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Splenic artery embolization provides value at all levels of severity of splenic laceration
S106
’
Tuesday
Scientific Session
within the past 5 years. Initially 57 patients were identified. 32 were eliminated for the following: flouroscopy time not included, additional procedures performed (i.e. IVC filter placement, pseudoaneurysm coiling), and embolization with a combination of materials. 25 patients underwent splenic angiogram followed by embolization using either Amplatzer plug or coils. Site of occlusion and embolization method were recorded, the latter being either coils (pushable or detachable) or Amplatzer plugs. Fluoroscopy time, periprocedural complications, and need for splenectomy were also evaluated. Results: Of the 25 patients who underwent proximal-to-mid splenic artery embolization 14 were embolized with Amplatzer plugs and 11 with coils. The mean flouroscopy time for Amplatzer plug was 13.6 minutes compared to 30.0 minutes for coil embolization (un-paired t-test p¼0.0002). Median values for each group 12 minutes Amplatzer arm vs 28.3 coils arm. Conclusions: Fluoroscopy time was significantly greater using coils compared to Amplatzer plugs. This will limit ionizing radiation exposure and ensure a quicker overall procedure, both important. We therefore recommend use of Amplatzer plug over coils for proximal-to-mid splenic artery embolization in a trauma setting when the celiac and splenic arterial anatomy are amenable to plug placement (1,2).
TUESDAY: Scientific Sessions
References 1. Sclafani S, Weisberg A, Scalea T, Phillips T, Duncan A. Blunt splenic injuries: nonsurgical treatment with CT, arteriography, and transcatheter arterial embolization of the splenic artery. Radiology 1991; 181:189-196. [PubMed] 2. Bessoud B, Denys A, Calmes JM, et al. Nonoperative management of traumatic splenic injuries: is there a role for proximal splenic artery embolization? AJR Am J Roentgenol 2006; 186:779-785. http://dx.doi.org/ 10.2214/AJR.04
3:18 PM
Abstract No. 229
Splenic artery embolization provides value at all levels of severity of splenic laceration B. Gardner1, A. Park2, S. Sabri3, Z. Haskal3, J. Angle3, A. Matsumoto4; 1University of Virginia, Charlottesville, VA; 2UVA Health System, Charlottesville, VA; 3N/A, Charlottesville, VA; 4University of Virginia Health System, Charlottesville, VA. Purpose: To evaluate the efficacy of splenic artery embolization and its relation to the degree of splenic laceration. Materials: Retrospective analysis of all patients who underwent splenic artery embolization between July 2003 and February 2015 at a single institution. Analysis included splenic injury grades by the American Association for the Surgery of Trauma (AAST) classification, embolization material, success rate, and 30 day mortality. Results: Of the 121 cases identified there were 2 Grade I, 8 Grade II, 56 Grade III, 41 Grade IV, and 14 Grade V splenic lacerations. 71% underwent embolization of the distal segment of the splenic artery and its branches. Coils were used alone in 54 of the cases (45%). There were 8 patients who had a failed initial embolization as defined by the need for further intervention or surgery: 4 Grade III patients (7%), 2 Grade IV patients (5%), and 2 Grade V patients (14%). Of these 8 patients, 6 were successfully managed by subsequent embolization and only 2 eventually required splenectomy (one patient with a Grade III and Grade
’
JVIR
V splenic laceration, respectively). 30 day mortality was 7 (5.8%), including 5 patients with concomitant intracranial injuries. Conclusions: Endovascular splenic artery embolization should be considered for the management of splenic laceration, regardless of the degree of injury.
