International Symposium on Endovascular Therapy (ISET) 2010 January 17 – 21, 2010, Hollywood, Florida Best of ISET Abstracts All ISET abstracts and posters are graded via blinded peer review based on scientięc merit, originality, relevance and clarity. Alternative Techniques for Below-the-Knee Recanalization: Procedural and Clinical Long Term Results. M. Di Primio⋅G. Angelopoulos⋅C. Reale, Department of Diagnostic Imaging, Interventional Radiology, Molecolar Imaging and Radiotherapy, University of Rome Tor Vergata, Rome, IT⋅R. Gandini⋅E. Pampana, et. al PURPOSE: Percutaneous arterial recanalization with PTA is becoming cornerstone of treatment of below-the- knee peripheral arterial disease. Nonetheless successful recanalization is not always obtained with traditional antegrade approaches. Recently new alternative techniques have been introduced to recanalize cases not treatable with an antegrade approach. We report our results focusing on anatomical indications, technical aspects and rationale of these new approaches. MATERIALS AND METHODS: In a single-center retrospective clinical analysis, from January 2005 to March 2009 we collected 1554 patients with critical limb ischemia for complex lesions of the popliteal and infrapopliteal vascular territory. In 184 patients (12%) traditional antegrade revascularization failed and alternative techniques were adopted. Of these subgroup 56 (4%) limbs were treated with transpedal retrograde approach, in 44 (3%) patients a pedal to plantar and 30 patients a plantar to pedal retrograde revascularization was perfomed. A trans- collateral angioplasty and retrograde revascularization was suitable in 54 patients. RESULTS: Successful recanalization was obtained in 181 patients (98%) with alternative techniques. Adjunctive popliteal stenting was perfomed only in 9 patients for suboptimal angioplasty results. Only two retroperitoneal bleeds and 12 minor complications were registered. Limb salvage rate at 1 year follow-up was 99%. All patients obtained an immediate improvement of clinical status. CONCLUSION: High failure rate for antegrade revascularization is reported in literature. Most of these patients are considered at risk for surgical approach. Alternative techniques may be usefull in these cases to obtain a signięcant improvement of symptoms with a safe and feasible technique. Ankle-Brachial Index and Cardiovascular Risk Prediction: An Analysis of 11,594 Individuals with 10-Year Follow-Up. T.P. Murphy, Vascular Disease Research Center, Rhode Island Hospital, Providence, RI, USA⋅R. Dhangana⋅M.J. Pencina⋅R.B. D’Agostino, Sr. PURPOSE: Low ankle-brachial index (ABI) is associated with increased risk of subsequent coronary heart disease events, independent of Framingham risk factors, but its use to predict risk has not been examined. MATERIALS AND METHODS: A post-hoc analysis of prospectively collected single cohort longitudinal follow- up data (Atherosclerosis Risk in Communities (ARIC) study) was performed, in which Framingham Risk Scores (FRS) were calculated and ABI’s measured at baseline. All participants were assessed for hard cardiovascular events over median follow-up of 10 years. Hazard ratios, c statistic, and net reclassięcation indexes were calculated to determine the independent discriminative ability of ABI compared with FRS. Additionally, ABI was also evaluated as a supplement to FRS, using a two-step process. RESULTS: 659 hard CVD events occurred. ABI was highly signięcantly associated with hCVD events with hazard ratios of 0.85 (95% CI 0.79-0.91) (P-value<0.0001); but the c statistic of FRS modięed with ABI was only modestly improved (0.756 to 0.758). Net reclassięcation improvement was small and statistically insignięcant (0.8%, P-value=0.50). Using a two-step process, ABI did not improve the performance of FRS. CONCLUSION: Although the ABI was highly independently associated with subsequent events in terms of hazard ratios, the Framingham Risk Score performed similarly with or without integration or supplementation with ABI. These ęndings do not provide strong evidence to support FRS modięcation to include ABI, nor obtaining ABI measurements on people with intermediate risk. Our data does not support the use of the ABI in a two-step fashion to assess risk. Changes in Patient Fitness and EVAR Suitability of Small AAAs: Which Should Have Early Repair? C.H. Timaran, University of Texas Southwestern Medical Center, Dallas, TX, USA⋅E.B. Rosero⋅J.G. Modrall⋅G.P. ClageĴ PURPOSE: The need for treatment of abdominal aortic aneurysms (AAAs) in patients unęt for open repair has not been established. The purpose of this study was to assess the longitudinal changes in patient ętness and endovascular suitability during surveillance of small AAAs and their potential implications for management. MATERIALS AND METHODS: We studied 62 patients referred for evaluation of nonruptured small AAAs who underwent follow-up by CT angiography. Fitness for surgical repair was assessed using the Customized Probability Index, a validated fitness score for AAA repair. Changes in patient ętness and EVAR suitability were assessed using paired nonparametric and survival analyses. RESULTS: The median age of the study cohort was 74 years (interquartile range [IQR], 65-77 years). The initial median ętness score was +4 (IQR, -5, +9). The median follow-up duration was 36 months (IQR, 16-53 months). Overall, patient ętness for open repair signięcantly decreased during the study period (63% vs 43% considered ęt for 1651
Transcript
International Symposium on Endovascular Therapy (ISET) 2010January 17 – 21, 2010, Hollywood, Florida
Best of ISET AbstractsAll ISET abstracts and posters are graded via blinded peer review
based on scienti c merit, originality, relevance and clarity.
Alternative Techniques for Below-the-Knee Recanalization: Procedural and Clinical Long Term Results.M. Di Primio⋅G. Angelopoulos⋅C. Reale, Department of Diagnostic Imaging, Interventional Radiology, Molecolar Imaging and Radiotherapy, University of Rome Tor Vergata, Rome, IT⋅R. Gandini⋅E. Pampana, et. al
PURPOSE: Percutaneous arterial recanalization with PTA is becoming cornerstone of treatment of below-the-knee peripheral arterial disease. Nonetheless successful recanalization is not always obtained with traditional antegrade approaches. Recently new alternative techniques have been introduced to recanalize cases not treatable with an antegrade approach. We report our results focusing on anatomical indications, technical aspects and rationale of these new approaches.
MATERIALS AND METHODS: In a single-center retrospective clinical analysis, from January 2005 to March 2009 we collected 1554 patients with critical limb ischemia for complex lesions of the popliteal and infrapopliteal vascular territory. In 184 patients (12%) traditional antegrade revascularization failed and alternative techniques were adopted. Of these subgroup 56 (4%) limbs were treated with transpedal retrograde approach, in 44 (3%) patients a pedal to plantar and 30 patients a plantar to pedal retrograde revascularization was perfomed. A trans-collateral angioplasty and retrograde revascularization was suitable in 54 patients.
RESULTS: Successful recanalization was obtained in 181 patients (98%) with alternative techniques. Adjunctive popliteal stenting was perfomed only in 9 patients for suboptimal angioplasty results. Only two retroperitoneal bleeds and 12 minor complications were registered. Limb salvage rate at 1 year follow-up was 99%. All patients obtained an immediate improvement of clinical status.
CONCLUSION: High failure rate for antegrade revascularization is reported in literature. Most of these patients are considered at risk for surgical approach. Alternative techniques may be usefull in these cases to obtain a signi cant improvement of symptoms with a safe and feasible technique.
Ankle-Brachial Index and Cardiovascular Risk Prediction: An Analysis of 11,594 Individuals with 10-Year Follow-Up.T.P. Murphy, Vascular Disease Research Center, Rhode Island Hospital, Providence, RI, USA⋅R. Dhangana⋅M.J. Pencina⋅R.B. D’Agostino, Sr.
PURPOSE: Low ankle-brachial index (ABI) is associated with increased risk of subsequent coronary heart disease events, independent of Framingham risk factors, but its use to predict risk has not been examined.
MATERIALS AND METHODS: A post-hoc analysis of prospectively collected single cohort longitudinal follow-up data (Atherosclerosis Risk in Communities (ARIC) study) was performed, in which Framingham Risk Scores (FRS) were calculated and ABI’s measured at baseline. All participants were assessed for hard cardiovascular events over median follow-up of 10 years. Hazard ratios, c statistic, and net reclassi cation indexes were calculated to determine the independent discriminative ability of ABI compared with FRS. Additionally, ABI was also evaluated as a supplement to FRS, using a two-step process.
