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Long-term results of microcoil embolization for colonic hemorrhage: how common is rebleeding?
S56
’
Monday
2:02 PM
Scientific Session
Abstract No. 112
Long-term results of microcoil embolization for colonic hemorrhage: how common is rebleeding?
MONDAY: Scientific Sessions
O. Ahmed1, B. Funaki1, D. Jilani2, S.K. Sheth1; 1University of Chicago, Chicago, IL; 2Wright State University Boonshoft School of Medicine, Dayton, OH Purpose: To determine the long-term results of patients undergoing transcatheter coil embolization for the treatment of acute colonic hemorrhage. Materials and Methods: An IRB approved retrospective study was conducted on all consecutive patients undergoing angiography for the evaluation of suspected colonic bleeding between January 2002 and December 2012. Patient data was collected by reviewing the electronic medical chart and procedure data from PACS. Baseline, procedural, and outcome parameters were recorded following Society of Interventional Radiology guidelines. Follow up was performed on patients up through one year from date of procedure, with minimum 180 day follow up on all cases. Results: A total of 87 mesenteric angiograms were performed on 79 patients for acute colonic hemorrhage. In this group, one or multiple sites of bleeding were identified in 40 cases. Coil embolization was performed in 85% (34/40), with the remainder of cases unsuitable for intervention due to diffuse multifocal bleeding or inability to perform superselective catheterization due to vasospasm or severe atherosclerosis. Technical success was achieved in 94% (32/34), with failure defined as persistent active bleeding despite embolization. One major complication occurred: ischemia requiring bowel resection. Four patients had low grade recurrent bleeding within one year which was treated by surgical resection. Two of these patients had malignancy, one had widespread diverticulosis, and the other had multifactorial bleeding. No cases of ischemic stricture occurred. All-cause mortality of treated patients at one year was 31% (10/32). Conclusion: Transcatheter coil embolization is a durable treatment option in the setting of acute colonic hemorrhage. A modest level of re-bleeding was seen in patients within oneyear that necessitated surgical resection; in the vast majority of patients, embolization proved to be definitive therapy.
2:10 PM
Abstract No. 113
Is preoperative renal embolization effective in reducing blood loss and transfusion requirements during nephrectomy for renal cell carcinoma? Results from a single institution J. Kee-Sampson1, S.K. Calhoun1, T. Yablonsky1, D. Saypol2,3, A. Bansal3; 1Radiology, Atlantic Health System – Morristown Medical Center, Morristown, NJ; 2 Garden State Urology, Whippany, NJ; 3Atlantic Health System – Morristown Medical Center, Morristown, NJ Purpose: To compare blood loss and transfusion requirements at nephrectomy in patients with renal cell carcinoma, without and with preoperative renal embolization. Materials and Methods: 122 patients who underwent nephrectomy for renal cell carcinoma at our institution from 2008 to August 2013 were retrospectively evaluated, which included patients who did and did not receive preoperative
’
JVIR
renal embolization. The patients were evaluated for estimated blood loss (EBL) and mean transfusion requirements (MTR) after being stratified by TNM staging and tumor volume. After matching for pathologic staging of at least T3a and a tumor volume between 100mL to 1000mL, EBL and MTR between the two groups were compared. Results: There were 8 patients in the non-embolized group and 9 patients in the embolized group with a pathologic staging of at least T3a and a tumor volume of 100-1000mL. The mean tumor volumes were 371 mL and 370 mL in the non-embolized group and embolized group respectively. The EBL in the nonembolized group was 1181 mL, versus 405 mL in the embolized group, with a MTR of 3.9 units in the non-embolized group versus 1.2 units in the embolized group. Conclusion: The data suggests that at our institution, preoperative renal artery embolization led to a 66% reduction in blood loss and 69% reduction in mean transfusion requirements at nephrectomy for renal cell carcinoma in masses that are between 100-1000mL in volume, with a pathologic stage of at least T3a.
2:18 PM
Abstract No. 114
Longitudinal outcomes of endovascularly managed iatrogenic renal bleeds G.K. Chiramel, S.N. Keshava, V. Moses; Radiology, Christian Medical College Vellore, Vellore, India Purpose: Iatrogenic vascular injuries to the kidney could be life threatening. The aim of this study was to evaluate the long term outcome of endovascularly managed iatrogenic renal injuries. Materials and Methods: This was a retrospective study of patients referred for endovascular management of severe bleeding after an invasive procedure on the kidney, either diagnostic or therapeutic. Information was retrieved from the Picture Archiving and Communication System (PACS), patients’ charts and electronic medical records. Follow up information was got from the outpatient records. Results: Over the study period of more than twelve years, 70 patients had developed significant bleeding after invasive renal procedures comprising of 18 percutaneous biopsies, 50 percutaneous nephrolithotomies and 2 surgeries. All patients had undergone emergency digital subtraction angiography. Embolisation was performed if a bleed could be identified. The first angiogram could detect an abnormality in 55 patients (78.6%). Fifteen patients had to undergo a second angiography and five underwent a third. Overall, 66 (94.3%) showed complete resolution. Three (4.3%) patients underwent nephrectomy and four patients (5.7%) died. There were two minor complications, both of which resolved spontaneously. There was no significant change in serum creatinine values. The patients were followed up for an average period of one year. Conclusion: Patients with severe bleeding from iatrogenic renal vascular injuries benefit from emergency digital subtraction angiography and embolisation. Upto 20% of the initial angiograms may be negative. A second or a third angiogram is beneficial to detect an unidentified or recurrent bleed. In an unidentified bleed in a symptomatic patient, empirical embolisation of the suspected site can provide some benefit.
