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Embolization of the gastroduodenal and right gastric arteries prior to radioembolization with glass microspheres: is it always necessary?
JVIR
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Posters and Exhibits
S175
Abstract No. 413 Embolization of the gastroduodenal and right gastric arteries prior to radioembolization with glass microspheres: is it always necessary? N. Hamoui, R. Salem, R.J. Lewandowski; Northwestern University, Chicago, IL Purpose: Prior to radioembolization with yttrium-90 (Y90), it is standard practice to coil embolize the gastroduodenal (GDA) and right gastric (RGA) arteries to mitigate complications from nontarget delivery of radioactive microspheres to the gastrointestinal tract. The aim of this study is to evaluate the necessity of prophylactic embolization of the GDA and RGA prior to radioembolization with glass microspheres (extended shelf-life). Materials and Methods: Consecutive patients with unresectable hepatocellular carcinoma (HCC) or liver metastases undergoing radioembolization with extended shelf-life glass microspheres were studied. Extended shelf-life microspheres were chosen secondary to their increased embolic load over standard glass microsphere dosimetry. The rate and location of RGA/GDA coil embolization during planning angiography was recorded. After Y90 treatment, clinical follow-up was performed at 1-month and every 3 months thereafter. Results: 134 patients with HCC or liver metastases were treated with extended shelf-life glass microspheres. Neither the GDA nor the RGA were coil embolized in 68.6% (n¼92) of patients. The RGA was coil embolized in 26.1% (n¼ 35) of patients, and the GDA was coil embolized in 14.2% (n¼14) of patients. Two patients (1%) developed gastrointestinal ulcers, both of which healed with conservative therapy. In one case, retrospective analysis of the angiogram demonstrated a small gastric vessel that was overlooked by the interventional radiologist. The microcatheter was placed proximal to the RGA at the time of treatment, resulting in non-target delivery of radioactive microspheres. The other patient developed an ulcer after 6 weeks of being asymptomatic; biopsy did not reveal microspheres. The ulcer healed with conservative measures. Conclusion: Y90 radioembolization with glass microspheres using the extended shelf-life dosimetry model is minimally embolic. This study shows that coil embolization of the GDA and/or RGA may not be mandatory to mitigate GI complications. Rather, prophylactic embolization of these vessels should be at the IR’s discretion, taking into consideration blood flow dynamics and catheter infusion position.
Abstract No. 414 Ear arteriovenous malformation management W.F. Yakes; Vascular Malformation Center, Englewood, CO
Abstract No. 415 Complication assesment in image-guided research biopsies for research B.C. Odisio, S. Harmoush, E. Joseph, Jr., M.J. Wallace; Section of Interventional Radiology, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX Purpose: 1554 research biopsies performed in 1190 patients were retrospectively reviewed. Procedures were stratified in three major categories in regards the biopsy site: lung, solid organs (SO), and node/mass (NM). Patients submitted to single session (SS) biopsy were compared with the ones submitted to multiple session (MS) biopsies. Biopsies where a diagnostic specimen was required in addition to the research specimen (DxRx) were compared with the biopsies where only research (Rx) samples were obtained. CR and grade between the different groups were evaluated and compared. Materials and Methods: 1554 research biopsies performed in 1190 patients were retrospectively reviewed. Procedures were stratified in four major categories in regards the biopsy site: lung, liver, other solid organs (OSO), and node/mass (NM). Patients submitted to single biopsy sessions were compared with the ones submitted to multiple biopsies sessions per protocol indication. Biopsies where a diagnostic specimen was required in addition to the research specimen (DxRx) were compared with the biopsies where only research (Rx) samples were obtained. CR and grade between the different groups were evaluated and compared. Results: Overall CR was 90/1464 (5.8%) stratified as 83 (5.3%) grade o 2 and 7 (0.04%) grade Z 3. CR by biopsy sites included: Lung: 24% (62/196); SO 3.2% (10/310); and NM: 1.8% (18/958), (po0.0001). Single session biopsy occurred in 877 patients with a CR of 7.18% (95% CI 5.47-8.89) and multiple session biopsies in 313 patients on a total of 677 sessions with a CR of 4% (95% CI 2.5-5.4) (p¼0.008). For lung biopsies the CR for SS was 43/164 (26.2%) and for MS 14/43 (32.56%). For organ biopsies the CR for SS was 7/148 (4.7%) and for MS was 3/83 (3.6%). There was no significant difference in Z 3 complications between SS and MS (p¼0.7). 622 DxRx biopsies were performed with a CR of 6.6% and 932 Rx biopsies were performed with a CR of 5.2% (p¼0.27). Conclusion: Lung biopsies is associated with a higher chance of complication when compared to the other biopsy sites. No statistically significance was encounteres between the groups in regards Grade Z 3 complications. Obtaining a diagnostic sample did not increase CR.