RESULTS: 659 hard CVD events occurred. ABI was highly signi cantly associated with hCVD events with hazard ratios of 0.85 (95% CI 0.79-0.91) (P-value<0.0001); but the c statistic of FRS modi ed with ABI was only modestly improved (0.756 to 0.758). Net reclassi cation improvement was small and statistically insigni cant (0.8%, P-value=0.50). Using a two-step process, ABI did not improve the performance of FRS.
CONCLUSION: Although the ABI was highly independently associated with subsequent events in terms of hazard ratios, the Framingham Risk Score performed similarly with or without integration or supplementation with ABI. These ndings do not provide strong evidence to support FRS modi cation to include ABI, nor obtaining ABI measurements on people with intermediate risk. Our data does not support the use of the ABI in a two-step fashion to assess risk.
Changes in Patient Fitness and EVAR Suitability of Small AAAs: Which Should Have Early Repair?C.H. Timaran, University of Texas Southwestern Medical Center, Dallas, TX, USA⋅E.B. Rosero⋅J.G. Modrall⋅G.P. Clage
PURPOSE: The need for treatment of abdominal aortic aneurysms (AAAs) in patients un t for open repair has not been established. The purpose of this study was to assess the longitudinal changes in patient tness and endovascular suitability during surveillance of small AAAs and their potential implications for management.
MATERIALS AND METHODS: We studied 62 patients referred for evaluation of nonruptured small AAAs who underwent follow-up by CT angiography. Fitness for surgical repair was assessed using the Customized Probability Index, a validated fitness score for AAA repair. Changes in patient tness and EVAR suitability were assessed using paired nonparametric and survival analyses.
RESULTS: The median age of the study cohort was 74 years (interquartile range [IQR], 65-77 years). The initial median tness score was +4 (IQR, -5, +9). The median follow-up
duration was 36 months (IQR, 16-53 months). Overall, patient tness for open repair signi cantly decreased during the study period (63% vs 43% considered t for
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open repair; McNemar test, P<.001). In fact, the median fitness score increased from +4 to +8.5 P=.001). The anatomic suitability for EVAR also signi cantly changed (81% vs 69%; P<.001). Of note, 45% of AAAs with marginal neck morphology, i.e. length < 15 mm and diameter >28 mm, vs. 3% of those with adequate necks were not suitable for EVAR at the end of follow-up P<.001). Long-term patient survival was not a ected by patient tness. Survival rates at 1, 3 and 5 years were 95%, 87% and 70% for un t patients vs. 96%, 92% and 73% for t patients, respectively P=0.8).
CONCLUSION: Significant changes in patient fitness and EVAR suitability occur during surveillance of small AAAs. EVAR suitability is primarily lost in small AAAs with marginal neck morphology. These data indicate that early repair for small AAAs may be justi ed in patients t for open repair if they are unsuitable for EVAR or have
marginal necks for EVAR, since surveillance may result in loss of patient tness and/or EVAR suitability that may preclude future repair.
Endovascular Repair Versus Open Surgery in EVAR-Suitable Patients with a Ruptured AAA.J.A. Ten Bosch, Atrium Medical Center, Heerlen, NL⋅E.M. Willigendael⋅E.R. de Loos⋅S.W. Koning⋅M.H. Prins, et. al
PURPOSE: In patients with a ruptured abdominal aortic aneurysm (rAAA), con icting e cacy results of endovascular aneurysm repair (rEVAR) compared to conventional open surgery are reported. Case control studies contain selection bias, mainly regarding anatomic AAA con guration (EVAR suitability) and hemodynamic stability (unstable patients who went directly for open repair). The objective of this study was to compare rEVAR with open surgery in EVAR-suitable patients with a rAAA who all underwent the same preoperative imaging protocol, irrespective of hemodynamic stability.
MATERIALS AND METHODS: Our policy is to perform a CT angiography (CTA) scan on all patients with suspected rAAA. All EVAR-suitable rAAA patients, as assessed on CTA afterwards by two independent experienced reviewers blinded for previous evaluation and intervention, were included. In this group of EVAR suitable patients, rEVAR was performed when the rEVAR-surgeon was on duty. Conventional open surgery was performed when the rEVAR-surgeon was not on duty (pseudo-randomization). Outcome parameters included: intra-operative, 30-day and 6-month mortality, all complications, complications requiring surgery, morbidity, and length of hospital stay.
RESULTS: From April 2002 until March 2008, 132 consecutive patients presented with a rAAA. 104 patients had a preoperative CTA scan. Of 104 patients, 25 underwent rEVAR and 79 open surgery. All 25 rEVAR patients and 33 patients in the open group were judged EVAR-suitable by the external reviewers and therefore included in the analysis. The intra-operative, 30-day and 6-month mortality was 4.0% (1/25), 20.0% (5/25) and 28.0% (7/25) a er rEVAR compared to 6.1% (2/33) (P=1.00), 45.5% (15/33) (P<0.05) and 54.5% (18/33) (P<0.05) a er open surgery, respectively. Median postoperative hospital stay was 8 days (IQR 5-18) a er rEVAR and 17 days (9, 5-28) a er open surgery (P=0.015).
CONCLUSION: This study shows an absolute perioperative mortality reduction of 25.5% of rEVAR over open surgery in EVAR suitable, hemodynamic comparable patients, which maintained during follow-up. These data suggest that rEVAR is a valuable treatment option for patients with a rAAA.
Intra-Muscular Use of S1P and VEGF for Angiogenesis in the Rabbit Ischemic Hind Limb.R. Uflacker, Medical University of South Carolina, Charleston, SC, USA⋅K. Argraves⋅C. Hannegan⋅B. Panzegrau⋅L. Gordon
PURPOSE: Many patients with leg ischemia are not suitable for conventional revascularization, and alternative treatments are necessary to avoid amputation. Several angiogenic factors have been identi ed such as Sphingosine 1-Phosphate (S1P) which is an angiogenic modulator for vascularization. VEGF is a vascular endothelial growth factor but without longevity. We veri ed that the combination of S1P+VEFG may create more stable neovascularization in an ischemic hind leg animal model.
MATERIALS AND METHODS: Ischemia was produced in the hind limbs of 40 New Zealand white rabbits with excision of the left femoral artery. The animals were divided in four groups, 10 receiving S1P solution, 10 receiving VGEF, 10 receiving a mixture of S1P+VEGF and 10 receiving rabbit serum albumin (control group), by intra-muscular injection in the le thigh immediately a er ischemia induction and then once a week during the follow up period up to the end points. Each animal group was equally divided in 4 weeks (N=5) and 8 weeks (N=5) endpoint groups. The follow up procedures were clinical observation of the cornea, nuclear medicine ow studies, muscle immunohistopathology and angiogram in the hind limbs at 4 and 8 weeks end-points.
RESULTS: Angiograms did not show any statistical di erence between the three treated groups (study groups) and untreated group (control group) in the ischemic hind legs. The corneal exam did not show corneal neo- vascularization in all three study groups compared to the control group. VEGF was shown to have a positive e ect in the region of interest Tc counts in both occluded and nonoccluded limbs. Analysis of the RBC relative data showed a statistically signi cant synergistic e ect between VEGF and S1P with occluded versus nonoccluded ratios higher when both drugs were given at both 4 and 8 weeks in the ischemic legs, compared to the control group.
CONCLUSION: We have demonstrated that acutely and mid term, the combination of VEGF and S1P stimulates angiogenesis and collateral growth and reduces the hemodynamic de cit in ischemic limbs. It seems that the angiogenesis promoted by VEGF is sustained by S1P. The application of this combination treatment may improve angiogenesis in limb ischemia.
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Is Gender Associated with Higher Re-Intervention Rates for Infragenicular Lesions?P.L. Faries⋅T.R. Shah, Mount Sinai Medical Center, New York, NY, USA⋅D.K. Han⋅P. Shirvalkar⋅M.L. Marin, et. al
PURPOSE: Infragenicular vessel disease is o en treated endovascularly instead of open surgery. However, li le is known concerning outcomes of peripheral interventions in women. We report our institutional experience in infragenicular interventions in women.
MATERIALS AND METHODS: Infragenicular interventions were retrospectively reviewed from 2002 to 2008. Primary endpoints included technical success, limb salvage, and reintervention rates with secondary endpoints of access site (i.e.: hematoma, thrombosis) and systemic complications (i.e.: myocardial infarction, death). Statistical analysis was conducted with SPSS so ware.
