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Catheter-directed thrombolysis versus ultrasound-accelerated thrombolysis for treatment of iliofemoral deep vein thrombosis: comparison of hospital cost and length of stay at a tertiary care hospital
JVIR
’
Scientific Session
4:51 PM
Wednesday
Abstract No. 305
Prophylactic uterine artery embolization in patients with abnormal placental attachment: initial experience J. Shah1, I. Hotalen1, D. Mobley1, S. Karakash2, S. Haberman2, F. Collado2, S. Sobolevsky1, S. Honig1; 1 Radiology, Maimonides Medical Center, New York, NY; 2 OB-GYN, Maimonides Medical Center, Brooklyn, NY
Venous Intervention Wednesday, March 4, 2015 3:30 PM – 5:00 PM Room: 316
Abstract No. 306
Catheter-directed thrombolysis versus ultrasoundaccelerated thrombolysis for treatment of iliofemoral deep vein thrombosis: comparison of hospital cost and length of stay at a tertiary care hospital S. Conus, D. Mittleider; Maine Medical Center, Portland, ME Purpose: Ultrasound-accelerated thrombolysis (UAT) is increasingly common compared with catheter-directed thrombolysis (CDT) despite the dramatic difference in cost between the two catheter types and limited data supporting UAT over CDT. This retrospective study assesses the impact of these catheters on overall hospital costs, Interventional Radiology (IR) costs, and hospital length of stay in patients within two treatment groups, evaluating the hypothesis that UAT may offset higher unit cost by decreasing hospital cost and length of stay. Materials and Methods: The medical records of patients undergoing thrombolysis for iliofemoral deep venous thrombosis at a tertiary care center between October 2010 and January 2014 were reviewed. Patients were divided into two groups: those treated with UAT and those treated with CDT. For each group, hospital length of stay following initiation of thrombolysis, overall cost of hospital stay and overall charge from the IR department during the hospital stay were collected and compared. Results: Forty-three patients met the study criteria. Twentytwo patients were treated using CDT, and 21 were treated with UAT. Average hospital length of stay following initiation of thrombolysis was 7.86 days in the CDT group and 6.14 days in the UAT group (p¼0.10). Average total hospital cost was $73,600.59 in the CDT group and $93,826.33 in the UAT group (p¼0.30). The total IR charge during hospitalization was $30,328.32 in the standard group and $36,405.14 in the ultrasound-accelerated group (p¼0.26). Conclusion: No statistically significant difference in total hospital cost, total IR cost, or hospital length of stay was demonstrated between those patients undergoing iliofemoral deep vein thrombolysis with CDT or UAT. As the list price for an ultrasound-accelerated thrombolytic catheter is $3225 greater than the list price for the standard infusion catheter used at our institution, these data do not support the added cost of ultrasound-accelerated lysis for iliofemoral DVT. Larger, prospective studies are needed to assess for any cost benefit of UAT over CDT.
3:39 PM
Scientific Session 37
S139
Abstract No. 307
Incidence of May-Thurner syndrome (MTS) in patients under evaluation of lower extremity venous reflux: implications for treatment O. Zurkiya, S. Ganguli, Z. Irani, R.W. Liu, G.R. Oliveira, G. Walker, S. Wicky, G.M. Salazar; Interventional Radiology, Massachusetts General Hospital, Boston, MA Purpose: May-Thurner anatomy (MTA) classically describes left iliac vein compression between the spine and right iliac artery. MTS refers to permanent sequelae of MTA including venous spurs, compromised flow and collateralization. MTS
WEDNESDAY: Scientific Sessions
Purpose: Placenta accreta/increta/percreta (AIP) is defined as abnormal attachment of all or part of the placenta to the myometrium and carries a high risk of hemorrhage and maternal mortality. The standard of care for management of placenta AIP has been cesarean-hysterectomy. In this series, we report an approach to the management of patients with abnormal placental attachment, in which patients underwent uterine artery embolization immediatley following delivery via cesarean section. Materials and Methods: Patients with suspected placenta AIP on both ultrasound and MRI underwent uterine artery catheterization prior to cesarean section, followed by cesarean section delivery. Patients who did not desire future fertility underwent cesarean section, uterine artery embolization with gelfoam, followed by hysterectomy. These patients were assessed post procedure for transfusions required as well as surgical complications. Patients who desired future fertility had the placenta left in situ, and underwent uterine artery embolization with gelfoam. Patients were followed and assessed for complications from angiography, postoperative complications and delayed passage of the placenta. Results: Over one year, 8 patients who were referred for suspected placenta AIP underwent uterine artery embolization. Four did not desire future fertility, and undwerwent cesarean section with hysterectomy. The remaining four patients desired future fertility and had the placenta left in situ. No angiographic complications were noted. Of the placentas left in situ, 3 either passed spontaneously or resorbed. 1 developed vaginal bleeding 7 weeks postoperatively, and underwent hysterectomy. Of those with no plans for future fertility, all successfully underwent hysterectomy. The number of units of red blood cells received per patient was 2, 1, 0 and 0 respectively. The only complication was a cystotomy due to the attachment of the placenta to the posterior bladder wall. Conclusion: Prophylactic uterine artery embolization allows for decreased blood loss and morbidity in patients undergoing cesearean hysterectomy and, when combined with nonremoval of the placenta, can provide an alernative to hysterectomy in patients desiring future fertility.
