- Email: [email protected]
Non-vascular Interventions: Spine Interventions
Non-vascular Interventions: Gynecologic Abstract No. 374 EE Selective Salpingography: A Simple Technique for Treating Fallopian Tube Occlusion. K. Surapaneni, St. Luke’s-Roosevelt Hospital Center, New York, NY, USA 䡠 J. Silberzweig PURPOSE: Selective salpingography is a therapeutic option to treat patients with fallopian tube occlusion. The purpose of this exhibit is to: 1) Review the pathophysiology of tubal obstruction; 2) Illustrate a simplified technique for selective salpingography using case material from our institution; 3) Discuss the benefits of performing selective salpingography at the time of diagnostic hysterosalpingography. MATERIALS AND METHODS: We perform hysterosalpingography and selective salpingography in a freestanding outpatient interventional radiology office using a mobile C-arm unit. Selective salpingography is performed in women with unilateral or bilateral proximal fallopian tube occlusions identified at the time of diagnostic hysterosalpingography. A conventional contrast hysterosalpingogram is initially performed using a balloon catheter. Selective salpingography is performed using a 40-cm-long 5-F Berenstein catheter in patients with unilateral or bilateral proximal fallopian tube occlusion identified at the time of hysterosalpingography. A 9-F hysterosalpingography balloon catheter is used for additional support if the Berenstein catheter cannot be securely positioned at the junction of the fallopian tube and the cornual portion of the uterine cavity. TEACHING POINTS: 1) Selective salpingography is a safe and effective technique to treat fallopian tube obstruction. Use of this relatively straightforward procedure provides valuable diagnostic information and potentially improves fertility. 2) One of the technical challenges of selective salpingography arises from difficulties in cannulation of the cornua. Our experience with a modified technique using a 5-F Berenstein catheter over other traditional fallopian tube catheterization sets results in easier cannulation of the cornua, shorter procedure time, and material cost savings.
Non-vascular Interventions: Pain Interventions
RESULTS: 82 anesthesia procedures with the conventional syringe resulted in a mean anesthesia administration time of 1.22 ⫾ 0.87 minutes, a mean anesthesia VAPS (patient pain) score of 5.60 ⫾ 3.11, a mean post-anesthesia procedure VAPS (patient pain) score 5.09 ⫾ 1.83, and a mean VASS (operator satisfaction) score of 5.00 ⫾ 3.4. In contrast, the RPD in 68 subjects resulted in a mean anesthesia administration time of 0.68 ⫾ 0.61 minutes (49% reduction) (p ⬍ 0.001), a mean anesthesia VAPS (patient pain) score of 3.93 ⫾ .2.56 (43% reduction) (p ⬍ 0.001), a mean post-anesthesia procedure VAPS (patient pain) score 2.04 ⫾ 0.27 (62% reduction) (p ⬍ 0.001), and a mean VASS (operator satisfaction) score of 8.74 ⫾ 0.91 (85% increase) (p ⬍ 0.001). With the conventional syringe 65% (51/82) vs. 35% (25/68) with the RPD experienced moderate to severe pain (VAPS score 5 or greater) during anesthesia, and 65% (48/82) vs. 5% (9/68) experienced moderate to severe pain during the subsequent deep syringe procedure. CONCLUSION: The greater control provided by the RPD markedly reduces patient pain during administration of local anesthesia, reduces anesthesia administration time, maintains the effectiveness of local anesthesia during deep needle procedures, and improves operator satisfaction with the anesthesia device. The RPD is superior to the conventional syringe for administering local lidocaine anesthesia for interventional procedures.
Non-vascular Interventions: Spine Interventions Abstract No. 376 Biochemical Markers of Bone Turnover in Percutaneous Vertebroplasty for Osteoporotic Compression Fracture. A. Komemushi, Kansai Medical University, Hirakata, Osaka, Japan 䡠 N. Tanigawa 䡠 S. Kariya 䡠 H. Kojima 䡠 Y. Shomura 䡠 S. Sawada PURPOSE: The purpose of the present study was to evaluate the relationships between biochemical markers of bone turnover and new compression fractures following vertebroplasty.
PURPOSE: The reciprocating procedure device (RPD) permits much greater control of the needle and syringe during syringe procedures. We hypothesized that better control of the needle provided by the RPD would result in more rapid, less painful, and more effective local anesthesia for interventional procedures.
