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Uterine artery embolization with gelfoam for symptomatic uterine arteriovenous shunting
JVIR
’
Posters and Exhibits
S209
cutoff value of the SSI for prediction of 450% volume reduction rate was 18.35 (area under the ROC curve, 0.73) with sensitivity and specificity of 78.9% and 58.7%, respectively. Conclusions: SSI of fibroid was significantly related to volume reduction rate after UFE. SSI may be useful in prediction the potential response to UFE.
Abstract No. 468 Uterine artery embolization with gelfoam for symptomatic uterine arteriovenous shunting E. Ahn1, J. Boos1, O. Brook2, S. Faintuch3, M. Ahmed4, A. Justaniah5, Q. Nguyen1; 1Beth Israel Deaconess Medical Center, Boston, MA; 2Chestnut Hill, MA; 3 Brighton, MA; 4Beth Israel Deaconess Medical Center/ Harvard, Boston, MA; 5Quincy, MA
Educational Exhibit
Abstract No. 469
Educational exhibit: bronchial artery embolization: an algorithm for management of hemoptysis in
L. Higgins1, O. Ahmed1, L. Higgins1, P. Mohabir1, D. Sze1, W. Kuo1, L. Hofmann2; 1Stanford University Medical Center, Stanford, CA; 2Stanford University Medical Center, Palo Alto, CA Learning Objectives: To describe our institutional protocol for the utilization of bronchial artery embolization (BAE) in the management of cystic fibrosis (CF) patients presenting with acute hemoptysis based on a single institution experience of patients in the Stanford Cystic Fibrosis foundation registry (2001-2015). Background: Chronic inflammation from cystic fibrosis results in angiogenesis and bronchial artery hypertrophy, placing patients suffering from this disease at risk for pulmonary hemorrhage. Hemoptysis in this subset, ranging from selflimiting to life-threatening, occurs at a rate of approximately 4-6%.1 When appropriately applied, bronchial artery embolization represents a safe and effective option for controlling bleeding. Clinical Findings/Procedure Details: We describe our multidisciplinary institutional protocol for the initial work up and application of bronchial artery embolization in cystic fibrosis patients presenting with varying degrees of hemoptysis. Guidelines regarding pre-procedure cross-sectional (including 3-D reformatted) imaging as well as indications for general anesthesia support are discussed. A clinical example is also included. Conclusions: After reviewing this exhibit, the viewer will become familiar with our standardized approach towards managing hemoptysis in cystic fibrosis patients with BAE. The guidelines presented reflect a consensus among interventional radiologists, pulmonologists, and intensivists at a single large academic institution treating a high volume of patients with CF. Reference 1. Flume PA, Yankaskas JR, Ebeling M, et al. Massive hemoptysis in cystic fibrosis. Chest 2005; 128:729–738.
Educational Exhibit
Abstract No. 470
Arteriovenous malformations of the knee soft tissues A. Vezeridis, H. Aryafar; University of California, San Diego, San Diego, CA Learning Objectives: 1. Recognize the imaging features of arteriovenous malformations (AVMs) of the knee soft tissues on radiograph, ultrasound, magnetic resonance, and angiography. 2. Review the vascular anatomy of the knee, which may contribute to pathophysiology of AVMs of the knee soft tissues. 3. Understand symptoms and treatment strategies in AVMs of the knee soft tissues. Background: AVMs of the knee soft tissues are a rare entity and therefore not well-described in classic textbooks nor the literature. Like AVMs elsewhere, these high flow congenital vascular malformations are characterized by a nidus of disorganized abnormal vessels connecting enlarged arteries and veins, bypassing normal capillaries. Symptoms can
Posters and Exhibits
Purpose: To evaluate the technical success rate, clinical success rate, and complications of bilateral uterine artery embolization (UAE) performed with gelfoam for symptomatic acquired uterine arteriovenous shunting (AVS). Materials: A retrospective review was performed of all uterine artery angiograms between January 2013 and September 2015 in patients of reproductive age with known or suspected symptomatic uterine arteriovenous shunting. Twelve patients underwent bilateral UAE with gelfoam for AV shunting seen on angiography. Main outcome measures were technical success, defined as angiographic resolution of AV shunting; and clinical success, defined as cessation of bleeding, resolution of findings on subsequent imaging studies, or minimal estimated blood loss (o25 cc) on subsequent elective D&C procedure. Complications after UAE were reviewed. Results: The technical success rate of gelfoam embolization was 91.7% (11/12): one embolization was initially attempted with gelfoam but was converted to coils due to development of coughing, chest tightness, and no slowing of flow in the vascular uterine lesion. Symptoms were assumed to be related to venous shunting of embolic though desaturation were not noted on pulse oximetry during the procedure. The procedure was clinically successful. Of the 11 technically successful gelfoam UAEs, the clinical success rate was 90.9% (10/11): one patient had a very large vascular uterine lesion and required 6 packets of gelfoam to reach near-stasis, but subsequently clinically had continued uterine bleeding. Pulmonary embolism was identified 72 hours after UAE in this same patient, who had a prior remote history of pulmonary embolism. No other complications were identified. Conclusions: Uterine artery embolization for symptomatic uterine arteriovenous shunting has a high technical and clinical success rate when performed with gelfoam alone. Careful embolization in these high-flow shunts is required to minimize the risk of non-target embolization.
cystic fibrosis patients based on 15 year institutional experience
’
Posters and Exhibits
S209
cutoff value of the SSI for prediction of 450% volume reduction rate was 18.35 (area under the ROC curve, 0.73) with sensitivity and specificity of 78.9% and 58.7%, respectively. Conclusions: SSI of fibroid was significantly related to volume reduction rate after UFE. SSI may be useful in prediction the potential response to UFE.