RESULTS: 289 patients had infragenicular interventions in 320 limbs; 134 (47%) were female (mean age 72.2 ± 12.5 years). Intervention indications included (men vs. women) claudication 16.8% vs. 25.2%, rest pain 11.1% vs. 12.8% and tissue loss 72.1% vs. 62.0%. Peripheral interventions of angioplasty, stenting, and atherectomy were equivalent in men and women (60.6% vs. 63.4%, 8.4% vs. 9.0%, 30.8% vs. 27.6%, respectively). Transatlantic Inter-Society Consensus (TASC) score distribution was also equivalent in both sexes. Average lesion length for men and women was 5.5 ± 3.6 cm vs. 5.9 ± 3.8 cm (P=ns). There was a trend towards greater average post-intervention increase in ankle-brachial index (ABI) in men as compared to women (0.20 ± 0.30 vs. 0.06 ± 0.24, P=ns). Women were 1.6× more likely to require a reintervention for angioplasty and 1.4× for atherectomy as compared to men (P<0.05). Women were also found to be reintervened much earlier than men (177 vs. 308 days, P<0.05). While overall complication rates were similar, females had comparatively higher rates of postoperative thrombosis (6.7%vs. 0.6%, P<0.05).CONCLUSION: For infragenicular interventions, females were 1.5 times more likely to develop restenosis requiring earlier reinterventions as compared to men. Also, females were 11.1× more likely to develop postoperative access site thrombosis and trended toward smaller increases in post-operative ABI as compared to males. Thus, female patients with infragenicular lesions should receive stronger consideration for more de nitive open bypass to avoid multiple reinterventions, postoperative complications, and possible limb loss.
Limb Salvage with the CROSSER Catheter in the Absence of Target Vessel Reconstitution.J.A. Mustapha, Metro Health Hospital, Wyoming, MI, USA
PURPOSE: Limb salvage is o en associated with multiple chronic total occlusions (CTO’s), some without clear vessel reconstitution. Absence of target vessel reconstitution reduces the prognosis for successful recanalization. The CROSSER® Catheter (FlowCardia, Inc., Sunnyvale, CA) uses high frequency vibration to quickly cross CTOs. The nature of the energy delivered by the CROSSER allows it to quickly and safely nd the true distal lumen allowing for subsequent angioplasty, debulking, etc. A retrospective study was performed to evaluate patients who were brought to the cath lab with no run-o to the foot.
MATERIALS AND METHODS: 32 diabetic chronic lower extremity ischemia (CLI) patients with below-knee occlusions involving all 3 runo vessels to the foot and previously scheduled for amputation, were referred for a second opinion and as a last resort to avoid amputation. The plan was to attempt each tibial until one was successfully recanalized. Initial angiographic ndings were as follows: 34% - No signi cant vessel reconstitution distal to the CTO. 48% - faint and signi cantly delayed filling of possible vessel reconstitution. 18% - vessel reconstitutions with moderate delayed lling. All patients were treated with the CROSSER catheter as a frontline therapy. The CROSSER was advanced slowly in all of the cases since target vessels were not clear and we were following the assumed anatomical distribution of the vessels. Following successful passage of the guidewire atherectomy and provisional angioplasty was utilized to improve ow to the foot.
RESULTS: CROSSER success rate on the rst a empted vessel was 92% using an average of 3.8 minutes of catheter activation time. The 8% of patients with failed rst a empt were then re-attempted during the same setting in a second tibial vessel with a 100% success rate. All patients le the cath lab with a palpable or Doppler pulse. All patients were angiographically followed six weeks post recanalization.
CONCLUSION: The CROSSER catheter is a viable limb salvage option for patients su ering from CLI, even in the absence of target vessel reconstitution.
Modern Ischemic Stroke Therapy in a Large Community Based Dedicated Stroke Center: A Five Year Retrospective Review.G.W. Stambo, St. Joseph’s Hospital, Department of Neurointerventional Radiology, Tampa, FL, USA⋅M.H. Berlet⋅D. Ste en⋅K. Van Epps⋅T. Woeste, et. al
PURPOSE: Endovascular stroke therapy has a signi cant impact on quality of life compared to conservative traditional treatments. Currently, there are no standard guidelines for the assessment and treatment of acute ischemic stroke patients. A retrospective review of acute ischemic stroke patient outcome data compared to other treatment modalities may give rise to more comprehensive acute stroke treatment guidelines. A standard stroke treatment algorithm may help give patients the best possible chance for a good outcome.
Study summary
COMPARISON GROUP 1 NO TREAT
GROUP 2 IV tPA
GROUP 3 IA tPA
GROUP 4 MERCI
GROUP 5 COMBINED
AGE ( range in years)
74 71 67 68 70
SEX (male: female) 9 15 9 9 4 5 9 8 6 2
Mean baseline NIHSS 11 11.8 16.1 15.9 15.7
Mean end NIHSS 8.9 4.7 7.4 3.1 10.6
Mean drop NIHSS 2.2 7.1 8.7 12.8 5.1
Mortality 2 0 0 0 2
MATERIALS AND METHODS: Seventy-six patients were placed into five different treatment groups for acute ischemic stroke. These groups included: Group 1 (no treatment) (n=24). Group 2 (intravenous tPA only)
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(n=18). Group 3 (intra-arterial tPA) n=9. Group 4 (MERCI Concentric Medical Mountain View, CA clot extraction) n=17. Group 5 (combined IA/MERCI) n=8. The pre and post NIH stroke scale values were obtained for each group. The results of the four treatment cohorts were compared to the no treatment group.
RESULTS: Group 1 presented with a mean NIHSS of 11.1 and 8.9 upon discharge from the hospital. There was only a mean of 2.2 improvement in NIHSS without treatment. Group 2 averaged an admission mean NIHSS of 11.8 and a discharge value of 4.7 resulting in a mean of improvement 7.1. Group 3 had a mean pre treatment NIHSS of 16.1 and 7.4 at discharge with a mean improvement of 8.7. Group 4, had a mean pre treatment NIHSS of 15.9 and discharge NIHSS of 3.1 with a mean improvement of 12.8. Group 5 averaged 15.7 pretreatment NIHSS and 10.6 NIHSS at discharge with a mean improvement of 5.1. Four patients expired during their admission, two from the control group, and two from the combined group.
CONCLUSION: Modern endovascular therapies for acute ischemic stroke result in a profound positive impact on clinical outcomes when implemented in the se ing of a dedicated comprehensive stroke team.
PEARL (PEripheral Use of AngioJet Rheolytic Thrombectomy with Mid-Length Catheters) Registry for DVT.R.A. Lookstein⋅L. Blitz⋅E. Simoni
PURPOSE: To report registry data in which deep vein thrombosis in lower and upper extremities were treated with rheolytic thrombectomy.
MATERIALS AND METHODS: A voluntary registry of the Possis Angiojet catheter used in the treatment of 160 patients with upper and lower extremity DVT was examined. An electronic data capture case report form was lled out by physician and sta tabulating patient DVT history, procedural information, post-case device performance assessment and acute adverse events. Three month clinical follow up was obtained to document continued symptomatic improvement. Cases were performed over 30 months at 31 U.S. clinical sites.
RESULTS: A total of 160 patients were treated including 99 male and 61 female (mean age 51; range 18 to 86). 26 upper extremity and 134 lower extremity DVT cases were included. 126 patients (79%) reported symptoms of less than 14 days. Combination therapy using Power Pulse Spray or Rapid Lysis techniques were used in 86% of cases (138/1160). 85% of cases were completed in less than 24 hours, and 96% in less than 48 hours. Substantial or complete lysis was achieved in 93% of all venous segments treated. Adjunctive venous stent placement was performed in 42 patients (25%). Three month follow up was available for 130/160 (81%) of patients and 104 patients (80%) report continued symptomatic improvement.
CONCLUSION: Rheolytic thrombectomy combined with adjunctive measures form an e ective and safe strategy for comprehensive vascular treatment of lower and upper extremity DVT.
Percutaneous Transluminal Angioplasty of the Subclavian Arteries. Long-Term Follow-Up.M.M. Henry, Cabinet de Cardiologie, Nancy, FR⋅I.I. Henry⋅A.A. Polydorou⋅M.M. Hugel
PURPOSE: To review feasibility, safety and long-term results of subclavian artery angioplasty.
