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Splenic artery aneurysms: a retrospective review at Kaiser Permanente
JVIR
’
Scientific Session
1:45 PM
Sunday
Abstract No. 42
Splenic artery aneurysms: a retrospective review at Kaiser Permanente D.S. Treister1, M. Khan1, R. Freed2, G.G. Vatakencherry2; 1 USC Keck School of Medicine, Los Angeles, CA; 2 Interventional Radiology, Kaiser Permanente, Los Angeles, CA
1:54 PM
Abstract No. 43
Partial splenic artery embolization in cancer patients with thrombocytopenia - the Moffitt experience B. Kis1, R. Duprey2,1, G.E. El-Haddad1, J. Sweeney1, B. Biebel1, R. Kim3, J. Choi1; 1Interventional Radiology, Moffitt Cancer Center, Tampa, FL; 2Morsani School of Medicine, USF, Tampa, FL; 3GI Oncology, Moffitt Cancer Center, Tampa, FL Purpose: The major reasons of pancytopenia in cancer patients are hypersplenism and bone marrow suppression from
S25
systemic chemo- or immunotherapy. Thrombocytopenia is the most common finding and it is particularly disabling as it contraindicates a necessary treatment to cancer patients including chemotherapy and/or surgery. The purpose of our study was to determine safety and efficacy of transarterial partial splenic artery embolization to improve platelet count in cancer patients with thrombocytopenia. Materials and Methods: This is a single institution retrospective study of 12 patients (8 males, 4 females, median age of 64.5) with different malignancies (4 hepatocellular, 4 colorectal, 2 myelodysplastic syndrome, 1 pancreatic cancer, 1 lymphoma) and concomitant thrombocytopenia who underwent transarterial partial splenic artery embolization with embolization microspheres from September 2012 to August 2014 to correct thrombocytopenia. The target embolization endpoint was 60-80% splenic infarct. Retrospective review of electronic medical records and imaging studies was performed to evaluate clinical and biochemical toxicities. Results: There was 100% technical success rate. The average post-procedure follow-up was 152 days. The pre-embolization platelet count was 64.1⫾6.6 (mean⫾SEM). The platelet count significantly increased in all patients following embolization, the platelet count was 171.6⫾18.9 at the first follow-up 2-4 weeks after the procedure. The peak platelet count was 187⫾24.1. The platelet count elevation was sustained in all patients during the follow-up period except one. One patient died 8 days after the procedure from sepsis. Nine patients had severe post-procedural pain requiring opiates for 41 week or hospital re-admission. Two patients developed non-occlusive splenic and/or portal vein thrombosis. Conclusion: Partial splenic embolization is effective and safe treatment to correct thrombocytopenia in cancer patients. The most common post-procedural complication is severe pain which is probably the most important factor to prevent the widespread use of this procedure.
2:03 PM
Abstract No. 44
Endovascular treatment of late bleeding complications after pancreas transplantation L.J. Pierce1, J. Golzarian1, J. Williams2, M. Andrew1; 1 Interventional Radiology, University of Minnesota, Saint Paul, MN; 2IR, Medical College of Wisconsin, Milwaukee, WI Purpose: To illustrate the unique angiographic challenges of pancreas transplant vascular complications and report outcomes of endovascular treatment. Materials and Methods: A retrospective review of electronic medical records and archived images was performed on adult patients with pancreas transplants with massive bleeding complications who were referred to Interventional Radiology for treatment. IRB approval was obtained. Between 1999 and 2013, 9 pancreas transplant patients presented with late acute bleeding complications and subsequently underwent urgent angiography with endovascular treatment. Four patients had arterioenteric fistulas, 1 had a pseudoaneurysm and arteriovenous fistula, 1 had a pseudoaneurysm and arterioenteric fistula, 2 had arterioureteral fistulas, and 1 had a retroperitoneal bleed. Results: Angiography demonstrated the origin of bleeding in 8 of 9 patients for whom endovascular repair was performed.
