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Role and utility of endovascular therapies in the treatment of vascular connective tissue disease emergencies
SCIENTIFIC POSTERS AND EDUCATIONAL EXHIBITS
Poster Session Educational Exhibit
Abstract No. 456
Role and utility of endovascular therapies in the treatment of vascular connective tissue disease emergencies
Posters and Exhibits
D. Sheeran1, A. Yaghoubian2, L. Wilkins3, P. Norton4, J. Angle2, K. Hagspiel2; 1University of Virginia Health System, Charlottesville, VA; 2Charlottesville, VA; 3 University of Virginia, Charlotesville, VA; 4University of Virginia, Charlottesville, VA Learning Objectives: 1. Describe the role of endovascular procedures in vascular connective tissue disease (CTD) related emergencies. 2. Demonstrate the effective use as well as potential complications following endovascular repair for vascular CTD related emergencies. 3. Review the most common vascular CTD’s and the most frequently associated vascular emergencies. Background: While rare, connective tissue diseases are responsible for an important subset of vascular emergencies. The predominant pathologies include Marfan Syndrome (Prevalence 1/5,000), Ehlers Danlos Syndrome (EDS) Type IV (Prevalence 1/90,000), and Loeys-Dietz Syndrome (LDS, Prevalence 1/1,000,000). These patients have shortened lifespans and can present with acute arterial dissections, aneurysms, and ruptures. Marfan syndrome often presents radiographically with anuloaortic ectasia, valvular disease, and/or aortic dissection. EDS presents at a young age with multi-territory aneurysm formation, dissection, occlusion, and/or vascular rupture. LDS is a recently recognized and more aggressive pathology in which aortic dissection is the most common cause of death. Clinical Findings/Procedure Details: Endovascular management of acute dissections, aneurysms, and even ruptures is now common practice in post-traumatic, atherosclerotic, and iatrogenic scenarios. However, there is a paucity of literature regarding its use in the subset of patients with a vascular CTD. The existing literature for the most part recommends avoidance of an endovascular approach and defers to open surgical intervention. We describe here the successful use of endovascular techniques as a rescue therapy in this patient population. With appropriate and close imaging follow-up this management strategy can serve as either definitive treatment or as a bridge/adjunct therapy to surgical management. Conclusions: CTD’s are an important group of pathology that need to be included in the differential diagnosis of young patients with acute vascular emergencies. This patient population can undergo successful endovascular management despite the increased vessel fragility and propensity for postprocedural complications. Following treatment, close interval follow-up is essential for continued clinical success. References 1. Bade M. et al. Endovascular abdominal aortic aneurysm repair in a patient with Ehlers-Danlos syndrome. J Vasc Surg 2007; 46(2):360–362.
2. Casey K, et al. Endovascular repair of bilateral iliac artery aneurysms in a patient with Loeys-Dietz syndrome. Ann Vasc Surg 2012; 26:107.e5–107.e10. 3. Taurino M, et al. Hybrid treatment for thoracoabdominal aortic aneurysms in patients with Marfan syndrome. Ann Vasc Surg 2015; 29:595.e5–595.e9. 4. Waterman A, et al. Endovascular treatment of acute and chronic aortic pathology in patients with Marfan syndrome. J Vasc Surg 2012; 55:1234–1241.
Educational Exhibit
Abstract No. 457
Stent-assisted transcatheter coil embolization of wide-necked renal artery aneurysms O. Ikeda1, Y. Tamura2, Y. Yamashita3, S. Inoue3; 1 Kumamoto University Hospital, Kumamoto-Shi, Kumamoto; 2Kumamoto Univercity Hospital, Kumamoto, Japan; 3Kumamoto University Hospital, Kumamoto, Kumamoto Purpose: We report treating wide-necked renal artery aneurysms (RAA) by stent-assisted coil embolization. Materials: We performed transcatheter coil embolization (TCE) in 19 patients. When the aneurysmal neck measures less than half of the short axis of the aneurysm we use sac packing only, when it measures more than half we perform stent-assisted coil embolization of the aneurysmal sac. Results: Patients whose RAA was more distal on the renal artery than the bifurcation (n¼12) underwent TCE by coilpacking the aneurysmal sac only. Single-stent-assisted coil embolization of the sac was used when the RAA was at the renal artery trunk or the distal renal artery (n¼4), partial stent in stent-assisted coil embolization of the aneurysmal sac when the RAA was at the renal artery bifurcation (n¼3). TCE was technically successful in all patients. However, in 2 of the 12 patients who underwent coil-packing of the sac only, the coils migrated into the distal renal artery, the native circulation was not preserved. One of 2 patients with fibromuscular dysplasia who was treated by partial stent in stent-assisted coil embolization manifested restenosis proximal to the stent; restenting was required to preserve the native arterial circulation. One patient treated by single-stent-assisted coil embolization showed coil compaction one year later and underwent reintervention. There were no instances of further recurrence or ectopic RAA. Follow-up showed that none of the stents had broken or become occluded. Conclusions: TCE can be an effective treatment of RAA and stent-assisted TCE is technically feasible and effective for widenecked RAAs.