MATERIALS AND METHODS: 357 patients (males: 205, mean age: 65.2 ± 12 y) underwent percutaneous treatment for subclavian artery (SA) occlusive disease (stenosis: 254, occlusion: 92). Le : 272, Right: 85, Innominate Artery: 18. Etiology: atheromatous: 349, others: 8 (Takayasu: 4). Mean % stenosis 82.8 ± 7.7. Mean lesion length: 23.7 ± 8.9 mm. Indications for treatment were upper limb ischemia (ULI) (n=167). Vertebrobasilar insu ciency (VBI) (n=137), associated VBI and ULI (n=103), coronary steal syndrome (n=16) asymptomatic patients with severe coronary disease (n=53) 29 patients had associated Vertebral Artery stenosis, 71 carotid stenoses, 303 lesions were prevertebral, 35 post vertebral, both 19. Percutaneous techniques included retrograde femoral (n=257), brachial artery (n=71) access or both (n=29) and in 6 cases the “pull through technique”). An isolated balloon angioplasty was performed in 59 cases and 298 stents were implanted (balloon expandable : 236, self expandable: 62.)
RESULTS: Technical success was obtained in 339 lesions (95%) 100% for stenoses. Only 74 occlusions were recanalized (80%). Four periprocedural events occurred (1.2%), 1 major (fatal stroke), 1 T.I.A., 2 arterial thromboses. At follow-up (mean follow-up: 68.7 months ± 37.5), we had 37 restenoses (12%). 13 occurred following angioplasty alone (18.8%) and 24 following angioplasty and stent implantation (8.6%) (P<0.01). Primary (PI) and secondary (PII) patencies on an intention to treat basis at 10-year follow-up were 79.5% and 85.7% respectively. In patients without initial stent placement, the rates were 67.5% and 75.5% while in those with stents, the rates rose to 91.2% and 97.6% (P<0.01). PI for all recanalized lesions were 85.3%, 79.1% without stent, 91.2% with stent (P<0.04) and PII 92.3%, 88.5%, 97.6% respectively (P<0.02).
CONCLUSION: P.T.A. is currently the treatment of choice for subclavian artery lesions. It is a safe and e ective procedure associated with low risks and good long-term results. Stents seem to limit the restenosis rate and improve long-term results.
Plasma Levels of Matrix Metalloproteinase-9 as Marker of Successful Endovascular Aneurysm Repair.J.A. Ten Bosch, Atrium Medical Center, Heerlen, Limburg, NL⋅F.A.M.V.I. Hellenthal⋅B. Pulinx⋅W.K.W.H. Wodzig⋅M.W. de Haan, et. al
PURPOSE: Repetitive computed tomography angiography (CTA) scans for the detection of endoleaks after endovascular aneurysm repair (EVAR) is common practice, but has known biological hazard and high costs. Identi cation of endoleakage by a simple blood test with high sensitivity could spare EVAR patients to undergo repetitive CTA. The objective was to evaluate the value of MMP-2, -9, and TIMP-1 as a diagnostic tool to discriminate between patients with and without endoleak.
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MATERIALS AND METHODS: All consecutive patients who visited the vascular outpatients clinic of both participating institutions and who had an endoleak present on post-EVAR CTA surveillance between January and July 2008 were prospectively enrolled in the study. Controls were EVAR patients without endoleak on CTA, frequency matched for age and gender. Plasma concentrations of MMP- 2, -9 and TIMP-1 were determined in duplicate. The ability to discriminate patients with an endoleak from patients without endoleak was investigated using receiver operating characteristic (ROC) curve and area under the curve (AUC). Main outcomes were sensitivity and speci city for di erent biomarker plasma concentration cut-o points.
RESULTS: Thirty-seven patients were included in the study of which 17 had an endoleak and 20 were selected as controls by frequency matching. MMP-2 and TIMP-1 could not discriminate between endoleak and controls. However, increased concentrations of MMP-9 were observed in patients with an endoleak (P<0.001) compared to patients without endoleak. The ROC curve of plasma MMP-9 concentrations showed that a cut o value of 55.18 resulted in 100% sensitivity and 96% speci city. The AUC was 0.988 (P<0.001).
CONCLUSION: The present study shows that plasma concentrations of MMP-9 can accurately discriminate between patients with and without an endoleak with both high sensitivity and speci city. CTA in the follow up of EVAR patients can possibly be reduced to patients with increase of plasma MMP-9 concentration.
RELAY™ Thoracic Stent-Graft Phase II Trial Update.M.A. Farber, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA⋅W.A. Lee
PURPOSE: To evaluate the safety and e cacy of the Relay™ Stent-Gra to treat thoracic aortic aneurysms (TAA).
MATERIALS AND METHODS: Between January 2007 and July 2009, eighty-seven (87) patients were enrolled in a prospective, non-randomized study conducted at 30 U.S. hospitals. Safety was evaluated by analyzing major adverse events through one year. E cacy was evaluated by the device-related adverse event rate of endovascular repair through one year post-procedure.
RESULTS: Based on analysis from April 2009, y-four percent (54%) of patients were males. The mean procedure time was 2.6 ± 1.3 hours and average hospital stay was 6.1 ± 4.8 days. Deployment success was 95%. Major adverse events were noted within 30 days of the procedure as outlined in the table below.
Table 1: Major Morbidity and MortalityPhase II Results ≤ 30 Days Post-procedure, %Mortality 6.9 (6/87)MI 3.2 (2/63)Respiratory Failure 7.9 (5/63)Renal Failure 1.6 (1/63)Paraplegia/Paralysis 2.3 (2/87)Stroke 6.9 (6/87)Procedural Bleeding 9.5 (6/63)Conversion 0Rupture 0Migration 0
CONCLUSION: Initial results of the Phase II study demonstrate a similar pro le to other devices with respect to device performance and overall morbidity in the treatment of individuals with thoracic aortic aneurysms.
Renal Angioplasty and Stenting. Limitations. Role of Embolic Protection Devices.M.M. Henry, Cabinet de Cardiologie, Nancy, FR⋅A.A. Polydorou⋅I.I. Henry⋅A.A. Polydorou⋅M.M. Hugel
PURPOSE: Despite good immediate and long-term results, post procedural deterioration of the renal function (RF) may occur a er Renal Artery Angioplasty and Stenting (RAAS) in 20-40% of the patients, which limits the immediate bene ts of the technique. Atheroembolism seems to play an important role. We evaluate feasibility and safety of RAAS under a distal protection device (DPD) to reduce the risk of atheroembolism and avoid deterioration of the RF.
MATERIALS AND METHODS: 151 RAAS performed under DPD in 131 hypertensive patients (M:91). Mean age: 64.8 ± 11.9 yrs with atherosclerotic renal artery stenosis (20 bilateral). 11 pts had solitary kidneys, 52 renal insu ciencies. We used occlusion balloon (n=46) or lters (n=105). We recently experimented and treated 12
patients with a new lter the Fibernet (Lumen Biomedical Plymouth MN) which can capture particles of 40μ without compromising the flow. Generated debris removed and analyzed. Blood pressure and serum creatinine levels followed. Techniques of RAAS under protection, limitations will be discussed.
RESULTS: Immediate technical success: 100%. Visible debris aspirated with Percusurge from all patients. Mean particle number: 98.1 ± 60.00. Mean diameter: 201.2 ± 76μ (38-6206). With current lters debris removed in 80% of the cases. With the Fibernet visible debris removed in all cases. Mean debris surface area: 121 mm². Mean number of particles 28-60μ : 2136 ± 776, >60μ: 5918 ± 1362. We observed one acute RF deterioration. Mean follow-up: 29.8 ± 16 months. Mean creatinine level remains constant during follow-up. At 6 months (111 patients) 82 patients stabilized, 28 with baseline renal insu ciency improved and we had only one RF deterioration (1%) in a patient with moderate renal insu ciency. At 2 years (92 patients) 66 stabilized, 22 improved and we had only 4 RF deterioration (5%).
CONCLUSION: This study demonstrates the feasibility and safety of DPD during renal interventions to protect against atheroembolism and seems to avoid RF deterioration a er the procedure and in the long-term. Indications will be discussed. Improvements in DPD for renal stenting are mandatory. Randomized studies are awaited.
The Use of COMIT Strategy To Improve First Case Start Times in an Interventional Radiology Academic Practice.H.B. Chrisman, Northwestern University Feinberg School of Medicine, Chicago, IL, USA⋅D. Liu⋅S. Mouli⋅R. Salem⋅R.A. Omary
PURPOSE: The Continuous Outcomes Measurement and Improvement Technique (COMIT) is a strategy employed by health care organizations to reduce variance by
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linking outcomes to the actual care process. It is unclear if this model is useful to improve operational e ciencies within interventional radiology (IR) clinical practices. We tested the hypothesis that adoption of the COMIT model improves rst case start times and reduces overtime (OT) occurrences within an academic IR practice.
