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Carotid and Neuro Interventions

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our imaging experience in 18 patients with suspected SVC obstruction. MATERIALS AND METHODS: We identified 18 patients presenting with suspected SVC syndrome based on the presence of facial swelling (4) or for a clinical indication of suspected ·SVC obstruction. Patients were, on average, 47 years of age (sdev: 13.9 years) and mainly women (83%). A history of prior line placement was noted in 14 (78%). Mag netic resonance venography was perfonned using Gradient Refocused Imaging and supplemented with MRV gadolinium imaging when possible. Ultrasound imaging was performed with color Doppler Imaging according to a standard protocol. Upper extremity veQography was performed when clinically indicated. RESULTS: The Magnetic resonance venogram was positive in 12 (67%) cases. Concurrent ultrasound imaging was done in 8 cases (44%), all positive for DVT. A venogram was perfonned in 8 cases, 7/8 being positive for SVC obstruction. Venous obstruction was seen in the right upper extremity in 5 cases and in the left upper extremity in 3 cases. CONCLUSION: We conclude that MRl is a useful screening technique in patients with suspected SVC syndrome. It likely can be used as a substitute for venography when therapeutic intervention is not deemed necessary. Poster No. 273 Angiographic Guidewire with Surface Markers: Effectiveness in Safety and Fluoroscopic Dose Reduction. S Kamei, Aichi Medical University, Nagakute-cho, Aichi- gun. Aichi, Japan 'r. Ishiguchi 'K. Murata·J Matsuda ·A. Nakamura'K. Ohno, et at. PURPOSE: Angiographic guidewire with surface markers was developed to know the accurate length inserted within the catheter. We investigated ifusing this guidewire will prevent a situation that the guidewire is advanced unintentionally out of a catheter potentially resulting a vascular injury, and if it will reduce radiation doses by minimizing unnecessary fluoroscopy. MATERIALS AND METHODS: Sixty consecutive patients who underwent angiography were randomized into two groups, using guidewires with surface markers (Marker group) or conventional guidewires without a marker (Control group). The newly developed guidewire is same as the conventional . 035-inch guidewire except for the markers on the proximal portions at 80cm, 100cm, II0cm and 120cm from the tip. Informed consent was obtained from all patient's before the procedures were carried out. Fluoroscopic images during all procedure were recorded. Fluoroscopic time for advancing a guiclewire out ofthe catheter in each insertion was measured. The number of times was also evaluated when a guidewire was advanced unintentionally out of the catheter before fluoroscopy was initiated. RESULTS: Guidewires were used 85 times in the Marker group and 79 times in the Control group. Mean fluoroscopic time were 3.3±1.2 seconds in the Marker group and 5.7±2.3 seconds in the Control group. The fluoroscopic time was significantly shorter in the Marker group (P<O.OOO I). Guidewire was advanced unintentionally out of the catheter three times (3.5%) only in the Control group. CONCLUSION: The guidewire with surface markers is effective for the safety of angiographic procedures and in reducing unnecessary fluoroscopic radiation. Carotid and Neuro Interventions Poster No, 274 · Occurrence of Bone Cement Extravasation with Kyphoplasty and Vertebroplasty. R.L. Cirillo, Durham Regional Medical Center/Duke University, Durham, NC, USA'S Sabourin PURPOSE: Vertebral augmentation with vertebroplasty and kyphoplasty are new techniques used to treat osteoporotic and metastatic compression fractures. Kyphoplasty has a theoretical advantage over vertebroplasty in decreasing the risk of bone cement leakage since a cavity is created with the bone tamps. The purpose of this paper is to retrospectively evaluate the occurrence of cement extravasation in our single academic institution. lvIATERIALS AND METHODS: We retrospectively reviewed our institution's experience with kyphoplasty and vertebroplasty. We reviewed the radiographic images of patients treated with both vertebroplasty and kyphoplasty at our institution and evaluated the occurrence of bone cement extravasation. We also looked at the occurrence of new vertebral body fractures after both of these spine interventions. RESULTS: From July 2001 through June 2003, 102 patients at our institution were treated with vertebroplasty withl73 levels treated. From October 2002 through May of 2003, 18 patients were treated with kyphoplasty with 22 levels treated. The occurrence of cement extravasation occurred in 118 cases out of 173 levels (68.2%) in patients treated with vertebroplasty and I case out of22 levels (4.5%) treated with kyphoplasty. The occurrence ofleakage into the epidural space occurred 9 times out of 102 patients (8.8%) with vertebroplasty and two patients (1.9%) experienced a pulmonary embol ism during vertebroplasty. No occurence of epidural leakage of cement or pulmonary emboli were encountered with kyphoplasty. Twenty six patients out of 102 (25.5 %) had a refracture with vertebroplasty with one patient having two re-fractures and one patient having three total re-fractw·es. One patient out of 18 (5.5 %) has refractured with kyphoplasty. CONCLUSION: Kyphoplasty and vertebroplasty are new techniques to treat painful compression fractures. This retrospective review demonstrates that vertebroplasty has a markedly increased risk of bone cement extravasation than compared to kyphoplasty. Poster No, 275 Percutaneous Pediculoplasty in Osteoporotic Compression Fractures. E.P. Eyheremendy, Hospital Aleman, Buenos Aires, Capital Federal, Argentina·E. Sanabria·SE. de Luca PURPOSE: To describe the technique for percutaneous pediculoplasty in the treatment of pain in connection with osteoporotic pedicle fractures. To present the clinical and radiological findings of this procedure. To assess whether pedicle fracture could be the cause of percutaneous veltebroplasty failure when this technique is not combined with percutaneous pediculoplasty. lvIATERIALS AND METHODS: The author describes five cases of osteoporotic vertebral and pedicular compression fractures treated with percutaneous vertebroplasty and percutaneou s pediculoplasty injecting polymethylmethacrylate under fluoroscopic guidance. In the first two patients percutaneous pediculoplasty was performed S237
Transcript
Page 1: Carotid and Neuro Interventions