Educational Exhibit
Abstract No. 458
Patency of balloon angioplasty or stent placement for treating venous stenosis in pediatric liver transplant recipients G. Ko1, D. Gwon2, K. Sung3, H. Yoon4, H. Ko5; 1Asan Medical Center, Seoul, Korea; 2Asan Medical Center, Seoul, IL; 3Asan Medical Center, Radiology, Seoul,
Poster Session Educational Exhibit
Abstract No. 456
Role and utility of endovascular therapies in the treatment of vascular connective tissue disease emergencies
Posters and Exhibits
D. Sheeran1, A. Yaghoubian2, L. Wilkins3, P. Norton4, J. Angle2, K. Hagspiel2; 1University of Virginia Health System, Charlottesville, VA; 2Charlottesville, VA; 3 University of Virginia, Charlotesville, VA; 4University of Virginia, Charlottesville, VA Learning Objectives: 1. Describe the role of endovascular procedures in vascular connective tissue disease (CTD) related emergencies. 2. Demonstrate the effective use as well as potential complications following endovascular repair for vascular CTD related emergencies. 3. Review the most common vascular CTD’s and the most frequently associated vascular emergencies. Background: While rare, connective tissue diseases are responsible for an important subset of vascular emergencies. The predominant pathologies include Marfan Syndrome (Prevalence 1/5,000), Ehlers Danlos Syndrome (EDS) Type IV (Prevalence 1/90,000), and Loeys-Dietz Syndrome (LDS, Prevalence 1/1,000,000). These patients have shortened lifespans and can present with acute arterial dissections, aneurysms, and ruptures. Marfan syndrome often presents radiographically with anuloaortic ectasia, valvular disease, and/or aortic dissection. EDS presents at a young age with multi-territory aneurysm formation, dissection, occlusion, and/or vascular rupture. LDS is a recently recognized and more aggressive pathology in which aortic dissection is the most common cause of death. Clinical Findings/Procedure Details: Endovascular management of acute dissections, aneurysms, and even ruptures is now common practice in post-traumatic, atherosclerotic, and iatrogenic scenarios. However, there is a paucity of literature regarding its use in the subset of patients with a vascular CTD. The existing literature for the most part recommends avoidance of an endovascular approach and defers to open surgical intervention. We describe here the successful use of endovascular techniques as a rescue therapy in this patient population. With appropriate and close imaging follow-up this management strategy can serve as either definitive treatment or as a bridge/adjunct therapy to surgical management. Conclusions: CTD’s are an important group of pathology that need to be included in the differential diagnosis of young patients with acute vascular emergencies. This patient population can undergo successful endovascular management despite the increased vessel fragility and propensity for postprocedural complications. Following treatment, close interval follow-up is essential for continued clinical success. References 1. Bade M. et al. Endovascular abdominal aortic aneurysm repair in a patient with Ehlers-Danlos syndrome. J Vasc Surg 2007; 46(2):360–362.
2. Casey K, et al. Endovascular repair of bilateral iliac artery aneurysms in a patient with Loeys-Dietz syndrome. Ann Vasc Surg 2012; 26:107.e5–107.e10. 3. Taurino M, et al. Hybrid treatment for thoracoabdominal aortic aneurysms in patients with Marfan syndrome. Ann Vasc Surg 2015; 29:595.e5–595.e9. 4. Waterman A, et al. Endovascular treatment of acute and chronic aortic pathology in patients with Marfan syndrome. J Vasc Surg 2012; 55:1234–1241.
Educational Exhibit
Abstract No. 457
Stent-assisted transcatheter coil embolization of wide-necked renal artery aneurysms O. Ikeda1, Y. Tamura2, Y. Yamashita3, S. Inoue3; 1 Kumamoto University Hospital, Kumamoto-Shi, Kumamoto; 2Kumamoto Univercity Hospital, Kumamoto, Japan; 3Kumamoto University Hospital, Kumamoto, Kumamoto Purpose: We report treating wide-necked renal artery aneurysms (RAA) by stent-assisted coil embolization. Materials: We performed transcatheter coil embolization (TCE) in 19 patients. When the aneurysmal neck measures less than half of the short axis of the aneurysm we use sac packing only, when it measures more than half we perform stent-assisted coil embolization of the aneurysmal sac. Results: Patients whose RAA was more distal on the renal artery than the bifurcation (n¼12) underwent TCE by coilpacking the aneurysmal sac only. Single-stent-assisted coil embolization of the sac was used when the RAA was at the renal artery trunk or the distal renal artery (n¼4), partial stent in stent-assisted coil embolization of the aneurysmal sac when the RAA was at the renal artery bifurcation (n¼3). TCE was technically successful in all patients. However, in 2 of the 12 patients who underwent coil-packing of the sac only, the coils migrated into the distal renal artery, the native circulation was not preserved. One of 2 patients with fibromuscular dysplasia who was treated by partial stent in stent-assisted coil embolization manifested restenosis proximal to the stent; restenting was required to preserve the native arterial circulation. One patient treated by single-stent-assisted coil embolization showed coil compaction one year later and underwent reintervention. There were no instances of further recurrence or ectopic RAA. Follow-up showed that none of the stents had broken or become occluded. Conclusions: TCE can be an effective treatment of RAA and stent-assisted TCE is technically feasible and effective for widenecked RAAs.
Educational Exhibit
Abstract No. 458
Patency of balloon angioplasty or stent placement for treating venous stenosis in pediatric liver transplant recipients G. Ko1, D. Gwon2, K. Sung3, H. Yoon4, H. Ko5; 1Asan Medical Center, Seoul, Korea; 2Asan Medical Center, Seoul, IL; 3Asan Medical Center, Radiology, Seoul,