MATERIALS AND METHODS: A single-institution IR practice at a large academic medical center (13 IR a endings, 8 fellows) was studied over a 30 day time period. Baseline metrics to determine high impact causative factors were studied as they related to rst case start time. Implementation of an action plan was then initiated which included the following: (1) a new prior day calling script and earlier arrival time (2) a formalized consent model and (3) single, consistent nurse manager to control the IR procedural area. Impact on deviation from rst case start time, and overtime occurrences over the 30 days following these changes were measured and compared to baseline measurements obtained during the initial phase. A total of 1545 patients were seen during
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3D Segmentation of RF Ablations in Porcine Kidneys: Impact of Ablation Time and Active Tip Length on Lesion Geometry.C.M. Sommer, University Hospital Heidelberg, Heidelberg, Baden-Wuerttemberg, DE⋅W. Omri⋅F. Arnegger⋅N. Kortes⋅H.G. Kenngo ⋅F. Nickel, et. al
PURPOSE: To describe the impact of ablation time and active tip length on RF ablation geometry in porcine kidneys applying a 3D segmentation technique.
MATERIALS AND METHODS: 32 RF ablations were created in 16 kidneys of 8 pigs by using a monopolar RF system. Ablations were created with an expandable RF electrode. Electrode power was 150W and temperature was 105°C. In each kidney, 1 RF ablation of the upper kidney pole (active tip length of 2 cm) and 1 RF ablation of the lower kidney pole (active tip length of 3 cm) was performed. RF ablation time in the right kidney was 6 minutes and in the le kidney 3 minutes. RF ablations were segmented manually with the Medical Imaging and Interaction Toolkit (MITK, German Cancer Research Center, Heidelberg, Germany) on axial contrast-enhanced CT scans and on 2 mm thick macroscopic slices along the long axis of the kidney (axial macroscopic slices). On the basis of the 3D segmentations, maximum vertical, long-axis and short-axis diameters as well as volumes (Vs), surfaces and shapes of the RF lesions were determined. Vs were compared to conventional calculated RF ablation volumes (prolate ellipsoide Vpe).
RESULTS: RF ablations created with an active tip length of 2 cm and an ablation time of 3 minutes had signi cantly lower maximum vertical diameters, Vs and surfaces compared to RF ablations created with an active
tip length of 3 cm and an ablation time of 6 minutes. RF ablations created with an active tip length of 3 cm and an ablation time of 3 minutes were not signi cantly di erent compared to RF ablations created with an active tip length of 2 cm and an ablation time of 6 minutes. Vs were signi cantly di erent compared to Vpe.
CONCLUSION: Ablation time and active tip length a ect signi cantly RF ablation geometry. For a more accurate determination of RF ablation volumes, 3D segmentation should be preferred to conventional volume calculation.
E ectiveness of Percutaneous Balloon Pericardiotomy in Patients with Pericardial E usion.I.H. Manoukov⋅O.I. Aliman⋅G.T. Tonev⋅T.M. Tsvetkovski⋅I.G. Deenichina, et. al
PURPOSE: Pericardial e usions from various clinical entities may result in cardiac tamponade requiring immediate drainage. In some patients, especially those with malignant diseases, the e usions may recur and require further therapy other than pericardiocentesis. Most of these cases are registered as a complication of late-stage disease and they are poor candidates for surgical pericardial windowing. The aim of our study was to examine the therapeutic value and safety of percutaneous balloon pericardiotomy in patients with symptomatic pericardial e usion secondary to malignant diseases.
MATERIALS AND METHODS: 28 patients (18 women and 10 men) aged 62,5 ± 13,1 (44-78) years were enrolled: 19 patients had lung cancer; 6 had breast cancer; 2 had colorectal cancer and in one patient metastatic liver cancer was identi ed. Cardiac involvement in the form of pericardial e usion or tamponade as the initial feature
the initial phase, and 1582 were seen during the 30 days following initiation of the action plan. We compared di erences in these outcome measures using paired t tests, with alpha = 0.05.
RESULTS: The top three causative factors were: (1) Late patient arrival, (2) No consent, (3) Physician availability. Percent of patients arriving at 7:00 improved from 58% to 75% (P<0.05). First case start time at 8:00 improved from 40% to 57% (P<0.05). OT occurrences decreased from 166 hr to 131 hr (P<0.05), resulting in a 21% decrease in overtime expenditures.
CONCLUSION: COMIT improves rst case start times and reduces OT occurrences in a large academic IR practice. The utility of this strategy in other types of practices awaits veri cation from further studies.
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of extracardiac malignancy was seen in 4 of our cases. In all patients a percutaneous balloon pericardiotomy was performed with a peripheral angioplasty balloon catheter (diameter 8 mm, length 20 mm), through a subxiphoid approach with evacuation of 1200 ± 400 ml of uid from the pericardial space.
RESULTS: No major complication was seen during these procedures and there was remarkable improvement in patients’ clinical condition. During the follow-up period (mean 6.3 month) there was reaccumulation of uid only in one of the patients with adenocarcinoma of the lungs. Despite the good postprocedural results, 1 patient died because of the malignant disease dissemination.
CONCLUSION: It is concluded that balloon pericardiotomy is a safe and useful alternative to surgical pericardial windowing for the treatment of symptomatic pericardial e usion with malignant etiology. The procedure was focused not only on treatment of cardiac tamponade, but on improving the quality of remaining life by prevention of symptomatic reaccumulation of pericardial e usion in these patients with poor survival due to the underlying extracardiac condition.
Electromagnetic Tracking for Renal Biopsies and RF Ablation in the Se ing of Multifocal Synchronous Renal Cell Carcinoma.N. Abi-Jaoudeh, National Institue of Health, Bethesda, MD, USA⋅H. Amalou⋅N. Glossop⋅J. Kruecker⋅S. Xu, et. al
PURPOSE: To determine feasibility and clinical e cacy of electromagnetic (EM) tracking for percutaneous biopsies and radiofrequency ablations (RF ablation) in patients with multifocal synchronous renal tumors including patients with Von Hippel Lindau syndrome.
MATERIALS AND METHODS: Both custom and commercial software and hardware were used for navigation during renal biopsies and ablations to facilitate localization and differentiation of multiple tumors. Ultrasound contrast, MRI, PET and contrast CT were registered to procedural ultrasound and/or procedural CT to facilitate multi-modality interventions, where the needle or electrode is manipulated in relation to pre-procedural 3D imaging data. Clinical data including system error and outcome were analyzed for positive diagnosis and successful ablation defined as lack of contrast enhancement on follow-up imaging.
RESULTS: Electromagnetic (EM) tracking was used for lesion-targeted renal biopsy in 10 patients and radiofrequency ablation in 8 patients between 2005 and 2009. The average number of ipsilateral renal lesions was 9.2 ranging up to 30. Navigation system was used to successfully localize or di erentiate target tumors from near by lesions which would otherwise be challenging with the use of conventional technique. 10/10 (100%) patients with biopsies had a positive pathology diagnosis. 6/8 (75%) underwent successful tracked renal RF ablation as de ned above. One patient treated with RF ablation was lost to follow-up and one patient recurred with an additional RF ablation treatment 5 month later. The median follow-up was 13 months (Range: 2-46 months).
CONCLUSION: Multiple metachronous kidney tumors
present a challenge for the interventional radiologist both for the diagnostic biopsy and ablation. Improved accuracy with EM tracking could potentially facilitate nephron sparing procedures. EM tracking allows real time intra-procedural use of pre-procedural imaging which be er localizes tumors.
Micro-Bland Embolization Combined with Radiofrequency Ablation for Treating Complex Hepatic Tumors.F. Orsi, European Institute of Oncology, Milan, IT⋅P. Della Vigna⋅G. Bonomo⋅L. Monfardini⋅G. Orgera
PURPOSE: Many studies have reported how tumor size, site and morphology may a ect local results of liver radiofrequency ablation (RF ablation). For that reason, the so-called “complex hepatic lesions” may be not candidate for percutaneous ablation therapy. The aim of this study is assessing the feasibility and local results of RF ablation performed immediately a er micro-bland embolization (MBTAE) in patients a ected by complex liver tumors (both primary and metastatic) who were excluded from surgery.
MATERIALS AND METHODS: 15 consecutive patients affected by single unresectable liver tumors, were treated with combined therapy: MBTAE with 40 and/or 100 μ micro-spheres followed, in the same session, by RF ablation, has been performed for treating a total of 15 lesions: 8 metastases from CRC, 2 HCC, 2 CCC, 1 metastasis from lung cancer and 2 from breast cancer. Biggest diameter of treated lesions ranged from 25 to 70 mm (median 35 mm).