MATERIALS AND METHODS: Initially, we enrolled 30 consecutive patients with vertebral compression fractures caused by osteoporosis. A total of 23 of the 30 patients visited our hospital for follow-up examinations for more than 4 weeks after vertebroplasty (mean follow-up term, 255.0 ⫾ 173.1 days; median follow-up term, 275.5 days; range, 31-591 days). These 23 patients (21 women, 2 men; mean age, 72.1 ⫾ 6.7 years) were divided into two groups such as new fracture group (7 patients) and no new fracture group (16 patients). Using Student’s t-test, we analyzed the differences between new fracture group and no new fracture group in the following parameters: bone-alkaline phosphatase, cross-linked N-telopeptide of type I collagen, deoxypyridinoline, type I collagen cross-linked C-telopeptide, bone Gla protein and bone mineral density.
MATERIALS AND METHODS: 150 local lidocaine anesthesia procedures were randomized between the RDP and the conventional syringe. The post-anesthesia pain-inducing procedure was deep needle aspiration for diagnostic and therapeutic purposes. Outcome measures included anesthe-
RESULTS: We identified 9 new fractures in 7 of the 23 patients. For new fracture group and no new fracture group, respectively, bone-alkaline phosphatase was 30.1 ⫾ 15.3 and 25.3 ⫾ 8.6 U/L, cross-linked N-telopeptide of type I collagen was 583.9 ⫾ 467.4 and 395.1 ⫾ 287.0 nmol
Abstract No. 375 Randomized, Controlled Trial of the Reciprocating Procedure Device for Local Anesthesia of Interventional Procedures. W.L. Sibbitt, Jr., University of New Mexico Health Sciences Center, Albuquerque, NM, USA 䡠 S.E. Nunez 䡠 S.C. Kettwich 䡠 L.G. Kettwich 䡠 A.D. Bankhurst
S134
sia administration time, patient pain during anesthesia, pain during the subsequent needle procedure, and operator satisfaction with the anesthesia device. Pain was measured by the Visual Analogue Pain Scale (VAPS).
BCE/mmol Cr, deoxypyridinoline was 70.8 ⫾ 40.5 and 59.5 ⫾ 46.5 nmol/mmol Cr, type I collagen cross-linked C-telopeptide was 4.8 ⫾ 1.5 and 5.5 ⫾ 3.4 ng/mL, bone Gla protein was 8.4 ⫾ 2.9 and 7.0 ⫾ 1.6 ng/mL, and bone mineral density 2.2 ⫾ 0.2 and 2.0 ⫾ 0.3 mmAl. There were no significant differences between new fracture group and no new fracture group in all biochemical markers of bone turnover we evaluated. CONCLUSION: In our limited study, there were no significant relationships between biochemical markers of bone turnover and new compression fractures following vertebroplasty.
Non-vascular Interventions: Urinary Abstract No. 377 EE Retroperitoneal Fibrosis Revisited: Current Diagnosis, Radiologic Presentations, Treatment, and Follow-Up. G. Levin, Winthrop-University Hospital, Mineola, NY, USA 䡠 D. Katz 䡠 A.Y. Choi 䡠 J.J. Hines 䡠 M. Hon 䡠 A.A. Fruauff PURPOSE: Retroperitoneal (RP) fibrosis is a relatively rare condition which is challenging for both establishing the correct diagnosis based on imaging findings and for determining the appropriate clinical management. RP fibrosis may be idiopathic or may be due to an underlying process such as an aneurysm or neoplasm. The role of the radiologist is crucial in early recognition, since clinical symptoms are usually non-specific and may initially be absent. Additionally, the imaging findings may vary depending on the chronicity of the fibrosis. Timely intervention and treatment can help to avoid detrimental consequences of this infiltrating and progressive disease. The purpose of this educational exhibit is therefore to review the imaging findings of retroperitoneal fibrosis using intravenous urography, retrograde urography, and cross-sectional imaging studies, as well as to review the natural history and treatment options for retroperitoneal fibrosis with an emphasis on the role of the interventional radiologist in diagnosis and treatment. MATERIALS AND METHODS: A variety of examples of retroperitoneal fibrosis will be shown on intravenous urography, CT, and MR, including complications. The role of the cross-sectional and interventional radiologist will be reviewed, as will the literature on RP fibrosis. The differential diagnosis will be illustrated, including lymphoma and sarcoma.