3:27 PM
Abstract No. 230
Embolization of renal arteries before transplantation in patients with polycystic kidney disease: a single institution long-term experience F. Cornelis, F. Petitpierre, Y. Le Bras, A. Lasserre, L. Couzi, C. Combes, P. Merville, J. Ferrière, N. Grenier; CHU Bordeaux, Bordeaux, France. Purpose: To assess retrospectively the long-term safety and efficacy of embolization of renal arteries (ERA) in patients with polycystic kidney disease (PKD) before renal transplantation. Materials: Between January 2008 and November 2013, 82 ERA procedures were performed on 76 kidneys in 73 patients (mean age 53 years, range: 34-72). All patients had terminalstage PKD and were under dialysis and on the renal transplant waiting list with a temporary contraindication due to excessive renal volume. Results: ERA was considered successful in 89.5% (68/76) of embolized kidneys, meaning that the temporary contraindication for transplantation could be withdrawn for 65 patients (on average 5.6 months, range: 2.8-24.3, after ERA). Mean volume reduction was 40 % (range: 2-69) at 3 months and 59% (35-86) thereafter (both po0.001). Postembolization syndrome occurred after 15 of 82 procedures (18.3 %). The severe complication rate was 4.9%. Forty-three (67.7 %) transplantation were successfully conducted after ERA with a mean follow-up of 26.2 months (range: 1.8-59.5) and the estimated 5-year graft survival rate was 95.3 % [95% CI: 82.7-98.8]. Conclusions: ERA is a safe and effective alternative to nephrectomy before renal transplantation in patients with PKD.
3:36 PM
Abstract No. 231
Demographic and volumetric imaging risk factors for treatment failure following transarterial embolization of sporadic and tuberous sclerosiscomplex associated renal angiomyolipomas R. Sheth1, A. Feldman2, E. Paul2, E. Thiele2, T. Walker2; 1 MD Anderson Cancer Center, Houston, TX; 2 Massachusetts General Hospital, Boston, MA. Purpose: To evaluate demographic and volumetric imaging risk factors for long term treatment failure following embolization of sporadic and tuberous sclerosis complex (TSC) associated angiomyolipomas (AMLs). Materials: A single institution, IRB-approved retrospective review of all transcatheter embolizations of renal AMLs between 2002 – 2014 was performed. Analysis of tumor volume and fat content was conducted using a standard
’
Tuesday
Scientific Session
within the past 5 years. Initially 57 patients were identified. 32 were eliminated for the following: flouroscopy time not included, additional procedures performed (i.e. IVC filter placement, pseudoaneurysm coiling), and embolization with a combination of materials. 25 patients underwent splenic angiogram followed by embolization using either Amplatzer plug or coils. Site of occlusion and embolization method were recorded, the latter being either coils (pushable or detachable) or Amplatzer plugs. Fluoroscopy time, periprocedural complications, and need for splenectomy were also evaluated. Results: Of the 25 patients who underwent proximal-to-mid splenic artery embolization 14 were embolized with Amplatzer plugs and 11 with coils. The mean flouroscopy time for Amplatzer plug was 13.6 minutes compared to 30.0 minutes for coil embolization (un-paired t-test p¼0.0002). Median values for each group 12 minutes Amplatzer arm vs 28.3 coils arm. Conclusions: Fluoroscopy time was significantly greater using coils compared to Amplatzer plugs. This will limit ionizing radiation exposure and ensure a quicker overall procedure, both important. We therefore recommend use of Amplatzer plug over coils for proximal-to-mid splenic artery embolization in a trauma setting when the celiac and splenic arterial anatomy are amenable to plug placement (1,2).