RESULTS: Technical success was achieved in all patients. Post RF ablation non-enhancing hypo-dense areas at MDCT, 24 hours a er treatment, ranged from 44 to 93 mm in diameter (median 78 mm). Long-lasting EASL Complete Response (CR) at MDCT has been obtained in all patients. FU ranges from 1 to 33 months (median 4 months).
CHARACTERISTICS OF THE LESIONS
Hystology FU Length (months) Tumor Size (mm) Size of Induced
All patients are alive and disease free at the last follow-up; only one out of 2 patients a ected by CCC, developed new hepatic metastases three months a er treatment. One major complication occurred to the patient with hylar CCC, who developed biliary injury, requiring a percutaneous le hepatic biliary drainage.
CONCLUSION: MBTAE has been carried out only with very small micro-spheres in order to induce a deep parenchymal ischemia for enhancing thermal e ect by RF ablation. Combined therapy, in our series, has improved the local results, allowing for a radical ablation of the so
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called “complex liver lesions”. However, our experience, is limited and further prospective studies are needed for validating the combined approach.
Painful Bone Metastases of RCC Managed with Embolization, Radiofrequency Ablation and Cementoplasty: Prospective Evaluation.C. Vulsaire⋅O. Pellerin, Interventional Radiology Departement Georges Pompidou European Hospital, Paris, FR⋅J. Médioni⋅S. Oudard⋅M. Sapoval
PURPOSE: The aim of this study was to assess the e cacy of a sequential interventional management of painful pelvic bone metastases of renal cell carcinoma (RCC). Interventional management consisted in:embolization followed by radio frequency ablation and cementoplasty (ERC).
MATERIALS AND METHODS: Between 01-2008 and 06-2009, 32 consecutives patients, mean age 61 years were referred for ERC. Pain and narcotic dose were evaluated using visual analog scale (VAS) before, at discharge and 30 days after ERC. Anti-angiogenic agents were stopped before ERC. Embolization was rst performed (Embosphere 700-900 2 ml) followed by radiofrequency ablation and cementoplasty. Target lesions were reached using C-arm Cone beam at panel CT.
RESULTS: 35 procedures were performed to treat 1.1 ± 0.4 lesion/patients [range, 1--5]. Mean lesion size was 28 ± 9 mm [range, 11-55 mm]. Technical success was obtained in all procedure. The only complication was 1 reversible buttock claudication related to internal iliac artery embolization. Mean VAS score decreased from 8.2 ± 1.6 [range, 5 -10] before procedure to 2.9 ± 1.5 [range, 0-7] at discharge and 1.6 ± 1.2 [range, 0-4] at 1 month (P<0.0001 Wilcoxon test). At discharge, the narcotics were divided by 2 in 17 patients (53%) and at 1 month in 25 (78%) patients. Three patients had complete pain relief at 1 month.
CONCLUSION: This speci c approach is e cient and safe for bone metastatic RCC patients. These preliminary results are positive enough to allow next step which will be ERC under continuous administration of anti-angiogenic drugs.
Plasma-Mediated Ablation for Treatment of Vertebral Compression Fractures Secondary to Multiple Myeloma and Lymphoma.B. Georgy, Department of Neuroradiology, UCSD, San Diego, CA, USA
PURPOSE: Painful vertebral body compression fractures (VCFs) secondary to advanced multiple myeloma (MM) or lymphoma of the spine can be complicated by cortical destruction and/or epidural extension, both contraindications to percutaneous vertebroplasty and vertebral augmentation. Typical surgical management carries high mortality and morbidity rates in this patient population. Alternately, a plasma-mediated device can be used to create a cavity in malignant lesions in the vertebral body, enhancing placement of bone cement to stabilize the anterior of the vertebral body. This study evaluated bone cement distribution and pain palliation in patients undergoing this procedure.
MATERIALS AND METHODS: 12 patients with MM (n=6), plasmacytoma (n=4), or lymphoma (n=2) were treated. All exhibited advanced metastatic lesions on the vertebral body (16 treated levels) with cortical disruption and/or epidural extension. A plasma-mediated RF device (Cavity SpineWand, ArthroCare, Austin, TX) ablated a void in the malignant mass. 3-6 mL of bone cement (Zimmer, Warsaw, IN) was then injected into the ablated cavity under uoroscopic guidance. CT scans and VAS pain scores were taken pre- and post-op.
RESULTS: In all but 2 levels, ∼75% of cement was deposited in the anterior. 2/3rds of the vertebral body. Five levels showed no leakage. Minimal, clinically insigni cant extravasation was noted in 11 levels (venous: 8, cortical: 2, discal and epidural: 1). VAS pain scores were available for 8 patients: 6 improved signi cantly, while 2 showed no change.
CONCLUSION: Plasma-mediated RF ablation combined with bone cement augmentation appears effective in treating MM or lymphoma patients with VCFs, stabilizing the anterior of the vertebral body with a predictable, safe cement deposition pa ern and yielding quick pain relief.
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Selected Poster Presentations from ISET 201010-Year Experience in the Endovascular Treatment of AAA.F. Fanelli, Department of Radiological Sciences Interventional Radiology Unit “Sapienza” - University of Rome, Rome, IT⋅F.M. Salvatori⋅E. Boa a⋅M. Allegri i⋅P. Lucatelli, et. al
A New Concept of Stent: The Multilayer Stent. First Human Study in Peripheral Aneurysm.M.M. Henry, Cabinet de Cardiologie, Nancy, FR⋅A.A. Polydorou⋅N.N. Frid⋅P.P. Gru az⋅I.I. Henry, et. al
A New Protection Device: The Fibernet. First Human Use in Carotid, Renal and Peripheral Interventions.M.M. Henry, Cabinet de Cardiologie, Nancy, FR⋅A.A. Polydorou⋅I.I. Henry⋅M.M. Hugel
Adjuvant Maneuvers To A ect Gra Tilt during EVAR with Angulated Necks.D.J. Minion, University of Kentucky Medical Center, Lexington, KY, USA
Alternative Techniques for Below-the-Knee Recanalization: Procedural and Clinical Long Term Results.M. Di Primio⋅G. Angelopoulos⋅C. Reale, Department of Diagnostic Imaging, Interventional Radiology, Molecolar Imaging and Radiotherapy, University of Rome Tor Vergata, Rome, IT⋅R. Gandini⋅E. Pampana, et. al
Anatomical Applicability of EVAR in Japanese AAA Patients—Which Endogra Is Best?A. Kitagawa, Kobe University Graduate School of Medicine, Kobe, JP⋅K. Sugimoto⋅M. Yamaguchi⋅K. Sugimura⋅Y. Okita
Ankle-Brachial Index and Cardiovascular Risk Prediction: An Analysis of 11,594 Individuals with 10-Year Follow-Up.T.P. Murphy, Vascular Disease Research Center, Rhode Island Hospital, Providence, RI, USA⋅R. Dhangana⋅M.J. Pencina⋅R.B. D’Agostino, Sr.
