procedure or arterial ligation. Over the past few years, minimally invasive and endovascular techniques have proven to be a viable alternative to the surgical approach. These include transcatheter coil embolization, stent-graft placement, and ultrasound guided percutaneous thrombin injection. Clinical Findings/Procedure Details: Of the seven cases reviewed from our institutions, all were successfully treated utilizing endovascular techniques, with post-embolization images demonstrating cessation of sac filling and resolution of the arteriovenous fistulas in those select cases. Conclusion and/or Teaching Points: Endovascular management of non-common femoral artery lower extremity pseudoaneurysms is a successful, minimally invasive, and cost-effective therapeutic option in comparison to the traditional surgical option, with a marked decrease in morbidity and mortality.