Abstract No. 378 Percutaneous Antegrade Removal of Double J Ureteral Stents through a 9-F Nephrostomy Route: Experience in 37 Cases. J.-H. Shin, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea 䡠 H.-K. Yoon 䡠 G.-Y. Ko 䡠 K.-B. Sung 䡠 H.-Y. Song PURPOSE: To evaluate the safety and clinical efficacy of an antegrade approach in the removal of double J ureteral
MATERIALS AND METHODS: Under fluoroscopic guidance, antegrade removal of 37 ureteral stents in 25 patients was attempted using a snare or basket. Indications for percutaneous stent removal included the presence of a preexisting nephrostomy route (n ⫽ 8), a surgical history resulting in an inaccessible retrograde route (n ⫽ 8), urethral stricture (n ⫽ 4), upward stent migration (n ⫽ 2), inability to take a lithotomy position (n ⫽ 1), fragmentation of the proximal stent (n ⫽ 1), and inability to find the ureteral orifice with a cystoscope (n ⫽ 1). RESULTS: Thirty-five (94.6%) of the 37 stents were successfully removed using a snare or basket. The removal procedure using a snare or basket failed in two stents (5.4%) because the stents were embedded against the renal calyx or pelvis. The overall complication rate was 21.6% (6 hematomas and 2 lacerations). All complications were minor and resolved spontaneously. CONCLUSION: Percutaneous antegrade removal of double J ureteral stents through a non-dilated nephrostomy route was effective without major complications in patients with an available nephrostomy route or an inaccessible retrograde option. Abstract No. 379 EE Renal Transplant Related Complications and Their Interventions. K. Burney, Southmead Hospital, Bristol, Gloucestershire, United Kingdom 䡠 G.S. Karnati 䡠 E. Loveday 䡠 A. Mitchelmore 䡠 M.J. Thornton PURPOSE: To illustrate the normal parenchymal, vascular, and pyeloureteral findings in renal transplantation and the imaging features of renal transplant related complications and their interventions. MATERIALS AND METHODS: We retrospectively reviewed the imaging of post renal transplant patients performed over the last 4 years. The imaging features of transplantation complications and their interventional management have been presented. Despite high graft and patient survival figures, a variety of parenchymal, vascular and urologic complications can threaten the transplant. They can be characterized as either early or late. Early complications appear in the first few weeks after transplantation and are usually attributable to surgical difficulties. Late complications appear some weeks after the procedure and are usually due to medical problems such as those related to immunosuppression and toxicity. A number of vascular complications can threaten the transplant, these can be related to either native or transplant arteries. Renal transplantation is associated with a 1% to 15% incidence of vascular complications. The vascular complications discussed include renal artery stenosis, native vascular disease, intrarenal arteriovenous fistulas and pseudoaneurysms which are usually caused by trauma during percutaneous needle biopsy. Percutaneous management of these conditions is also discussed. The prevalence of urologic complications following renal transplantation is 2.6%–13%. The urological complications highlighted include urinomas, ureteral necrosis and ureteral obstruction which occurs in 3-6% of grafts. Postoperative ureteral edema or blood clots and peritransplant fluid collections and rarely ureter herniation may obstruct the ureter. In some cases, uncontrolled hypertension may be seen and may require embolization of the native kidneys.
POSTER SESSIONS
TEACHING POINTS: 1. To review the imaging findings of retroperitoneal fibrosis using intravenous urography, CT, and MR images. 2. To review the differential diagnosis for retroperitoneal fibrosis on imaging studies. 3. To understand the natural history and treatment options for retroperitoneal fibrosis, with emphasis on the role of the interventionalist for diagnosis and treatment.
stents through preexisting non-dilated nephrostomy routes under fluoroscopic guidance.
S135
Non-vascular Interventions: Pain Interventions
RESULTS: 82 anesthesia procedures with the conventional syringe resulted in a mean anesthesia administration time of 1.22 ⫾ 0.87 minutes, a mean anesthesia VAPS (patient pain) score of 5.60 ⫾ 3.11, a mean post-anesthesia procedure VAPS (patient pain) score 5.09 ⫾ 1.83, and a mean VASS (operator satisfaction) score of 5.00 ⫾ 3.4. In contrast, the RPD in 68 subjects resulted in a mean anesthesia administration time of 0.68 ⫾ 0.61 minutes (49% reduction) (p ⬍ 0.001), a mean anesthesia VAPS (patient pain) score of 3.93 ⫾ .2.56 (43% reduction) (p ⬍ 0.001), a mean post-anesthesia procedure VAPS (patient pain) score 2.04 ⫾ 0.27 (62% reduction) (p ⬍ 0.001), and a mean VASS (operator satisfaction) score of 8.74 ⫾ 0.91 (85% increase) (p ⬍ 0.001). With the conventional syringe 65% (51/82) vs. 35% (25/68) with the RPD experienced moderate to severe pain (VAPS score 5 or greater) during anesthesia, and 65% (48/82) vs. 5% (9/68) experienced moderate to severe pain during the subsequent deep syringe procedure. CONCLUSION: The greater control provided by the RPD markedly reduces patient pain during administration of local anesthesia, reduces anesthesia administration time, maintains the effectiveness of local anesthesia during deep needle procedures, and improves operator satisfaction with the anesthesia device. The RPD is superior to the conventional syringe for administering local lidocaine anesthesia for interventional procedures.