’
Monday
2:02 PM
Scientific Session
Abstract No. 112
Long-term results of microcoil embolization for colonic hemorrhage: how common is rebleeding?
MONDAY: Scientific Sessions
O. Ahmed1, B. Funaki1, D. Jilani2, S.K. Sheth1; 1University of Chicago, Chicago, IL; 2Wright State University Boonshoft School of Medicine, Dayton, OH Purpose: To determine the long-term results of patients undergoing transcatheter coil embolization for the treatment of acute colonic hemorrhage. Materials and Methods: An IRB approved retrospective study was conducted on all consecutive patients undergoing angiography for the evaluation of suspected colonic bleeding between January 2002 and December 2012. Patient data was collected by reviewing the electronic medical chart and procedure data from PACS. Baseline, procedural, and outcome parameters were recorded following Society of Interventional Radiology guidelines. Follow up was performed on patients up through one year from date of procedure, with minimum 180 day follow up on all cases. Results: A total of 87 mesenteric angiograms were performed on 79 patients for acute colonic hemorrhage. In this group, one or multiple sites of bleeding were identified in 40 cases. Coil embolization was performed in 85% (34/40), with the remainder of cases unsuitable for intervention due to diffuse multifocal bleeding or inability to perform superselective catheterization due to vasospasm or severe atherosclerosis. Technical success was achieved in 94% (32/34), with failure defined as persistent active bleeding despite embolization. One major complication occurred: ischemia requiring bowel resection. Four patients had low grade recurrent bleeding within one year which was treated by surgical resection. Two of these patients had malignancy, one had widespread diverticulosis, and the other had multifactorial bleeding. No cases of ischemic stricture occurred. All-cause mortality of treated patients at one year was 31% (10/32). Conclusion: Transcatheter coil embolization is a durable treatment option in the setting of acute colonic hemorrhage. A modest level of re-bleeding was seen in patients within oneyear that necessitated surgical resection; in the vast majority of patients, embolization proved to be definitive therapy.
2:10 PM
Abstract No. 113
Is preoperative renal embolization effective in reducing blood loss and transfusion requirements during nephrectomy for renal cell carcinoma? Results from a single institution J. Kee-Sampson1, S.K. Calhoun1, T. Yablonsky1, D. Saypol2,3, A. Bansal3; 1Radiology, Atlantic Health System – Morristown Medical Center, Morristown, NJ; 2 Garden State Urology, Whippany, NJ; 3Atlantic Health System – Morristown Medical Center, Morristown, NJ Purpose: To compare blood loss and transfusion requirements at nephrectomy in patients with renal cell carcinoma, without and with preoperative renal embolization. Materials and Methods: 122 patients who underwent nephrectomy for renal cell carcinoma at our institution from 2008 to August 2013 were retrospectively evaluated, which included patients who did and did not receive preoperative
’
JVIR
renal embolization. The patients were evaluated for estimated blood loss (EBL) and mean transfusion requirements (MTR) after being stratified by TNM staging and tumor volume. After matching for pathologic staging of at least T3a and a tumor volume between 100mL to 1000mL, EBL and MTR between the two groups were compared. Results: There were 8 patients in the non-embolized group and 9 patients in the embolized group with a pathologic staging of at least T3a and a tumor volume of 100-1000mL. The mean tumor volumes were 371 mL and 370 mL in the non-embolized group and embolized group respectively. The EBL in the nonembolized group was 1181 mL, versus 405 mL in the embolized group, with a MTR of 3.9 units in the non-embolized group versus 1.2 units in the embolized group. Conclusion: The data suggests that at our institution, preoperative renal artery embolization led to a 66% reduction in blood loss and 69% reduction in mean transfusion requirements at nephrectomy for renal cell carcinoma in masses that are between 100-1000mL in volume, with a pathologic stage of at least T3a.
2:18 PM
Abstract No. 114
Longitudinal outcomes of endovascularly managed iatrogenic renal bleeds G.K. Chiramel, S.N. Keshava, V. Moses; Radiology, Christian Medical College Vellore, Vellore, India Purpose: Iatrogenic vascular injuries to the kidney could be life threatening. The aim of this study was to evaluate the long term outcome of endovascularly managed iatrogenic renal injuries. Materials and Methods: This was a retrospective study of patients referred for endovascular management of severe bleeding after an invasive procedure on the kidney, either diagnostic or therapeutic. Information was retrieved from the Picture Archiving and Communication System (PACS), patients’ charts and electronic medical records. Follow up information was got from the outpatient records. Results: Over the study period of more than twelve years, 70 patients had developed significant bleeding after invasive renal procedures comprising of 18 percutaneous biopsies, 50 percutaneous nephrolithotomies and 2 surgeries. All patients had undergone emergency digital subtraction angiography. Embolisation was performed if a bleed could be identified. The first angiogram could detect an abnormality in 55 patients (78.6%). Fifteen patients had to undergo a second angiography and five underwent a third. Overall, 66 (94.3%) showed complete resolution. Three (4.3%) patients underwent nephrectomy and four patients (5.7%) died. There were two minor complications, both of which resolved spontaneously. There was no significant change in serum creatinine values. The patients were followed up for an average period of one year. Conclusion: Patients with severe bleeding from iatrogenic renal vascular injuries benefit from emergency digital subtraction angiography and embolisation. Upto 20% of the initial angiograms may be negative. A second or a third angiogram is beneficial to detect an unidentified or recurrent bleed. In an unidentified bleed in a symptomatic patient, empirical embolisation of the suspected site can provide some benefit.