Abstract No. 468 Uterine artery embolization with gelfoam for symptomatic uterine arteriovenous shunting E. Ahn1, J. Boos1, O. Brook2, S. Faintuch3, M. Ahmed4, A. Justaniah5, Q. Nguyen1; 1Beth Israel Deaconess Medical Center, Boston, MA; 2Chestnut Hill, MA; 3 Brighton, MA; 4Beth Israel Deaconess Medical Center/ Harvard, Boston, MA; 5Quincy, MA
Educational Exhibit
Abstract No. 469
Educational exhibit: bronchial artery embolization: an algorithm for management of hemoptysis in
L. Higgins1, O. Ahmed1, L. Higgins1, P. Mohabir1, D. Sze1, W. Kuo1, L. Hofmann2; 1Stanford University Medical Center, Stanford, CA; 2Stanford University Medical Center, Palo Alto, CA Learning Objectives: To describe our institutional protocol for the utilization of bronchial artery embolization (BAE) in the management of cystic fibrosis (CF) patients presenting with acute hemoptysis based on a single institution experience of patients in the Stanford Cystic Fibrosis foundation registry (2001-2015). Background: Chronic inflammation from cystic fibrosis results in angiogenesis and bronchial artery hypertrophy, placing patients suffering from this disease at risk for pulmonary hemorrhage. Hemoptysis in this subset, ranging from selflimiting to life-threatening, occurs at a rate of approximately 4-6%.1 When appropriately applied, bronchial artery embolization represents a safe and effective option for controlling bleeding. Clinical Findings/Procedure Details: We describe our multidisciplinary institutional protocol for the initial work up and application of bronchial artery embolization in cystic fibrosis patients presenting with varying degrees of hemoptysis. Guidelines regarding pre-procedure cross-sectional (including 3-D reformatted) imaging as well as indications for general anesthesia support are discussed. A clinical example is also included. Conclusions: After reviewing this exhibit, the viewer will become familiar with our standardized approach towards managing hemoptysis in cystic fibrosis patients with BAE. The guidelines presented reflect a consensus among interventional radiologists, pulmonologists, and intensivists at a single large academic institution treating a high volume of patients with CF. Reference 1. Flume PA, Yankaskas JR, Ebeling M, et al. Massive hemoptysis in cystic fibrosis. Chest 2005; 128:729–738.
Educational Exhibit
Abstract No. 470
Arteriovenous malformations of the knee soft tissues A. Vezeridis, H. Aryafar; University of California, San Diego, San Diego, CA Learning Objectives: 1. Recognize the imaging features of arteriovenous malformations (AVMs) of the knee soft tissues on radiograph, ultrasound, magnetic resonance, and angiography. 2. Review the vascular anatomy of the knee, which may contribute to pathophysiology of AVMs of the knee soft tissues. 3. Understand symptoms and treatment strategies in AVMs of the knee soft tissues. Background: AVMs of the knee soft tissues are a rare entity and therefore not well-described in classic textbooks nor the literature. Like AVMs elsewhere, these high flow congenital vascular malformations are characterized by a nidus of disorganized abnormal vessels connecting enlarged arteries and veins, bypassing normal capillaries. Symptoms can
Posters and Exhibits
Purpose: To evaluate the technical success rate, clinical success rate, and complications of bilateral uterine artery embolization (UAE) performed with gelfoam for symptomatic acquired uterine arteriovenous shunting (AVS). Materials: A retrospective review was performed of all uterine artery angiograms between January 2013 and September 2015 in patients of reproductive age with known or suspected symptomatic uterine arteriovenous shunting. Twelve patients underwent bilateral UAE with gelfoam for AV shunting seen on angiography. Main outcome measures were technical success, defined as angiographic resolution of AV shunting; and clinical success, defined as cessation of bleeding, resolution of findings on subsequent imaging studies, or minimal estimated blood loss (o25 cc) on subsequent elective D&C procedure. Complications after UAE were reviewed. Results: The technical success rate of gelfoam embolization was 91.7% (11/12): one embolization was initially attempted with gelfoam but was converted to coils due to development of coughing, chest tightness, and no slowing of flow in the vascular uterine lesion. Symptoms were assumed to be related to venous shunting of embolic though desaturation were not noted on pulse oximetry during the procedure. The procedure was clinically successful. Of the 11 technically successful gelfoam UAEs, the clinical success rate was 90.9% (10/11): one patient had a very large vascular uterine lesion and required 6 packets of gelfoam to reach near-stasis, but subsequently clinically had continued uterine bleeding. Pulmonary embolism was identified 72 hours after UAE in this same patient, who had a prior remote history of pulmonary embolism. No other complications were identified. Conclusions: Uterine artery embolization for symptomatic uterine arteriovenous shunting has a high technical and clinical success rate when performed with gelfoam alone. Careful embolization in these high-flow shunts is required to minimize the risk of non-target embolization.
cystic fibrosis patients based on 15 year institutional experience