Aortic Chimney Stent Grafting in Severe Arteriosclerotic Aorto-Iliac Disease: A Case Report.J.C. Ritter, University Hospital of South Manchester, Manchester, GB⋅J.S. Butterfield⋅C.N. McCollum⋅R.J. Ashleigh
Assess the Aorta by 3D Free Breathing Steady State Free Precession vs MRA.O. Gomaa, Jackson Memorial Hospital/University of Miami, Miami, FL, USA⋅G. Narayanan⋅R Gebker⋅B. Schnackenburg⋅T. Kokocinski, et. al
Atherectomy of the Iliac Arteries. Is It the Treatment of Choice?R. Schutzer, North Shore University Hospital, Manhasset, NY, USA
Carotid Angioplasty and Stenting in Octogenarians. Is it Safe?M.M. Henry, Cabinet de Cardiologie, Nancy, FR⋅I.I. Henry⋅A.A. Polydorou⋅M.M. Hugel
CAS under Protection: Gold Standard Treatment of a Carotid Stenosis in High and Low Risk Patients.M.M. Henry, Cabinet de Cardiologie, Nancy, FR⋅I.I. Henry⋅A.A. Polydorou⋅M.M. Hugel
Changes in Patient Fitness and EVAR Suitability of Small AAAs: Which Should Have Early Repair?C.H. Timaran, University of Texas Southwestern Medical Center, Dallas, TX, USA⋅E.B. Rosero⋅J.G. Modrall⋅G.P. Clage
Clinical Experience with 0.018 Azur Hydrocoils: Technical Success, Challenges and Complications.B.S. Kapoor, University of Alabama at Birmingham, Birmingham, AL, USA
Clinical Follow Up a er Bilateral Hypogastric Artery Occlusion for EVAR.G. Vatakencherry⋅P.J. Didomenico, Kaiser Permanente, Los Angeles, CA, USA
Contrast Enhanced MRA with Vasovist as a Novel Method in Detection and Localization of Bleeding.D.C. Durant, Sunnybrook Health Sciences Center, Toronto, ON, CA⋅E. David⋅A. Moody⋅A. Nelson⋅R. Pugash, et. al
Cosmetic Treatments: An Emerging Field of Interest for Interventional Radiologists.I.C. De Bernardi, University of Insubria, Varese, IT⋅G. Carra ello⋅D. Mariani⋅E. Bracchi⋅C. Fugazzola
Dual Energy CT of Endoleak after Endovascular Aneurysm Repair with Blending of 80 and 140 kV Datasets.W. Higashiura, Nara Medical University, Kashihara, Nara, JP⋅S. Kitano⋅N. Marugami⋅S. Hidaka⋅H. Sakaguchi, et. al
Embolization of Uterine Fibroids with Precisely Calibrated Microspheres.A.J. Smeets, St Elisabeth Ziekenhuis, Tilburg, NL⋅R. N enhuis⋅P.N. Lohle⋅W.J. v Roo ⋅L.E. Lampmann, et. al
Endovascular Management of Subclavian Artery Stenosis Using Balloon Expandable Covered Stents.R. Bashir⋅J.C. George, Temple University Hospital, Philadelphia, PA, USA
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Endovascular Repair Versus Open Surgery in EVAR-Suitable Patients with a Ruptured AAA.J.A. Ten Bosch, Atrium Medical Center, Heerlen, NL⋅E.M. Willigendael⋅E.R. de Loos⋅S.W. Koning⋅M.H. Prins, et. al
Endovascular Therapy for Infrainguinal Lesions in Octagenarians: Not as Safe as You May Think.T.R. Shah, Mount Sinai Medical Center, New York, NY, USA⋅D.K. Han⋅O. Nwokocha⋅S. Ellozy⋅A. Vouyouka, et. al
Ethnic Disparities in Critical Limb Ischemia.N.J. Gargiulo III, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA⋅D.J. O’Connor⋅F.J. Veith⋅E.C. Lipsitz⋅W.D. Suggs, et. al
Hybrid Procedures for Complex Thoracic Aortic Diseases.S.G.J. Silva, Santa Marcelina Hospital, Sao Paulo, SP, BR⋅F.L. Galastri⋅D.S. Coelho⋅T.P. Tonial⋅R.B. Biagioni, et. al
Intraluminal Recanalization of Long Infrainguinal Chronic Total Occlusions Using the Crosser System.A. Spinelli, Department of Diagnostic Imaging, Interventional Radiology, Molecolar Imaging and Radiotherapy, University of Rome Tor Vergata, Rome, IT⋅R. Gandini⋅V. Pipitone⋅T. Volpi⋅C. Del Giudice, et. al
Intra-Muscular Use of S1P and VEGF for Angiogenesis in the Rabbit Ischemic Hind Limb.R. Uflacker, Medical University of South Carolina, Charleston, SC, USA⋅K. Argraves⋅C. Hannegan⋅B. Panzegrau⋅L. Gordon
Investigation of Reduced Permeability Expanded PTFE Gra for EVAR Using a Canine Model.T.R. Shah, Mount Sinai Medical Center, New York, NY, USA⋅M. Sadek⋅I. Turnbull⋅P. Faries
Is Gender Associated with Higher Re-Intervention Rates for Infrageniculate Lesions?P.L. Faries⋅T.R. Shah, Mount Sinai Medical Center, New York, NY, USA⋅D.K. Han⋅P. Shirvalkar⋅M.L. Marin, et. al
Limb Salvage with Novel Endovascular Devices in the Absence of Target Vessel Reconstitution.J. Mustapha, Metro Health Hospital, Wyoming, MI, USA
Limb Salvage with the CROSSER Catheter in the Absence of Target Vessel Reconstitution.J.A. Mustapha, Metro Health Hospital, Wyoming, MI, USA
Long Term E cacy and Complication of Permanent Caval Filtration.U. Pua⋅L. Quek⋅D. Wong
Modern Ischemic Stroke Therapy in a Large Community Based Dedicated Stroke Center: A Five Year Retrospective Review.G.W. Stambo, St. Joseph’s Hospital, Department of Neurointerventional Radiology, Tampa, FL, USA⋅M.H. Berlet⋅D. Ste en⋅K. Van Epps⋅T. Woeste, et. al
Native Artery Endovascular Reconstruction Versus Redo Surgery a er Femoro-Popliteal Gra Failure.M.I. Sharkawy, Faculty of Medicine-Cairo University, Cairo, EG⋅A.M. Farghaly
New Arterial Access Approach Helps Be er Sealing. Clinical Experience (334 Patients) with the Arstasis System.A.A. Ebner, Santa Clara, Asuncion, PY⋅S. Gallo⋅E. Alvarez⋅E. Silva
New Distal Embolic Protection Device Using a 3 Dimensional Filter. Fibernet: 1st Carotid Human Study.M.M. Henry, Cabinet de Cardiologie, Nancy, FR⋅A.A. Polydorou⋅I.I. Henry⋅A.A. Polydorou⋅M.M. Hugel
PCI in a Diabetic Patient with Meningioma & History of Recurrent Bleeding Peptic Ulcer Using Catania Stent.M.S. Mohamed, National Heart Institute, Cairo, EG
PEARL (PEripheral Use of AngioJet Rheolytic Thrombectomy with Mid-Length Catheters) Registry for DVT.R.A. Lookstein⋅L. Blitz⋅E. Simoni
Percutaneous Approach to Severe Ischemic Hand Disease: Technical Aspect and Results.C. Del Giudice, Department of Diagnostic Imaging, Interventional Radiology, Molecolar Imaging and Radiotherapy, University of Rome Tor Vergata, Rome, IT⋅R. Gandini⋅E. Pampana⋅G. Angelopoulos⋅D. Konda, et. al
Percutaneous Transluminal Angioplasty and Stenting of Extracranial Vertebral Artery Stenoses.M. Henry, Cabinet de Cardiologie, Nancy, FR⋅I. Henry⋅A. Polydorou⋅M. Hugel
Percutaneous Transluminal Angioplasty of the Subclavian Arteries. Long-Term Follow-Up.M.M. Henry, Cabinet de Cardiologie, Nancy, FR⋅I.I. Henry⋅A.A. Polydorou⋅M.M. Hugel
Plasma Levels of Matrix Metalloproteinase-9 as Marker of Successful Endovascular Aneurysm Repair.J.A. Ten Bosch, Atrium Medical Center, Heerlen, Limburg, NL⋅F.A.M.V.I. Hellenthal⋅B. Pulinx⋅W.K.W.H. Wodzig⋅M.W. de Haan, et. al
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Power Pulse Spray and Angiojet Thrombectomy in Cancer Patients with Massive Pulmonary Embolism.M. Sharifi, Arizona Cardiovascular Consultants and A.T. Still University, Mesa, AZ, USA⋅M. Mehdipour⋅A. Berkovits⋅J. Nabong⋅G. Smith
Proportion of Critical Ischemia Patients Who Require Open Procedures in a Center Favoring Endovascular Treatment.W.D. Suggs⋅N.J. Gargiulo III, Albert Einstein College of Medicine and Monte ore Medical Center, New York, NY, USA⋅F.J. Veith⋅E.C. Lipsitz⋅D.J. O’Connor, et. al
