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Technique of placement of peritoneal dialysis catheter using fluoroscopy and ultrasound guidance
S148
Posters and Exhibits
Background: Gastrointestinal bleeding remains a common and life-threatening medical emergency, particularly in the at-risk patient on anticoagulant medication, with bleeding diathesis, or with liver disease. At many centers, the management of occult gastrointestinal bleeding often requires on-call interventional radiologist involvement in bleed localization. The interventionalist must be able to expediently review imaging findings, most commonly using CTA, to decide whether to pursue intervention. Clinical Findings/Procedure Details: From our database and from a review of literature, we will present: 1. The spectrum of CTAfindings found in patients with gastrointestinal bleeding. 2. The limitations of CT imaging and appropriate uses of radionuclide imaging or angiogaphy. 3. Therapeutic considerations as they relate to salient CT findings. Conclusion and/or Teaching Points: After reviewing this exhibit, the interventional radiologist should be capable of: 1). Understanding the spectrum of pertinent CTAfindings in the bleeding patient. 2). Understand the limitations of CT in diagnosing acute bleeds. 3). Appreciate when angiography or radionuclide imaging should be pursued. 4). Discuss cases where CT imaging findings have altered management plans or therapy choice.
Abstract No. 326 Endovascular intervention for the management of pancreatitis-related bleeding: a retrospective analysis of thirty patients at a single institution
Posters and Exhibits
J. Kim1, J. Shin2, H. Yoon2, G. Ko2, D. Gwon2, K. Sung2; 1 Radiology, Ajou University Hospital, Suwon, Republic of Korea; 2Radiology, Asan Medical Center, Seoul, Republic of Korea Purpose: The aim of this study was to assess the outcome of endovascular intervention for the management of pancreatitisrelated hemorrhage. Materials and Methods: From January 2000 to July 2012, thirty patients underwent endovascular intervention for the management of pancreatitis-related hemorrhage. The underlying etiology of the disease, the clinical symptoms and laboratory findings, abnormalities seen on computed tomography, and details regarding the endovascular procedures were assessed, as were the outcome of each procedure and procedure-related complications. Results: A total of 33 endovascular procedures were performed in 37 visceral arteries. The splenic artery (n¼15, 40.5%) was the most commonly treated artery, and pseudoaneurysm was the most commonly detected abnormality on digital subtraction angiography (n¼29, 78.4%).Transcatheter embolization was performed in all but two patients in whom stentgrafts were placed in order to exclude splenic artery pseudoaneurysms. Embolization was performed using coils (n¼18) and/ or N-butyl cyanoacrylate (n¼16). Successful hemostasis was achieved during 30 procedures (90.9%) on the initial attempt. Splenic infarction was demonstrated on follow-up CT in nine patients and, while seven patients experienced clinical success, two patients required additional hospitalization. Among the successfully treated patients, none had recurrent bleeding during a mean follow-up duration of 28.5 months. Conclusion: Transcatheter embolization is effective for managing pancreatitis-related bleeding and has a low risk of complications.
Educational Exhibit
’
JVIR
Abstract No. 327
Technique of placement of peritoneal dialysis catheter using fluoroscopy and ultrasound guidance A.K. Abdel Aal, S. Saddekni, N. Ertel, E. Underwood, R. Oser, M.F. Hamed; Radiology, University of Alabama at Birmingham, Birmingham, AL Learning Objectives: The objective of this educational exhibit is to: 1. Discuss the indications and contraindications of peritoneal dialysis (PD) catheter placement in the new era of urgent-start PD. 2. Review the pre-procedure patient preparation. 3. Demonstrate a minimally invasive technique for placement of PD catheters. 4. Highlight the importance of the use of ultrasound (including gray-scale and color Doppler ultrasound) as well as fluoroscopy to guide safe placement of PD catheter and minimize complications. 5. Describe the essential methods of catheter care after placement.6. Highlight complications and how to avoid and how to manage them. Background: PD catheters can be placed by interventional radiologists and this approach may offer scheduling efficiencies, is cost-effective and is a minimally-invasive approach to PD catheter placement. In the USA, changes in the dialysis reimbursement structure by the Centers of Medicare and Medicaid Services is expected to result in increasing use of PD, a less costly dialysis modality, which offers the patient the opportunity to receive dialysis in the home setting, have more independence for travel and work schedules, and preserves vascular access for future dialysis options. Therefore, placement of PD catheters by interventional radiologists may be increasingly requested by nephrology practices, as recent publications have demonstrated the favorable impact of Interventional Radiology PD catheter placement capabilities on PD practices. Clinical Findings/Procedure Details: The authors submit this proposed technique with detailed description of the steps for placement of PD catheters using ultrasound and fluoroscopic guidance by interventional radiologists. We will support our description of the technique with images from our institutional archive. Conclusion and/or Teaching Points: After viewing this exhibit, the viewer will be familiar with the advantages of using ultrasound and fluoroscopic guidance for placement of PD catheters. Performing this technique by interventional radiologists may allow for expeditious placement of permanent PD catheters in the late-referred patient with end-stage renal disease, thus facilitating urgent-start PD, and avoiding the need for temporary vascular access catheters.
Abstract No. 328 Initial clinical experience with percutaneous irreversible electroporation of renal tumors A. Ahmad1, M. Morgan2, S.P. Reis1, C.K. Trimmer1,2, J. Cadeddu2,1; 1International Radiology, UT Southwestern Medical Center, Dallas, TX; 2UROLOGY, UT Southwestern Medical Center, Dallas, TX Purpose: The purpose of this study was to retrospectively evaluate initial IRE experience in order to assess the feasibility, safety, effectiveness and radiographic outcomes of renal tumor ablation by IRE.