our imaging experience in 18 patients with suspected SVC obstruction.

MATERIALS AND METHODS: We identified 18 patients presenting with suspected SVC syndrome based on the presence of facial swelling (4) or for a clinical indication of suspected ·SVC obstruction. Patients were, on average, 47 years of age (sdev: 13.9 years) and mainly women (83%). A history of prior line placement was noted in 14 (78%). Magnetic resonance venography was perfonned using Gradient Refocused Imaging and supplemented with MRV gadolinium imaging when possible. Ultrasound imaging was performed with color Doppler Imaging according to a standard protocol. Upper extremity veQography was performed when clinically indicated.

RESULTS: The Magnetic resonance venogram was positive in 12 (67%) cases. Concurrent ultrasound imaging was done in 8 cases (44%), all positive for DVT. A venogram was perfonned in 8 cases, 7/8 being positive for SVC obstruction. Venous obstruction was seen in the right upper extremity in 5 cases and in the left upper extremity in 3 cases.

CONCLUSION: We conclude that MRl is a useful screening technique in patients with suspected SVC syndrome. It likely can be used as a substitute for venography when therapeutic intervention is not deemed necessary.

Poster No. 273

Angiographic Guidewire with Surface Markers: Effectiveness in Safety and Fluoroscopic Dose Reduction. S Kamei, Aichi Medical University, Nagakute-cho, Aichi­gun. Aichi, Japan 'r. Ishiguchi 'K. Murata·J Matsuda ·A. Nakamura'K. Ohno, et at.

PURPOSE: Angiographic guidewire with surface markers was developed to know the accurate length inserted within the catheter. We investigated ifusing this guidewire will prevent a situation that the guidewire is advanced unintentionally out of a catheter potentially resulting a vascular injury, and if it will reduce radiation doses by minimizing unnecessary fluoroscopy.

MATERIALS AND METHODS: Sixty consecutive patients who underwent angiography were randomized into two groups, using guidewires with surface markers (Marker group) or conventional guidewires without a marker (Control group). The newly developed guidewire is same as the conventional . 035-inch guidewire except for the markers on the proximal portions at 80cm, 100cm, II0cm and 120cm from the tip. Informed consent was obtained from all patient's before the procedures were carried out. Fluoroscopic images during all procedure were recorded. Fluoroscopic time for advancing a guiclewire out ofthe catheter in each insertion was measured. The number of times was also evaluated when a guidewire was advanced unintentionally out of the catheter before fluoroscopy was initiated.

RESULTS: Guidewires were used 85 times in the Marker group and 79 times in the Control group. Mean fluoroscopic time were 3.3±1.2 seconds in the Marker group and 5.7±2.3 seconds in the Control group. The fluoroscopic time was significantly shorter in the Marker group (P<O.OOO I). Guidewire was advanced unintentionally out of the catheter three times (3.5%) only in the Control group.

