- Email: [email protected]
Abstract No. 351: CT guided translateral approach via the space between carotid sheath and vertebral artery to metastatic involved the upper cervical spine for percutaneous vertebroplasty
Abstract No. 350 EE Inferior petrosal sinus sampling: Technique and rationale K. Yeddula, S.I. Iqbal, T.G. Walker, G.M. Salazar, B. Pomerantz, S. Ganguli, S. Wicky, S.P. Kalva; Massachusetts General Hospital, Boston, MA. Learning Objectives: To describe the clinical relevance, technique, and results of inferior petrosal sinus sampling (IPSS) for suspected pituitary disease Background: The purpose of IPSS is to measure pituitary hormone output directly, by sampling pituitary venous effluent. Blood from the inferior petrosal sinus reflects the hormonal composition of pituitary venous effluents. Bilateral simultaneous sampling of the inferior petrosal sinuses is a highly sensitive, specific and accurate test for diagnosing Cushing’s disease. It also distinguishes Cushing’s disease from the ectopic ACTH syndrome. Clinical Findings/Procedure Details: Inferior petrosal sinus sampling is performed by simultaneous bilateral common femoral vein access. The Davis catheter is maneuvered to the contra lateral internal jugular vein and parked at the level of angle of mandible. Co-axially a micro-catheter is passed and the inferior petrosal sinus is catheterized. This is done on both sides and checked by contrast injection, which should show both inferior petrosal sinuses. Once both inferior petrosal sinuses are selected, 100mcg corticotropin releasing hormone (CRH) is injected in a peripheral vein and samples are collected at 3, 5, 10, and 15 minutes from both inferior petrosal sinus and peripheral vein. Conclusion and/or Teaching Points: The IPSS procedure is safe, and can be performed as an outpatient procedure with minimal morbidity and mortality. It is helpful in lateralizing the side of pituitary microadenoma and hyperfunction, as well as in differentiating between pituitary and extra-pituitary cause of cushings syndrome. Abstract No. 351 CT guided translateral approach via the space between carotid sheath and vertebral artery to metastatic involved the upper cervical spine for percutaneous vertebroplasty L. Zheng Yin; West China Hospital, Sichuan University, Chengdu, China. Purpose: Percutaneous vertebroplasty(PV) in the upper cervical spine(C1; C2;C3) is a challenging procedure, The purpose of this study was to evaluate the feasibility, safety, and therapeutic effects of PV for metastatic involved the upper cervical spine from lateral approach via the space between carotid sheath and vertebral artery under CT guidance. Materials and Methods: From March 2003 to March 2009, 7 patients included one patient with lytic metastasis of left lateral mass of C1, four patients with lytic metastasis of C2 body, two patients with lytic metastasis of C3 body. Under
S132
local anesthesia, had undergone PV through lateral-approach under CT guidance, needle advanced in step by step through the space between carotid sheath and vertebral artery, all cases had PV indication for pain control and spine stabilization. Results: 1.8ml of cement injected in C1. The mean 2.6 ml (range, 2.0-3.5 ml) injected in C2. 2.2ml and 2.5ml of cement injected separately in two C3 involved patients. Cement leakage was detected in one patient with a little cement leakage into epidural space, no postprocedural clinical manifestations were observed. All pts had been followed up more than five months, Pain improvement was achieved in all pts. All pts dismissed external neck brace support after PV. Conclusion: PV of the upper cervical spine from lateral approach via the space between carotid sheath and vertebral artery is an effective option in the treatment strategies of patients with metastasis to C1 or C2 or C3. Nevertheless, it is a challenging procedure and must perform under CT guidance in step by step to avoid injuring internal carotid artery, vein, and vertebral artery. Abstract No. 352 The outpatient vascular and interventional radiology practice from 2001-2008 S. Misra, A. Khosla, J. Friese, H. Bjarnason, P. Glovicki, T. Rooke, M.A. McKusick; Mayo Clinic, Rochester, MN. Purpose: To describe our experience with our outpatient vascular interventional radiology (IR) practice with respect to number of patients seen, number of procedures performed, and number of imaging studies ordered in follow-up. Materials and Methods: Our outpatient vascular IR practice was established in 2001 with two physicians spending 0.1 FTE per year with a third physician joined in 2004. We retrospectively reviewed from all patients seen by an interventional radiologist 2001 to July 2008. The following data were collected for each IR physician per year: the number of new and established patients seen, the number and type of procedures performed, and the number and type of imaging studies ordered. Data are presented as mean ⫾ standard deviation/IR physician/year. Results: In 2001, the average number of new patients seen was 61 ⫾ 11 which peaked by 2006 at 127 ⫾ 28. A similar trend occurred with the established patients. In 2001, the procedure performed with the greatest frequency was abdominal aortogram with stent placement, which started at 18 ⫾ 2 and peaked by 2006 at 37 ⫾ 23. In addition, the number of ancillary imaging ordered by each physician grew each year and by 2006 –2007 it was nearly 93 ⫾ 77. Conclusion: A robust outpatient IR practice in vascular disease can be developed in 3–5 years. The interventional radiologist can successfully consult on vascular patients and gradually grow a practice in procedural volume along with downstream imaging studies being ordered for the diagnostic radiology department.
S132
local anesthesia, had undergone PV through lateral-approach under CT guidance, needle advanced in step by step through the space between carotid sheath and vertebral artery, all cases had PV indication for pain control and spine stabilization. Results: 1.8ml of cement injected in C1. The mean 2.6 ml (range, 2.0-3.5 ml) injected in C2. 2.2ml and 2.5ml of cement injected separately in two C3 involved patients. Cement leakage was detected in one patient with a little cement leakage into epidural space, no postprocedural clinical manifestations were observed. All pts had been followed up more than five months, Pain improvement was achieved in all pts. All pts dismissed external neck brace support after PV. Conclusion: PV of the upper cervical spine from lateral approach via the space between carotid sheath and vertebral artery is an effective option in the treatment strategies of patients with metastasis to C1 or C2 or C3. Nevertheless, it is a challenging procedure and must perform under CT guidance in step by step to avoid injuring internal carotid artery, vein, and vertebral artery. Abstract No. 352 The outpatient vascular and interventional radiology practice from 2001-2008 S. Misra, A. Khosla, J. Friese, H. Bjarnason, P. Glovicki, T. Rooke, M.A. McKusick; Mayo Clinic, Rochester, MN. Purpose: To describe our experience with our outpatient vascular interventional radiology (IR) practice with respect to number of patients seen, number of procedures performed, and number of imaging studies ordered in follow-up. Materials and Methods: Our outpatient vascular IR practice was established in 2001 with two physicians spending 0.1 FTE per year with a third physician joined in 2004. We retrospectively reviewed from all patients seen by an interventional radiologist 2001 to July 2008. The following data were collected for each IR physician per year: the number of new and established patients seen, the number and type of procedures performed, and the number and type of imaging studies ordered. Data are presented as mean ⫾ standard deviation/IR physician/year. Results: In 2001, the average number of new patients seen was 61 ⫾ 11 which peaked by 2006 at 127 ⫾ 28. A similar trend occurred with the established patients. In 2001, the procedure performed with the greatest frequency was abdominal aortogram with stent placement, which started at 18 ⫾ 2 and peaked by 2006 at 37 ⫾ 23. In addition, the number of ancillary imaging ordered by each physician grew each year and by 2006 –2007 it was nearly 93 ⫾ 77. Conclusion: A robust outpatient IR practice in vascular disease can be developed in 3–5 years. The interventional radiologist can successfully consult on vascular patients and gradually grow a practice in procedural volume along with downstream imaging studies being ordered for the diagnostic radiology department.