Posters and Exhibits
Background: Gastrointestinal bleeding remains a common and life-threatening medical emergency, particularly in the at-risk patient on anticoagulant medication, with bleeding diathesis, or with liver disease. At many centers, the management of occult gastrointestinal bleeding often requires on-call interventional radiologist involvement in bleed localization. The interventionalist must be able to expediently review imaging findings, most commonly using CTA, to decide whether to pursue intervention. Clinical Findings/Procedure Details: From our database and from a review of literature, we will present: 1. The spectrum of CTAfindings found in patients with gastrointestinal bleeding. 2. The limitations of CT imaging and appropriate uses of radionuclide imaging or angiogaphy. 3. Therapeutic considerations as they relate to salient CT findings. Conclusion and/or Teaching Points: After reviewing this exhibit, the interventional radiologist should be capable of: 1). Understanding the spectrum of pertinent CTAfindings in the bleeding patient. 2). Understand the limitations of CT in diagnosing acute bleeds. 3). Appreciate when angiography or radionuclide imaging should be pursued. 4). Discuss cases where CT imaging findings have altered management plans or therapy choice.
Abstract No. 326 Endovascular intervention for the management of pancreatitis-related bleeding: a retrospective analysis of thirty patients at a single institution
Posters and Exhibits
J. Kim1, J. Shin2, H. Yoon2, G. Ko2, D. Gwon2, K. Sung2; 1 Radiology, Ajou University Hospital, Suwon, Republic of Korea; 2Radiology, Asan Medical Center, Seoul, Republic of Korea Purpose: The aim of this study was to assess the outcome of endovascular intervention for the management of pancreatitisrelated hemorrhage. Materials and Methods: From January 2000 to July 2012, thirty patients underwent endovascular intervention for the management of pancreatitis-related hemorrhage. The underlying etiology of the disease, the clinical symptoms and laboratory findings, abnormalities seen on computed tomography, and details regarding the endovascular procedures were assessed, as were the outcome of each procedure and procedure-related complications. Results: A total of 33 endovascular procedures were performed in 37 visceral arteries. The splenic artery (n¼15, 40.5%) was the most commonly treated artery, and pseudoaneurysm was the most commonly detected abnormality on digital subtraction angiography (n¼29, 78.4%).Transcatheter embolization was performed in all but two patients in whom stentgrafts were placed in order to exclude splenic artery pseudoaneurysms. Embolization was performed using coils (n¼18) and/ or N-butyl cyanoacrylate (n¼16). Successful hemostasis was achieved during 30 procedures (90.9%) on the initial attempt. Splenic infarction was demonstrated on follow-up CT in nine patients and, while seven patients experienced clinical success, two patients required additional hospitalization. Among the successfully treated patients, none had recurrent bleeding during a mean follow-up duration of 28.5 months. Conclusion: Transcatheter embolization is effective for managing pancreatitis-related bleeding and has a low risk of complications.
Educational Exhibit
’
JVIR
Abstract No. 327
Technique of placement of peritoneal dialysis catheter using fluoroscopy and ultrasound guidance A.K. Abdel Aal, S. Saddekni, N. Ertel, E. Underwood, R. Oser, M.F. Hamed; Radiology, University of Alabama at Birmingham, Birmingham, AL Learning Objectives: The objective of this educational exhibit is to: 1. Discuss the indications and contraindications of peritoneal dialysis (PD) catheter placement in the new era of urgent-start PD. 2. Review the pre-procedure patient preparation. 3. Demonstrate a minimally invasive technique for placement of PD catheters. 4. Highlight the importance of the use of ultrasound (including gray-scale and color Doppler ultrasound) as well as fluoroscopy to guide safe placement of PD catheter and minimize complications. 5. Describe the essential methods of catheter care after placement.6. Highlight complications and how to avoid and how to manage them. Background: PD catheters can be placed by interventional radiologists and this approach may offer scheduling efficiencies, is cost-effective and is a minimally-invasive approach to PD catheter placement. In the USA, changes in the dialysis reimbursement structure by the Centers of Medicare and Medicaid Services is expected to result in increasing use of PD, a less costly dialysis modality, which offers the patient the opportunity to receive dialysis in the home setting, have more independence for travel and work schedules, and preserves vascular access for future dialysis options. Therefore, placement of PD catheters by interventional radiologists may be increasingly requested by nephrology practices, as recent publications have demonstrated the favorable impact of Interventional Radiology PD catheter placement capabilities on PD practices. Clinical Findings/Procedure Details: The authors submit this proposed technique with detailed description of the steps for placement of PD catheters using ultrasound and fluoroscopic guidance by interventional radiologists. We will support our description of the technique with images from our institutional archive. Conclusion and/or Teaching Points: After viewing this exhibit, the viewer will be familiar with the advantages of using ultrasound and fluoroscopic guidance for placement of PD catheters. Performing this technique by interventional radiologists may allow for expeditious placement of permanent PD catheters in the late-referred patient with end-stage renal disease, thus facilitating urgent-start PD, and avoiding the need for temporary vascular access catheters.
Abstract No. 328 Initial clinical experience with percutaneous irreversible electroporation of renal tumors A. Ahmad1, M. Morgan2, S.P. Reis1, C.K. Trimmer1,2, J. Cadeddu2,1; 1International Radiology, UT Southwestern Medical Center, Dallas, TX; 2UROLOGY, UT Southwestern Medical Center, Dallas, TX Purpose: The purpose of this study was to retrospectively evaluate initial IRE experience in order to assess the feasibility, safety, effectiveness and radiographic outcomes of renal tumor ablation by IRE.