SUNDAY: Scientific Sessions
Purpose: Splenic artery aneurysms are the most common visceral aneurysms. While their incidence has grown with increased use of cross-sectional imaging, little is known about the natural history of these lesions. We sought to investigate patient characteristics, clinical risk factors, and growth patterns of splenic artery aneurysms in a large patient cohort. Materials and Methods: A patient list was retrieved from all Kaiser Permanente sites in Southern California via query of the electronic medical records system for the ICD9 code 442.83 (splenic artery aneurysm). Patient charts were retrospectively reviewed and demographics and medical comorbidities documented for each case. Cases of splenic pseudoaneurysm were excluded. Image reports were reviewed to find the oldest and most recent imaging in which the lesion was noted and the size was recorded for each. The patient chart was also reviewed for interventions in the form of open surgical or IR procedures. Results: 569 patient with splenic artery aneurysms were identified with females accounting for 78% (n¼442) of cases. The mean number of pregnancies in the 221 women with a documented obstetrics history was 3.9. The largest proportion of patients were White (69.1%), followed by Hispanic (22.5%), Asian (4.5%), and African American (3.8%). Current or former smokers made up 43.5% of all patients. The most frequent comorbidities in patients with splenic artery aneurysms were hypertension (67.4%), hyperlipidemia (55.9%), obesity (28.9%), diabetes mellitus (27.6%), atherosclerosis (25.3%), and liver cirrhosis (7.9%). 60 patients underwent a therapeutic procedure for their aneurysm including 39 with IR (primarily coil embolization), 18 with surgery, and 3 requiring both surgical and IR management. Longitudinal imaging data were available for 277 patients. 179 (65%) of these patients had aneurysms that were stable or decreased in maximum dimension. In the 98 patients who experienced interval aneurysm growth, the average growth rate was 0.95 mm/year. Conclusion: The preliminary results from our patient cohort represent the largest retrospective review of splenic artery aneurysms and aid in better defining the patient risk factors and natural history of these lesions.
’
’
Scientific Session
1:45 PM
Sunday
Abstract No. 42
Splenic artery aneurysms: a retrospective review at Kaiser Permanente D.S. Treister1, M. Khan1, R. Freed2, G.G. Vatakencherry2; 1 USC Keck School of Medicine, Los Angeles, CA; 2 Interventional Radiology, Kaiser Permanente, Los Angeles, CA
1:54 PM
Abstract No. 43
Partial splenic artery embolization in cancer patients with thrombocytopenia - the Moffitt experience B. Kis1, R. Duprey2,1, G.E. El-Haddad1, J. Sweeney1, B. Biebel1, R. Kim3, J. Choi1; 1Interventional Radiology, Moffitt Cancer Center, Tampa, FL; 2Morsani School of Medicine, USF, Tampa, FL; 3GI Oncology, Moffitt Cancer Center, Tampa, FL Purpose: The major reasons of pancytopenia in cancer patients are hypersplenism and bone marrow suppression from
S25
systemic chemo- or immunotherapy. Thrombocytopenia is the most common finding and it is particularly disabling as it contraindicates a necessary treatment to cancer patients including chemotherapy and/or surgery. The purpose of our study was to determine safety and efficacy of transarterial partial splenic artery embolization to improve platelet count in cancer patients with thrombocytopenia. Materials and Methods: This is a single institution retrospective study of 12 patients (8 males, 4 females, median age of 64.5) with different malignancies (4 hepatocellular, 4 colorectal, 2 myelodysplastic syndrome, 1 pancreatic cancer, 1 lymphoma) and concomitant thrombocytopenia who underwent transarterial partial splenic artery embolization with embolization microspheres from September 2012 to August 2014 to correct thrombocytopenia. The target embolization endpoint was 60-80% splenic infarct. Retrospective review of electronic medical records and imaging studies was performed to evaluate clinical and biochemical toxicities. Results: There was 100% technical success rate. The average post-procedure follow-up was 152 days. The pre-embolization platelet count was 64.1⫾6.6 (mean⫾SEM). The platelet count significantly increased in all patients following embolization, the platelet count was 171.6⫾18.9 at the first follow-up 2-4 weeks after the procedure. The peak platelet count was 187⫾24.1. The platelet count elevation was sustained in all patients during the follow-up period except one. One patient died 8 days after the procedure from sepsis. Nine patients had severe post-procedural pain requiring opiates for 41 week or hospital re-admission. Two patients developed non-occlusive splenic and/or portal vein thrombosis. Conclusion: Partial splenic embolization is effective and safe treatment to correct thrombocytopenia in cancer patients. The most common post-procedural complication is severe pain which is probably the most important factor to prevent the widespread use of this procedure.