Non-vascular Interventions: Spine Interventions Abstract No. 376 Biochemical Markers of Bone Turnover in Percutaneous Vertebroplasty for Osteoporotic Compression Fracture. A. Komemushi, Kansai Medical University, Hirakata, Osaka, Japan 䡠 N. Tanigawa 䡠 S. Kariya 䡠 H. Kojima 䡠 Y. Shomura 䡠 S. Sawada PURPOSE: The purpose of the present study was to evaluate the relationships between biochemical markers of bone turnover and new compression fractures following vertebroplasty.
PURPOSE: The reciprocating procedure device (RPD) permits much greater control of the needle and syringe during syringe procedures. We hypothesized that better control of the needle provided by the RPD would result in more rapid, less painful, and more effective local anesthesia for interventional procedures.
MATERIALS AND METHODS: Initially, we enrolled 30 consecutive patients with vertebral compression fractures caused by osteoporosis. A total of 23 of the 30 patients visited our hospital for follow-up examinations for more than 4 weeks after vertebroplasty (mean follow-up term, 255.0 ⫾ 173.1 days; median follow-up term, 275.5 days; range, 31-591 days). These 23 patients (21 women, 2 men; mean age, 72.1 ⫾ 6.7 years) were divided into two groups such as new fracture group (7 patients) and no new fracture group (16 patients). Using Student’s t-test, we analyzed the differences between new fracture group and no new fracture group in the following parameters: bone-alkaline phosphatase, cross-linked N-telopeptide of type I collagen, deoxypyridinoline, type I collagen cross-linked C-telopeptide, bone Gla protein and bone mineral density.
MATERIALS AND METHODS: 150 local lidocaine anesthesia procedures were randomized between the RDP and the conventional syringe. The post-anesthesia pain-inducing procedure was deep needle aspiration for diagnostic and therapeutic purposes. Outcome measures included anesthe-
RESULTS: We identified 9 new fractures in 7 of the 23 patients. For new fracture group and no new fracture group, respectively, bone-alkaline phosphatase was 30.1 ⫾ 15.3 and 25.3 ⫾ 8.6 U/L, cross-linked N-telopeptide of type I collagen was 583.9 ⫾ 467.4 and 395.1 ⫾ 287.0 nmol
Abstract No. 375 Randomized, Controlled Trial of the Reciprocating Procedure Device for Local Anesthesia of Interventional Procedures. W.L. Sibbitt, Jr., University of New Mexico Health Sciences Center, Albuquerque, NM, USA 䡠 S.E. Nunez 䡠 S.C. Kettwich 䡠 L.G. Kettwich 䡠 A.D. Bankhurst
S134
sia administration time, patient pain during anesthesia, pain during the subsequent needle procedure, and operator satisfaction with the anesthesia device. Pain was measured by the Visual Analogue Pain Scale (VAPS).
BCE/mmol Cr, deoxypyridinoline was 70.8 ⫾ 40.5 and 59.5 ⫾ 46.5 nmol/mmol Cr, type I collagen cross-linked C-telopeptide was 4.8 ⫾ 1.5 and 5.5 ⫾ 3.4 ng/mL, bone Gla protein was 8.4 ⫾ 2.9 and 7.0 ⫾ 1.6 ng/mL, and bone mineral density 2.2 ⫾ 0.2 and 2.0 ⫾ 0.3 mmAl. There were no significant differences between new fracture group and no new fracture group in all biochemical markers of bone turnover we evaluated. CONCLUSION: In our limited study, there were no significant relationships between biochemical markers of bone turnover and new compression fractures following vertebroplasty.