3:30 PM
’
’
Scientific Session
4:51 PM
Wednesday
Abstract No. 305
Prophylactic uterine artery embolization in patients with abnormal placental attachment: initial experience J. Shah1, I. Hotalen1, D. Mobley1, S. Karakash2, S. Haberman2, F. Collado2, S. Sobolevsky1, S. Honig1; 1 Radiology, Maimonides Medical Center, New York, NY; 2 OB-GYN, Maimonides Medical Center, Brooklyn, NY
Venous Intervention Wednesday, March 4, 2015 3:30 PM – 5:00 PM Room: 316
Abstract No. 306
Catheter-directed thrombolysis versus ultrasoundaccelerated thrombolysis for treatment of iliofemoral deep vein thrombosis: comparison of hospital cost and length of stay at a tertiary care hospital S. Conus, D. Mittleider; Maine Medical Center, Portland, ME Purpose: Ultrasound-accelerated thrombolysis (UAT) is increasingly common compared with catheter-directed thrombolysis (CDT) despite the dramatic difference in cost between the two catheter types and limited data supporting UAT over CDT. This retrospective study assesses the impact of these catheters on overall hospital costs, Interventional Radiology (IR) costs, and hospital length of stay in patients within two treatment groups, evaluating the hypothesis that UAT may offset higher unit cost by decreasing hospital cost and length of stay. Materials and Methods: The medical records of patients undergoing thrombolysis for iliofemoral deep venous thrombosis at a tertiary care center between October 2010 and January 2014 were reviewed. Patients were divided into two groups: those treated with UAT and those treated with CDT. For each group, hospital length of stay following initiation of thrombolysis, overall cost of hospital stay and overall charge from the IR department during the hospital stay were collected and compared. Results: Forty-three patients met the study criteria. Twentytwo patients were treated using CDT, and 21 were treated with UAT. Average hospital length of stay following initiation of thrombolysis was 7.86 days in the CDT group and 6.14 days in the UAT group (p¼0.10). Average total hospital cost was $73,600.59 in the CDT group and $93,826.33 in the UAT group (p¼0.30). The total IR charge during hospitalization was $30,328.32 in the standard group and $36,405.14 in the ultrasound-accelerated group (p¼0.26). Conclusion: No statistically significant difference in total hospital cost, total IR cost, or hospital length of stay was demonstrated between those patients undergoing iliofemoral deep vein thrombolysis with CDT or UAT. As the list price for an ultrasound-accelerated thrombolytic catheter is $3225 greater than the list price for the standard infusion catheter used at our institution, these data do not support the added cost of ultrasound-accelerated lysis for iliofemoral DVT. Larger, prospective studies are needed to assess for any cost benefit of UAT over CDT.
3:39 PM
Scientific Session 37
S139
Abstract No. 307
Incidence of May-Thurner syndrome (MTS) in patients under evaluation of lower extremity venous reflux: implications for treatment O. Zurkiya, S. Ganguli, Z. Irani, R.W. Liu, G.R. Oliveira, G. Walker, S. Wicky, G.M. Salazar; Interventional Radiology, Massachusetts General Hospital, Boston, MA Purpose: May-Thurner anatomy (MTA) classically describes left iliac vein compression between the spine and right iliac artery. MTS refers to permanent sequelae of MTA including venous spurs, compromised flow and collateralization. MTS
WEDNESDAY: Scientific Sessions
Purpose: Placenta accreta/increta/percreta (AIP) is defined as abnormal attachment of all or part of the placenta to the myometrium and carries a high risk of hemorrhage and maternal mortality. The standard of care for management of placenta AIP has been cesarean-hysterectomy. In this series, we report an approach to the management of patients with abnormal placental attachment, in which patients underwent uterine artery embolization immediatley following delivery via cesarean section. Materials and Methods: Patients with suspected placenta AIP on both ultrasound and MRI underwent uterine artery catheterization prior to cesarean section, followed by cesarean section delivery. Patients who did not desire future fertility underwent cesarean section, uterine artery embolization with gelfoam, followed by hysterectomy. These patients were assessed post procedure for transfusions required as well as surgical complications. Patients who desired future fertility had the placenta left in situ, and underwent uterine artery embolization with gelfoam. Patients were followed and assessed for complications from angiography, postoperative complications and delayed passage of the placenta. Results: Over one year, 8 patients who were referred for suspected placenta AIP underwent uterine artery embolization. Four did not desire future fertility, and undwerwent cesarean section with hysterectomy. The remaining four patients desired future fertility and had the placenta left in situ. No angiographic complications were noted. Of the placentas left in situ, 3 either passed spontaneously or resorbed. 1 developed vaginal bleeding 7 weeks postoperatively, and underwent hysterectomy. Of those with no plans for future fertility, all successfully underwent hysterectomy. The number of units of red blood cells received per patient was 2, 1, 0 and 0 respectively. The only complication was a cystotomy due to the attachment of the placenta to the posterior bladder wall. Conclusion: Prophylactic uterine artery embolization allows for decreased blood loss and morbidity in patients undergoing cesearean hysterectomy and, when combined with nonremoval of the placenta, can provide an alernative to hysterectomy in patients desiring future fertility.
3:30 PM
’