Posters and Exhibits
Purpose: To determine the efficacy of Ethanol Endovascular Repair of Ear Arteriovenous Malformation (AVMs). Materials and Methods: Ten patients (7 females, 3 males; age range 6-39 years; mean age: 22 years) with ear AVMs presented for therapy. Two patients had failed prior embolizations (PVA/coils/ nBCA/steroids) and 2 patients had other therapies (laser/excisions/ grafting). All presented with grossly enlarged painful ear with intermittent bleeding. All patients underwent transcatheter and direct puncture ethanol Rx (86 procedures).
Results: All 10 patients were cured of the AVM at long-term follow-up (mean follow-up: 52 months). One patient had transient partial VII nerve palsy. Two patients had minor blisters and ear injuries. Conclusion: Ethanol endovascular repair of Ear AVMs can effect cures in this vexing lesion that previously was treated with resection of the ear with high recurrence rates. This series documents longterm cures of AVMs of the ear and scalp that in the world’s literature previously were not treatable by endovascular approaches. No recurrences were noted in this series.
’
Posters and Exhibits
S175
Abstract No. 413 Embolization of the gastroduodenal and right gastric arteries prior to radioembolization with glass microspheres: is it always necessary? N. Hamoui, R. Salem, R.J. Lewandowski; Northwestern University, Chicago, IL Purpose: Prior to radioembolization with yttrium-90 (Y90), it is standard practice to coil embolize the gastroduodenal (GDA) and right gastric (RGA) arteries to mitigate complications from nontarget delivery of radioactive microspheres to the gastrointestinal tract. The aim of this study is to evaluate the necessity of prophylactic embolization of the GDA and RGA prior to radioembolization with glass microspheres (extended shelf-life). Materials and Methods: Consecutive patients with unresectable hepatocellular carcinoma (HCC) or liver metastases undergoing radioembolization with extended shelf-life glass microspheres were studied. Extended shelf-life microspheres were chosen secondary to their increased embolic load over standard glass microsphere dosimetry. The rate and location of RGA/GDA coil embolization during planning angiography was recorded. After Y90 treatment, clinical follow-up was performed at 1-month and every 3 months thereafter. Results: 134 patients with HCC or liver metastases were treated with extended shelf-life glass microspheres. Neither the GDA nor the RGA were coil embolized in 68.6% (n¼92) of patients. The RGA was coil embolized in 26.1% (n¼ 35) of patients, and the GDA was coil embolized in 14.2% (n¼14) of patients. Two patients (1%) developed gastrointestinal ulcers, both of which healed with conservative therapy. In one case, retrospective analysis of the angiogram demonstrated a small gastric vessel that was overlooked by the interventional radiologist. The microcatheter was placed proximal to the RGA at the time of treatment, resulting in non-target delivery of radioactive microspheres. The other patient developed an ulcer after 6 weeks of being asymptomatic; biopsy did not reveal microspheres. The ulcer healed with conservative measures. Conclusion: Y90 radioembolization with glass microspheres using the extended shelf-life dosimetry model is minimally embolic. This study shows that coil embolization of the GDA and/or RGA may not be mandatory to mitigate GI complications. Rather, prophylactic embolization of these vessels should be at the IR’s discretion, taking into consideration blood flow dynamics and catheter infusion position.