CONCLUSION: The guidewire with surface markers is effective for the safety of angiographic procedures and in reducing unnecessary fluoroscopic radiation.

Carotid and Neuro Interventions

Poster No, 274

·Occurrence of Bone Cement Extravasation with Kyphoplasty and Vertebroplasty. R.L. Cirillo, Durham Regional Medical Center/Duke University, Durham, NC, USA'S Sabourin

PURPOSE: Vertebral augmentation with vertebroplasty and kyphoplasty are new techniques used to treat osteoporotic and metastatic compression fractures. Kyphoplasty has a theoretical advantage over vertebroplasty in decreasing the risk of bone cement leakage since a cavity is created with the bone tamps. The purpose of this paper is to retrospectively evaluate the occurrence of cement extravasation in our single academic institution.

lvIATERIALS AND METHODS: We retrospectively reviewed our institution's experience with kyphoplasty and vertebroplasty. We reviewed the radiographic images of patients treated with both vertebroplasty and kyphoplasty at our institution and evaluated the occurrence of bone cement extravasation. We also looked at the occurrence of new vertebral body fractures after both of these spine interventions.

RESULTS: From July 2001 through June 2003, 102 patients at our institution were treated with vertebroplasty withl73 levels treated. From October 2002 through May of 2003, 18 patients were treated with kyphoplasty with 22 levels treated. The occurrence of cement extravasation occurred in 118 cases out of 173 levels (68.2%) in patients treated with vertebroplasty and I case out of22 levels (4.5%) treated with kyphoplasty. The occurrence ofleakage into the epidural space occurred 9 times out of 102 patients (8.8%) with vertebroplasty and two patients (1.9%) experienced a pulmonary embol ism during vertebroplasty. No occurence of epidural leakage of cement or pulmonary emboli were encountered with kyphoplasty. Twenty six patients out of 102 (25.5 %) had a refracture with vertebroplasty with one patient having two re-fractures and one patient having three total re-fractw·es. One patient out of 18 (5.5 %) has refractured with kyphoplasty.

CONCLUSION: Kyphoplasty and vertebroplasty are new techniques to treat painful compression fractures. This retrospective review demonstrates that vertebroplasty has a markedly increased risk of bone cement extravasation than compared to kyphoplasty .

Poster No, 275

Percutaneous Pediculoplasty in Osteoporotic Compression Fractures. E.P. Eyheremendy, Hospital Aleman, Buenos Aires, Capital Federal, Argentina·E. Sanabria·SE. de Luca

PURPOSE: To describe the technique for percutaneous pediculoplasty in the treatment of pain in connection with osteoporotic pedicle fractures. To present the clinical and radiological findings of this procedure. To assess whether pedicle fracture could be the cause of percutaneous veltebroplasty failure when this technique is not combined with percutaneous pediculoplasty.

lvIATERIALS AND METHODS: The author describes five cases of osteoporotic vertebral and pedicular compression fractures treated with percutaneous vertebroplasty and percutaneou s pediculoplasty injecting polymethylmethacrylate under fluoroscopic guidance. In the first two patients percutaneous pediculoplasty was performed

S237

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S238

in a second procedure because percutaneous vertebroplasty had failed to control pain. In these patients as well as in the next three cases there were radiological findings consistent with pedicular fracture: signs of edema on MRl, cortical disruption on CT and/or increase up take in bone scan.

RESULTS: All patients referred complete pain relief after the procedure with a mean follow up of 6.5 months.

CONCLUSION: Percutaneous pediculoplasty is a safe and effective method to reduce vertebroplasty failures caused by pedicle lesions.

Poster No. 276

Percutaneous Sacroplasty for Sacral Insuffiency Fractures: Case Comparison Outcome Trial. R.S Florek, West Jefferson Medical Center, Marrero, LA, USA .c. Simonson

PURPOSE: Sacral Insuffiency Fracture(SIF) is a debilitating complication of osteoporosis. Percutaneous injection of bone cement offers simple and effective pain control. We report three cases of SIF for comparison outcome of sacroplasty versus medical management.