Prospective Determination of Candidates for Pharmacomechanical Thrombolysis.S.J. Klein, Stony Brook University Medical Center, Stony Brook, NY, USA⋅A.P. Gasparis⋅D. Virvilis⋅J.A. Ferre i⋅N. Labropoulos
Protégé GPS Stents in Brachiocephalic Vein Stenosis/Occlusion: A Case Study.B. Kapoor, University of Alabama at Birmingham, Birmingham, AL, USA⋅A. Feng
Radiofrequency Perforation System Use for In Vivo Antegrade Fenestration (IVAF) of Aortic Stent Gra .L.W. Tse, Division of Vascular Surgery, Toronto General Hospital, PMCC, UHN, University of Toronto, Toronto, ON, CA⋅S. Lerouge⋅B. Bui⋅E. Therasse⋅H. Héon, et. al
Rapid Endovascular Control of Hemmorhage Secondary to Malignant Carotid Erosion with Airway Compromise.L. Pillai, West Virginia University Medical Center, Morgantown, WV, USA⋅A. d’Audi ret⋅P. Zimmerman
RELAY™ Thoracic Stent-Graft Phase II Trial Update.M.A. Farber, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA⋅W.A. Lee
Renal Angioplasty and Stenting under Protection. Limitations. First Human Study with the Fibernet.M.M. Henry, Cabinet de Cardiologie, Nancy, FR⋅A.A. Polydorou⋅A.A. Polydorou⋅I.I. Henry⋅M.M. Hugel
Renal Angioplasty and Stenting. A Series of 1132 Procdures. How To Avoid and Manage Complications?M.M. Henry, Cabinet de Cardiologie, Nancy, FR⋅I.I. Henry⋅A.A. Polydorou⋅A.A. Polydorou⋅M.M. Hugel
Renal Angioplasty and Stenting. Limitations. Role of Embolic Protection Devices.M.M. Henry, Cabinet de Cardiologie, Nancy, FR⋅A.A. Polydorou⋅I.I. Henry⋅A.A. Polydorou⋅M.M. Hugel
Renal Artery Aneurysm. First Human Study with the Multilayer Stent.M.M. Henry, Cabinet de Cardiologie, Nancy, FR⋅A.A. Polydorou⋅N.N. Frid⋅P.P. Gru az⋅I.I. Henry, et. al
SFA Angioplasty and Stent Placement for Flush Occlusion Performed Entirely through the Posterior Tibial Artery.L. Pillai, West Virginia University Medical Center, Morgantown, WV, USA⋅A. d’Audi ret⋅P. Zimmerman
Silverhawk Directional Atherectomy Alone in the Treatment of Femoropopliteal Obliterative Disease.M. Rossi, ‘Sapienza’ S. Andrea University Hospital, Rome, IT⋅M. Citone⋅A. Rebonato⋅F. Fanelli⋅N. Maltze , et. al
Size Variability of the Distal Abdominal Aorta in Healthy Volunteers.N.I. Garbani, Nova Southeastern University, Fort Lauderdale, FL, USA
Subintimal Angioplasty for Super cial Femoral Artery TASC II D Lesions in Critical Limb Ischemia.C. Del Giudice, Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, “Tor Vergata” University of Rome, Rome, IT⋅R. Gandini⋅E. Pampana⋅M. Di Primio⋅C. Reale, et. al
Successful Endovascular Thrombolysis for Massive Pulmonary and IVC Thromboembolism with Arrow-Trelotola Device.Y.K. Cho, Eulji General Hospital, Seoul, KR
Symptomatic Atherosclerotic Middle Cerebral Artery Stenosis Treatment with Self-Expandable Intracranial Stents.C. Del Giudice, Department of Diagnostic Imaging, Interventional Radiology, Molecolar Imaging and Radiotherapy, University of Rome Tor Vergata, Rome, IT⋅R. Gandini⋅E. Pampana⋅F. Massari⋅A. Chiaravallo i, et. al
The Use of COMIT Strategy To Improve First Case Start Times in an Interventional Radiology Academic Practice.H.B. Chrisman, Northwestern University Feinberg School of Medicine, Chicago, IL, USA⋅D. Liu⋅S. Mouli⋅R. Salem⋅R.A. Omary
The Utility of Vasovist in Steady State MR Angiography (SS-CEMRA) for Detection of Renal Artery Stenosis.A. Nelson⋅D.C. Durant, Sunnybrook Health Sciences Center, Toronto, ON, CA⋅G. Annamalai⋅E. David⋅R. Pugash, et. al
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Transradial Puncture for Upper Extremity Hemodialysis Fistula Interventions: Early Experience.J.H. Rundback, Columbia University College of Physicians and Surgeons, New York, NY, USA⋅D.A. Zharnest
Traumatic Right Pulmonary Artery Pseudoaneurysm Embolization with Coils: Case Report.J.M. Hidalgo⋅S. Echeverri, Universidad de Antioquia, Medellín, Antioquia, CO⋅J.H. Patiño
Value of Volume Time Curves in Assessment of Diastolic Dysfunction in Left Ventricular Hypertrophy.O. Gomaa, Jackson Memorial Hospital/University of Miami, Miami, FL, USA⋅D. Eber⋅B. Schnackenburg⋅H. Peusens⋅E. Fleck, et. al
Selected Poster Presentations from CIO 2010
3D Segmentation of RF Ablations in Porcine Kidneys: Impact of Ablation Time and Active Tip Length on Lesion Geometry.C.M. Sommer, University Hospital Heidelberg, Heidelberg, Baden-Wuerttemberg, DE⋅W. Omri⋅F. Arnegger⋅N. Kortes⋅H.G. Kenngo ⋅F. Nickel, et. al
Alveolar Soft Part Sarcoma of the Tongue Base: Palliation of an Unresectable Tumor with Percutaneous Cryoablation.J.D. York, Naval Medical Center Portsmouth, Portsmouth, VA, USA⋅W.R. Graf⋅E.A. Larkins⋅W.P. Magdycz
E ectiveness of Percutaneous Baloon Pericardiotomy in Patients with Pericardial E usion.I.H. Manoukov⋅O.I. Aliman⋅G.T. Tonev⋅T.M. Tsvetkovski⋅I.G. Deenichina, et. al
Electromagnetic Tracking for Renal Biopsies and RFA in the Se ing of Multifocal Synchronous Renal Cell Carcinoma.N. Abi-Jaoudeh, National Institue of Health, Bethesda, MD, USA⋅H. Amalou⋅N. Glossop⋅J. Kruecker⋅S. Xu, et. al
Image-Guided Ablation of Synchronous Bilateral Renal Masses.A.P. Patel, Virginia Commonwealth University School of Medicine - INOVA Campus, Falls Church, VA, USA⋅A.T. Drooz
Left Hepatic Hypertrophy after Portal Vein Embolization with N-BCA in Patients with Planned Right Hepatic Resection.R.H. Siegelbaum, Mount Sinai Hospital, New York, NY, USA⋅E.D. Lehrman⋅P.A. Stangl⋅I. Oyfe⋅J.L. Weintraub
Micro-Bland Embolization Combined with Radiofrequency Ablation for Treating Complex Hepatic Tumors.F. Orsi, European Institute of Oncology, Milan, IT⋅P. Della Vigna⋅G. Bonomo⋅L. Monfardini⋅G. Orgera
Microwave Ablation (MWA) for the Treatment of Lung Tumors: Preliminary Experience.I.C. De Bernardi, University of Insubria, Varese, IT⋅G. Carra ello⋅M. Mangini⋅D. Mariani⋅E. Bracchi, et. al
Painful Bone Metastasis of RCC Managed with Embolisation Radiofrequency and Cementoplasty: Prospective Evaluation.C. Vulsaire⋅O. Pellerin, Interventional Radiology Departement Georges Pompidou European Hospital, Paris, FR⋅J. Médioni⋅S. Oudard⋅M. Sapoval
Plasma-Mediated Ablation for Treatment of Vertebral Compression Fractures Secondary to Multiple Myeloma and Lymphoma.B. Georgy, Department of Neuroradiology, UCSD, San Diego, CA, USA
Temporal Stability of Percutaneously Implanted Coiled Wire Fiducial Markers for Liver IGRT.V.M. Gironda, H Lee Mo Cancer Center/University of South Florida, Tampa, FL, USA⋅G.G. Zhang⋅M.S. Russell⋅V. Feygelman⋅J. Choi, et. al
Yttrium-90 Resin Microspheres: Treatment of Unoperable and Chemorefractory Primary and Secondary Liver Malignancies.I.I. Öz, Ankara University Medical Faculty, Ankara, TR⋅Ö. Küçük⋅S. Laçin⋅U. Sanlidilek⋅S. Bilgiç
Vertebral Angioplasty Stenting. Are Protection Devices Useful?M.M. Henry, Cabinet de Cardiologie, Nancy, FR⋅A.A. Polydorou⋅I.I. Henry⋅M.M. Hugel
Vertebral Artery Stenting in Therapy of Recidivant Vertebrobasilar Ishemic Infarction.T.T. Seruga, University Clinical Centre Maribor, Maribor, SI⋅M. Jevsek
