Abstract No. 361: Results of Angioplasty for Renal Artery Stenosis in Pediatric Patients: A Ten-Year Experience

lar embolization with NBCA. NBCA was the only embolic agent in 14 patients and in one patient a liquid coil was additionally used. NBCA was mixed with iodized-oil at a ratio of 1:3 in order to control its polymerization time and make it radiopaque. Diagnostic angiography and transcatheter embolization were performed at the same sitting. Embolized sites included gastrointestinal tract, spleen, kidney, liver, chest, oral cavity, and buttock. RESULTS: NBCA embolization was successful in 14 of 15 patients (93 %), with complete occlusion of pseudoaneurysms and cessation of bleeding. In one patient who had a gastroduodenal artery stump pseudoaneurysm, NBCA embolization failed and a stent-graft was placed in the hepatic artery excluding pseudoaneurysm. Distal non-target embolization occurred in two patients without clinical significance. CONCLUSION: NBCA embolization of pseudoaneurysms was a feasible and effective treatment. However, the liquid nature of NBCA carries high potentiality of non-target embolization. Abstract No. 361 Results of Angioplasty for Renal Artery Stenosis in Pediatric Patients: A Ten-Year Experience. A. Srinivasan, L. Fontalvo-Herazo, M.S. Keller, G. Krishnamurthy, E. Nijs, A. Cahill; The Children’s Hospital of Philadelphia, Philadelphia, PA. PURPOSE: Renal artery stenosis (RAS) is a significant cause of childhood hypertension (HTN), as it is amenable to treatment. Fibromuscular dysplasia (FMD) and Neurofibromatosis type 1 (NF1) are the two most common causes of pediatric RAS. To date, no studies have evaluated pediatric renal artery angioplasty (RAA) in the United States. We desire to describe results of RAA with regard to long-term results based on clinical and angiographic follow-up, as well as immediate result and morbidity. MATERIALS & METHODS: We evaluated 16 children (8 female; age range 2-17 y, median 13.5 y) who underwent RAA, over the course of 10 years. 6 patients also carried a diagnosis of NF1. A positive end-result was achieved in 9 (56%), with resolution of HTN in 2 (13%) and improved control in the rest. 7 (44%) had a negative end-result: One had stenosis refractory to angioplasty, and 6 had recurrent HTN and stenosis despite initial good result; 4 patients went on to surgery. Mean time to relapse was 3.8 mo (range 1-11 mo, median 3 mo). 2 patients with negative end-results underwent repeat RAA; all those with bilateral or intraparenchymal disease had a negative result. Neither the diagnosis of NF1 nor the presence of ostial lesions predicted the result. The only complication was a contained dissection, managed conservatively, without sequela. No patient was stented. Cutting balloons were used after initial failure to efface in 3 patients (successful in 2/3), without adverse event. RESULTS: Results show that the rate of long-term success for RAA in pediatric FMD is less than that reported for adults, suggesting a more aggressive pathophysiology in children. However, a beneficial result was achieved in a majority, with RAA curative in a much smaller fraction. In general, worsening HTN was noted within a few months in those who fail primary RAA. In our series, the need for repeat angioplasty portended a negative end-result, as did the presence of bilateral or intraparenchymal disease, which may be markers for an aggressive process S134

CONCLUSION: Results demonstrate that RAA for pediatric RAS related to FMD and NF1 is a clinically feasible and safe procedure and also characterize its utility and prognosis of patient response. Abstract No. 362 Transjugular Intrahepatic Portosystemic Shunt: Comparison of Right Versus Left Jugular Access for Hepatic and Portal Vein Cannulation. J.A. Swenson, K.J. Cho; Universtiy of Michigan, Ann Arbor, MI. PURPOSE: To review the complications, technical failure rate and anatomy comparing the right and left jugular approach for transjugular intrahepatic portocaval shunts. MATERIALS & METHODS: One hundred fifty-four attempted TIPS at the University of Michigan Department of Radiology were identified from January 1, 2004 to October 1, 2008. Out of these 154 procedures, 53 were performed from a left jugular approach, 99 used a right internal jugular approach, and 2 used alternative approaches. Procedural complications and 30 day morbidity including liver failure and death were collected for both groups. RESULTS: One hundred forty-eight of the 154 total procedures resulted in successful creation of a TIPS. All of the 6 unsuccessful procedures used a right internal jugular approach. On a second attempt, two were successful one with a right internal jugular approach and the other using the left internal jugular approach. Procedural complications were not significantly different between the left and right internal jugular approaches. One hundred twenty-one of the 154 procedures were performed by the three physicians with the highest TIPS volume over this period. These three physicians performed 52 of the 53 left internal jugular TIPS procedures and had only one unsuccessful TIPS placement. The remaining 33 procedures were performed by 7 different physicians and had 5 unsuccessful TIPS placements. We reviewed available multi-planar MRI and multi-phase CT images for the unsuccessful TIPS placements and compared them to the successful placements. There was no significant difference in the sagittal and coronal angulation of the hepatic veins or the relationship of the right hepatic and right portal vein. CONCLUSION: There are potential technical advantages of a left sided jugular access site which include a possible straighter course from a left jugular access site to the preferred targeted site of portal vein. In our series, the complication rate for a left jugular approach is similar to a right jugular approach, while the technical failure rate is lower with higher physician TIPS procedural volume and left jugular approach. Abstract No. 363 EE Endovascular Strategies in Difficult and Challenging Iliac Access During Aortic Stent Graft. Tips and Tricks with Current Non-Custom Devices. K. Tan, K.W. Sniderman, D.K. Rajan, J.R. Kachura, J. Jaskolka, M.E. Simons, R. Beecroft; Toronto General Hospital, Toronto, ON, Canada. PURPOSE: Access-related limitations, namely small-caliber vessels, tortuous or calcified stenotic vessels, are often encountered during endovascular aortic aneurysm repair. Frequently, surgical bypass conduit or conversion to open repair is required. The purpose of this exhibit is to demon-