Non-vascular Interventions: Urinary Abstract No. 377 EE Retroperitoneal Fibrosis Revisited: Current Diagnosis, Radiologic Presentations, Treatment, and Follow-Up. G. Levin, Winthrop-University Hospital, Mineola, NY, USA 䡠 D. Katz 䡠 A.Y. Choi 䡠 J.J. Hines 䡠 M. Hon 䡠 A.A. Fruauff PURPOSE: Retroperitoneal (RP) fibrosis is a relatively rare condition which is challenging for both establishing the correct diagnosis based on imaging findings and for determining the appropriate clinical management. RP fibrosis may be idiopathic or may be due to an underlying process such as an aneurysm or neoplasm. The role of the radiologist is crucial in early recognition, since clinical symptoms are usually non-specific and may initially be absent. Additionally, the imaging findings may vary depending on the chronicity of the fibrosis. Timely intervention and treatment can help to avoid detrimental consequences of this infiltrating and progressive disease. The purpose of this educational exhibit is therefore to review the imaging findings of retroperitoneal fibrosis using intravenous urography, retrograde urography, and cross-sectional imaging studies, as well as to review the natural history and treatment options for retroperitoneal fibrosis with an emphasis on the role of the interventional radiologist in diagnosis and treatment. MATERIALS AND METHODS: A variety of examples of retroperitoneal fibrosis will be shown on intravenous urography, CT, and MR, including complications. The role of the cross-sectional and interventional radiologist will be reviewed, as will the literature on RP fibrosis. The differential diagnosis will be illustrated, including lymphoma and sarcoma.
Abstract No. 378 Percutaneous Antegrade Removal of Double J Ureteral Stents through a 9-F Nephrostomy Route: Experience in 37 Cases. J.-H. Shin, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea 䡠 H.-K. Yoon 䡠 G.-Y. Ko 䡠 K.-B. Sung 䡠 H.-Y. Song PURPOSE: To evaluate the safety and clinical efficacy of an antegrade approach in the removal of double J ureteral
MATERIALS AND METHODS: Under fluoroscopic guidance, antegrade removal of 37 ureteral stents in 25 patients was attempted using a snare or basket. Indications for percutaneous stent removal included the presence of a preexisting nephrostomy route (n ⫽ 8), a surgical history resulting in an inaccessible retrograde route (n ⫽ 8), urethral stricture (n ⫽ 4), upward stent migration (n ⫽ 2), inability to take a lithotomy position (n ⫽ 1), fragmentation of the proximal stent (n ⫽ 1), and inability to find the ureteral orifice with a cystoscope (n ⫽ 1). RESULTS: Thirty-five (94.6%) of the 37 stents were successfully removed using a snare or basket. The removal procedure using a snare or basket failed in two stents (5.4%) because the stents were embedded against the renal calyx or pelvis. The overall complication rate was 21.6% (6 hematomas and 2 lacerations). All complications were minor and resolved spontaneously. CONCLUSION: Percutaneous antegrade removal of double J ureteral stents through a non-dilated nephrostomy route was effective without major complications in patients with an available nephrostomy route or an inaccessible retrograde option. Abstract No. 379 EE Renal Transplant Related Complications and Their Interventions. K. Burney, Southmead Hospital, Bristol, Gloucestershire, United Kingdom 䡠 G.S. Karnati 䡠 E. Loveday 䡠 A. Mitchelmore 䡠 M.J. Thornton PURPOSE: To illustrate the normal parenchymal, vascular, and pyeloureteral findings in renal transplantation and the imaging features of renal transplant related complications and their interventions. MATERIALS AND METHODS: We retrospectively reviewed the imaging of post renal transplant patients performed over the last 4 years. The imaging features of transplantation complications and their interventional management have been presented. Despite high graft and patient survival figures, a variety of parenchymal, vascular and urologic complications can threaten the transplant. They can be characterized as either early or late. Early complications appear in the first few weeks after transplantation and are usually attributable to surgical difficulties. Late complications appear some weeks after the procedure and are usually due to medical problems such as those related to immunosuppression and toxicity. A number of vascular complications can threaten the transplant, these can be related to either native or transplant arteries. Renal transplantation is associated with a 1% to 15% incidence of vascular complications. The vascular complications discussed include renal artery stenosis, native vascular disease, intrarenal arteriovenous fistulas and pseudoaneurysms which are usually caused by trauma during percutaneous needle biopsy. Percutaneous management of these conditions is also discussed. The prevalence of urologic complications following renal transplantation is 2.6%–13%. The urological complications highlighted include urinomas, ureteral necrosis and ureteral obstruction which occurs in 3-6% of grafts. Postoperative ureteral edema or blood clots and peritransplant fluid collections and rarely ureter herniation may obstruct the ureter. In some cases, uncontrolled hypertension may be seen and may require embolization of the native kidneys.
POSTER SESSIONS
TEACHING POINTS: 1. To review the imaging findings of retroperitoneal fibrosis using intravenous urography, CT, and MR images. 2. To review the differential diagnosis for retroperitoneal fibrosis on imaging studies. 3. To understand the natural history and treatment options for retroperitoneal fibrosis, with emphasis on the role of the interventionalist for diagnosis and treatment.
stents through preexisting non-dilated nephrostomy routes under fluoroscopic guidance.
S135