MATERIALS AND METHODS: Three patients in their early seventies with clinically diagnosed SIF were confmned with positive bone scans. One was managed with analgesics and retained walking and sitting mobility. The other two were bed-ridden due to debilitating pain. One of these was managed with medical analgesics and the other underwent CT guided percutaneous injection (sacroplasty) of polymethylmethacrylate(PMMA) directly into the sacral fracture. Investigational Review Board was not required for single case trial under Compassionate Use Indication. Patient and family. members were advised of the off-label use of PMMA for treatment of this type of fracture. Options of medical management or surgical fixation ofthe fracture were discussed. Initial imaging with radiography and fluoroscopy failed to show the fracture line or the foramenal margins in the osteoporotic bone and was not considered safe. CT scan guidance readily delineated the fracture and the sacral foramina. Immediate, 30 day, 90 day, and 6 month follow-up compatison of the three patients are reviewed.

RESULTS: The patient who retained mobility with medical pain control progressed back to her normal mobility. The patient who was bed-ridden with pain and underwent sacroplasty experienced immediate post-operative pain relief and returned to her baseline mobility with normal life activities. The patient who was bed-ridden with pain and had analgesic pain control suffered decreasing mental status and increasing 'third-spacing' offluid and secondary congestive failure, and was dead approximately 3 months post fracture.

CONCLUSION: Sacralinsuffiency fractures are a debilitating and potentially lethal complication of osteoporosis. Percutaneous sacroplasty using standard polymethylmethacrylate bone cement offers the possibility of returning patient mobility and pain relief. CT scan guidance offers superior imaging of the fracture compared to fluoroscopy of these landmarks.

Aneurysms/Dissections

Poster No. 277

Endovascular External-Internal Ilaic Artery Bypass to Preserve Pelvic Blood Flow in Treating Aortoiliac Aneurysms. M Mehta, Albany Medical College, Vascular Institute, Albany, NY, USA·K. Dowling·R. Darling·K.J. Ozsvath 'SP Roddy 'PS Paty, et at.

PURPOSE: Endovascular aneurysm repair (EVAR) is associated with decreased morbidity and mortality in treatment of elective and ruptured abdominal aortoiliac aneurysms (AIA). However, during EVAR, interruption of bilateral hypogastric arteries is sometimes needed to completely exclude the aortoiliac aneurysms, which can sometimes lead to a consider.able morbidity. We report our experience of endovascular external-internal iliac artery bypass to preserve pelvic blood flow with stentgrafts (Wallgraft, Boston Scientific Corp, Natik, MA; Viabahn, WL Gore, Tempe, AZ).

MATERIALS AND METHODS: From 2003 - 2003,6 patients have undergone endovascular external-internal iliac artery bypass during emergent (n=2) and elective (n=4) repair of complex AlA. Data were prospectively collected in a vascular registry, and patients were evaluated for aneilrysm exclusion, stentgraft patency, and complications of pelvic ischemia.

RESULTS: Four patients underwent EVAR with an aorto­uni-iliac stentgraft, a femoral-femoral bypass, and an endovascular external-internal bypass. Two other patients with prior open surgical aorto bi-external iliac bypass presented with >4 cm common iliac artery aneurysms, and underwent endovascular external-internal iliac bypass for aneurysm exclusion. All 6 patients had successful endovascular external­internal iliac bypass. None of the patients developed complications of pelvic ischemia; including buttock necrosis, buttock claudication, ischemic colitis, impotence, or low~r extremity neurological deficits. There were no endoleaks or deaths, and all stentgrafts have remained patent.

CONCLUSION: Endovascular external to internal iliac bypass is feasible and safe. This technique can facilitate pelvic blood flow in patients with ruptured AAAs undergoing EVAR with an aorto-uni-iliac stentgraft and a femoral-femoral bypass, and in patients with extensive aortoiliac aneurysms exteildiqg up to the iliac bifurcation bilaterally.

Poster No. 278

A New Model of Abdominal Aortic Aneurysm with Gastric Serosa Patch: Surgical Technique and Short-Term Evaluation. J. Us6n, Centro de Cirugia de Minima Invasion, Caceres, Spain' V Crisostomo'F Sun ·B. Loscertales 'FM Sanchez'M Maynar

PURPOSE: To develop an abdominal aortic aneurysm (AAA) model that resembles human aneurysms with potential for further growth and a predictable tendency to rupture, that can be used in the training and development of new endoprostheses.

MATERIALS AND METHODS: An infrarenal AAA model was created with an autologous gastric serosa patch in 5 domestic swine. Pre-and post-surgical digital subtraction aortograms (DSA) were obtained to document the appearance and dimensions ofthe aneurysm. Animals were followed with DSA and ultrasonography (B-mode and Doppler) on days 7, 14, 30,45, 60 and 90 after model creation. Aneurysmal


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