TUESDAY: Scientific Sessions
References 1. Sclafani S, Weisberg A, Scalea T, Phillips T, Duncan A. Blunt splenic injuries: nonsurgical treatment with CT, arteriography, and transcatheter arterial embolization of the splenic artery. Radiology 1991; 181:189-196. [PubMed] 2. Bessoud B, Denys A, Calmes JM, et al. Nonoperative management of traumatic splenic injuries: is there a role for proximal splenic artery embolization? AJR Am J Roentgenol 2006; 186:779-785. http://dx.doi.org/ 10.2214/AJR.04
3:18 PM
Abstract No. 229
Splenic artery embolization provides value at all levels of severity of splenic laceration B. Gardner1, A. Park2, S. Sabri3, Z. Haskal3, J. Angle3, A. Matsumoto4; 1University of Virginia, Charlottesville, VA; 2UVA Health System, Charlottesville, VA; 3N/A, Charlottesville, VA; 4University of Virginia Health System, Charlottesville, VA. Purpose: To evaluate the efficacy of splenic artery embolization and its relation to the degree of splenic laceration. Materials: Retrospective analysis of all patients who underwent splenic artery embolization between July 2003 and February 2015 at a single institution. Analysis included splenic injury grades by the American Association for the Surgery of Trauma (AAST) classification, embolization material, success rate, and 30 day mortality. Results: Of the 121 cases identified there were 2 Grade I, 8 Grade II, 56 Grade III, 41 Grade IV, and 14 Grade V splenic lacerations. 71% underwent embolization of the distal segment of the splenic artery and its branches. Coils were used alone in 54 of the cases (45%). There were 8 patients who had a failed initial embolization as defined by the need for further intervention or surgery: 4 Grade III patients (7%), 2 Grade IV patients (5%), and 2 Grade V patients (14%). Of these 8 patients, 6 were successfully managed by subsequent embolization and only 2 eventually required splenectomy (one patient with a Grade III and Grade
’
JVIR
V splenic laceration, respectively). 30 day mortality was 7 (5.8%), including 5 patients with concomitant intracranial injuries. Conclusions: Endovascular splenic artery embolization should be considered for the management of splenic laceration, regardless of the degree of injury.
3:27 PM
Abstract No. 230
Embolization of renal arteries before transplantation in patients with polycystic kidney disease: a single institution long-term experience F. Cornelis, F. Petitpierre, Y. Le Bras, A. Lasserre, L. Couzi, C. Combes, P. Merville, J. Ferrière, N. Grenier; CHU Bordeaux, Bordeaux, France. Purpose: To assess retrospectively the long-term safety and efficacy of embolization of renal arteries (ERA) in patients with polycystic kidney disease (PKD) before renal transplantation. Materials: Between January 2008 and November 2013, 82 ERA procedures were performed on 76 kidneys in 73 patients (mean age 53 years, range: 34-72). All patients had terminalstage PKD and were under dialysis and on the renal transplant waiting list with a temporary contraindication due to excessive renal volume. Results: ERA was considered successful in 89.5% (68/76) of embolized kidneys, meaning that the temporary contraindication for transplantation could be withdrawn for 65 patients (on average 5.6 months, range: 2.8-24.3, after ERA). Mean volume reduction was 40 % (range: 2-69) at 3 months and 59% (35-86) thereafter (both po0.001). Postembolization syndrome occurred after 15 of 82 procedures (18.3 %). The severe complication rate was 4.9%. Forty-three (67.7 %) transplantation were successfully conducted after ERA with a mean follow-up of 26.2 months (range: 1.8-59.5) and the estimated 5-year graft survival rate was 95.3 % [95% CI: 82.7-98.8]. Conclusions: ERA is a safe and effective alternative to nephrectomy before renal transplantation in patients with PKD.
3:36 PM
Abstract No. 231
Demographic and volumetric imaging risk factors for treatment failure following transarterial embolization of sporadic and tuberous sclerosiscomplex associated renal angiomyolipomas R. Sheth1, A. Feldman2, E. Paul2, E. Thiele2, T. Walker2; 1 MD Anderson Cancer Center, Houston, TX; 2 Massachusetts General Hospital, Boston, MA. Purpose: To evaluate demographic and volumetric imaging risk factors for long term treatment failure following embolization of sporadic and tuberous sclerosis complex (TSC) associated angiomyolipomas (AMLs). Materials: A single institution, IRB-approved retrospective review of all transcatheter embolizations of renal AMLs between 2002 – 2014 was performed. Analysis of tumor volume and fat content was conducted using a standard