Abstract No. 414 Ear arteriovenous malformation management W.F. Yakes; Vascular Malformation Center, Englewood, CO
Abstract No. 415 Complication assesment in image-guided research biopsies for research B.C. Odisio, S. Harmoush, E. Joseph, Jr., M.J. Wallace; Section of Interventional Radiology, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX Purpose: 1554 research biopsies performed in 1190 patients were retrospectively reviewed. Procedures were stratified in three major categories in regards the biopsy site: lung, solid organs (SO), and node/mass (NM). Patients submitted to single session (SS) biopsy were compared with the ones submitted to multiple session (MS) biopsies. Biopsies where a diagnostic specimen was required in addition to the research specimen (DxRx) were compared with the biopsies where only research (Rx) samples were obtained. CR and grade between the different groups were evaluated and compared. Materials and Methods: 1554 research biopsies performed in 1190 patients were retrospectively reviewed. Procedures were stratified in four major categories in regards the biopsy site: lung, liver, other solid organs (OSO), and node/mass (NM). Patients submitted to single biopsy sessions were compared with the ones submitted to multiple biopsies sessions per protocol indication. Biopsies where a diagnostic specimen was required in addition to the research specimen (DxRx) were compared with the biopsies where only research (Rx) samples were obtained. CR and grade between the different groups were evaluated and compared. Results: Overall CR was 90/1464 (5.8%) stratified as 83 (5.3%) grade o 2 and 7 (0.04%) grade Z 3. CR by biopsy sites included: Lung: 24% (62/196); SO 3.2% (10/310); and NM: 1.8% (18/958), (po0.0001). Single session biopsy occurred in 877 patients with a CR of 7.18% (95% CI 5.47-8.89) and multiple session biopsies in 313 patients on a total of 677 sessions with a CR of 4% (95% CI 2.5-5.4) (p¼0.008). For lung biopsies the CR for SS was 43/164 (26.2%) and for MS 14/43 (32.56%). For organ biopsies the CR for SS was 7/148 (4.7%) and for MS was 3/83 (3.6%). There was no significant difference in Z 3 complications between SS and MS (p¼0.7). 622 DxRx biopsies were performed with a CR of 6.6% and 932 Rx biopsies were performed with a CR of 5.2% (p¼0.27). Conclusion: Lung biopsies is associated with a higher chance of complication when compared to the other biopsy sites. No statistically significance was encounteres between the groups in regards Grade Z 3 complications. Obtaining a diagnostic sample did not increase CR.
Posters and Exhibits
Purpose: To determine the efficacy of Ethanol Endovascular Repair of Ear Arteriovenous Malformation (AVMs). Materials and Methods: Ten patients (7 females, 3 males; age range 6-39 years; mean age: 22 years) with ear AVMs presented for therapy. Two patients had failed prior embolizations (PVA/coils/ nBCA/steroids) and 2 patients had other therapies (laser/excisions/ grafting). All presented with grossly enlarged painful ear with intermittent bleeding. All patients underwent transcatheter and direct puncture ethanol Rx (86 procedures).
Results: All 10 patients were cured of the AVM at long-term follow-up (mean follow-up: 52 months). One patient had transient partial VII nerve palsy. Two patients had minor blisters and ear injuries. Conclusion: Ethanol endovascular repair of Ear AVMs can effect cures in this vexing lesion that previously was treated with resection of the ear with high recurrence rates. This series documents longterm cures of AVMs of the ear and scalp that in the world’s literature previously were not treatable by endovascular approaches. No recurrences were noted in this series.