2:03 PM
Abstract No. 44
Endovascular treatment of late bleeding complications after pancreas transplantation L.J. Pierce1, J. Golzarian1, J. Williams2, M. Andrew1; 1 Interventional Radiology, University of Minnesota, Saint Paul, MN; 2IR, Medical College of Wisconsin, Milwaukee, WI Purpose: To illustrate the unique angiographic challenges of pancreas transplant vascular complications and report outcomes of endovascular treatment. Materials and Methods: A retrospective review of electronic medical records and archived images was performed on adult patients with pancreas transplants with massive bleeding complications who were referred to Interventional Radiology for treatment. IRB approval was obtained. Between 1999 and 2013, 9 pancreas transplant patients presented with late acute bleeding complications and subsequently underwent urgent angiography with endovascular treatment. Four patients had arterioenteric fistulas, 1 had a pseudoaneurysm and arteriovenous fistula, 1 had a pseudoaneurysm and arterioenteric fistula, 2 had arterioureteral fistulas, and 1 had a retroperitoneal bleed. Results: Angiography demonstrated the origin of bleeding in 8 of 9 patients for whom endovascular repair was performed.
SUNDAY: Scientific Sessions
Purpose: Splenic artery aneurysms are the most common visceral aneurysms. While their incidence has grown with increased use of cross-sectional imaging, little is known about the natural history of these lesions. We sought to investigate patient characteristics, clinical risk factors, and growth patterns of splenic artery aneurysms in a large patient cohort. Materials and Methods: A patient list was retrieved from all Kaiser Permanente sites in Southern California via query of the electronic medical records system for the ICD9 code 442.83 (splenic artery aneurysm). Patient charts were retrospectively reviewed and demographics and medical comorbidities documented for each case. Cases of splenic pseudoaneurysm were excluded. Image reports were reviewed to find the oldest and most recent imaging in which the lesion was noted and the size was recorded for each. The patient chart was also reviewed for interventions in the form of open surgical or IR procedures. Results: 569 patient with splenic artery aneurysms were identified with females accounting for 78% (n¼442) of cases. The mean number of pregnancies in the 221 women with a documented obstetrics history was 3.9. The largest proportion of patients were White (69.1%), followed by Hispanic (22.5%), Asian (4.5%), and African American (3.8%). Current or former smokers made up 43.5% of all patients. The most frequent comorbidities in patients with splenic artery aneurysms were hypertension (67.4%), hyperlipidemia (55.9%), obesity (28.9%), diabetes mellitus (27.6%), atherosclerosis (25.3%), and liver cirrhosis (7.9%). 60 patients underwent a therapeutic procedure for their aneurysm including 39 with IR (primarily coil embolization), 18 with surgery, and 3 requiring both surgical and IR management. Longitudinal imaging data were available for 277 patients. 179 (65%) of these patients had aneurysms that were stable or decreased in maximum dimension. In the 98 patients who experienced interval aneurysm growth, the average growth rate was 0.95 mm/year. Conclusion: The preliminary results from our patient cohort represent the largest retrospective review of splenic artery aneurysms and aid in better defining the patient risk factors and natural history of these lesions.
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