+ All Categories
Home > Documents > Poster Session 2

Poster Session 2

Date post: 30-Dec-2016
Category:
Upload: doancong
View: 216 times
Download: 0 times
Share this document with a friend
of 4 /4
252 MATERIALS AND METHODS: The first portion of the graft to be deployed consisted of two anchoring Z stents connected by struts over which a small-pore polyester tube was placed and attached. A triple-body inner Z stent was then placed within the graft lumen between the anchoring stents. A coaxial delivery system was de- signed for the two-stage deployment, which was evalu- ated in eight dogs. RESULTS: Graft delivery was completely successful in four cases. In the second and third dogs, the lumen of the graft material had to be recatheterized for deploy- ment of the inner stent because of technical problems with the delivery system. These problems were solved by improving the method for joining the sections of the delivery system. In two animals, premature deployment of the inner stent resulted in a wide gap between this stent and the caudal anchoring stent. The gap was easily bridged with a single body Z-stent in both animals. CONCLUSION: Endovascular assembly of an aortic stent graft is feasible. This approach to graft deployment re- duces the size of the delivery system, which may obviate the need for a cutdown. Take Home Points: Endovascular assembly of an aortic stent graft is feasible and reduces the size of the required delivery system. Monday, March 10, 1997 3:30-5:00 pm Poster Session 2 3:30 pm Factors Contributing to Unsuccessful US-guided COD1pression Repair of PostcatheteriZation pseudoaneurysms X. Yang, MD, PhD, Kuopio, Finland H. Manninen, MD, PhD· E. Kaukanen, MD S. SOimakallio, MD, PhD PURPOSE: To clarify the factors contributing to failure of US-guided congression repair (UGCR) of postcatheter- ization femoral arterial pseudoaneurysms. MATERIALS AND METHODS: We reviewed the clinical courses of 5,632 patients who underwent different car- diovascular catheterizations through a femoral approach during the period of 2 years. Femoral arterial pseudoan- eurysm was found in 45 (0.8%) patients. Altogether, 17 factors including patient's clinical features, anticoagulant therapy, catheterization procedures, UGCR procedures, and pseudoaneurysmal characteristics, were analyzed by using the statistics of multiple logistic regression. RESULTS: The pseudoaneurysms were successfully treated with UGCR in 37 (82.2%) patients. Another eight (17.8%) patients with unsuccessful UGCR required sur- gical repair. The frequency of UGCR failure was statisti- cally significantly higher (P < .05) in those patients with high systolic blood pressure (;;" 160 mm Hg), anticoagu- lant therapy during UGCR procedure, and wide pseu- doaneurysmal neck (;;" 2 mm), in comparison with the control patients. CONCLUSION: Hypertension and anticoagulant usage as well as the wide neck of pseudoaneurysm are three sig- nificant factors that contribute to failure of UGCR of post- catheterization femoral artery pseudoaneurysms. Take Home Points: Hypertension should be managed for a successful UGCR procedure. 3:40 pm Changes in the Aortic Bifurcation Angle in the Presence of Abdominal Aortic Aneurysms T. Fathy Massoud, MD, Los Angeles, CA • G j. Hademenos, PhD j. W Sayre, PhD E. W.l. Fletcher, MD PURPOSE: To compare values of the aortic bifurcation angle (ABA) in the presence of abdominal aortic aneu- rysms (AAAs) with those from normal subjects. MATERIALS AND METHODS: The ABA was measured on frontal angiograms of 71 patients (37 males and 34 fe- males; mean age, 66 years) with nondiseased aortas and common iliac arteries, and 27 patients (17 males and 10 females; mean age, 69 years) with angiographically documented AAAs. Statistical analysis was performed with multivariable (age, sex, and AAA presence) linear regression analysis and a two sample Kolomogorov- Smirnov test for equality of distributions. RESULTS: The range of ABAs for normal subjects was 15°-80° (mean, 39.0°) and that in the presence of AAAs was 15°-120° (mean, 57.4°). The Kolomogorov-Smirnov test yielded a statistical result D = 0.4674, which was highly significant (P < .00001). A strong bimodal distri- bution (with a peak at acute angles [mode 20°] and an- other peak at obtuse angles [mode 90°]) was observed for values of ABAs in the presence of AAAs. The ABAs of normal subjects showed a unimodal distribution (mode 40°). There was no statistical correlation between ABA and patient age or sex. CONCLUSIONS: When compared to normal, the ABA changes significantly in the presence of an AAA to as- sume either a markedly acute configuration or an obtuse splaying. Knowledge of these induced alterations in ABA is useful in understanding the morphogenesis of AAAs and as reference values for endovascular procedures centered on the aorto-iliac junction, including stent graft placement. Take Home Points: 1. AAAs induce changes in the aortic bifurcation angle (ABA), which becomes either very acute (- 20°) or obtuse (- 90°) compared to normal (- 40°).
Transcript
Page 1: Poster Session 2

252

MATERIALS AND METHODS: The first portion of thegraft to be deployed consisted of two anchoring Z stentsconnected by struts over which a small-pore polyestertube was placed and attached. A triple-body inner Zstent was then placed within the graft lumen betweenthe anchoring stents. A coaxial delivery system was de­signed for the two-stage deployment, which was evalu­ated in eight dogs.

RESULTS: Graft delivery was completely successful infour cases. In the second and third dogs, the lumen ofthe graft material had to be recatheterized for deploy­ment of the inner stent because of technical problemswith the delivery system. These problems were solvedby improving the method for joining the sections of thedelivery system. In two animals, premature deploymentof the inner stent resulted in a wide gap between thisstent and the caudal anchoring stent. The gap was easilybridged with a single body Z-stent in both animals.

CONCLUSION: Endovascular assembly of an aortic stentgraft is feasible. This approach to graft deployment re­duces the size of the delivery system, which may obviatethe need for a cutdown.

Take Home Points: Endovascular assembly of an aorticstent graft is feasible and reduces the size of the requireddelivery system.

Monday, March 10, 19973:30-5:00 pm

Poster Session 2

3:30 pm

Factors Contributing to Unsuccessful US-guidedCOD1pression Repair ofPostcatheteriZation pseudoaneurysmsX. Yang, MD, PhD, Kuopio, Finland •

H. Manninen, MD, PhD· E. Kaukanen, MD •

S. SOimakallio, MD, PhD

PURPOSE: To clarify the factors contributing to failure ofUS-guided congression repair (UGCR) of postcatheter­ization femoral arterial pseudoaneurysms.

MATERIALS AND METHODS: We reviewed the clinicalcourses of 5,632 patients who underwent different car­diovascular catheterizations through a femoral approachduring the period of 2 years. Femoral arterial pseudoan­eurysm was found in 45 (0.8%) patients. Altogether, 17

factors including patient's clinical features, anticoagulanttherapy, catheterization procedures, UGCR procedures,and pseudoaneurysmal characteristics, were analyzed byusing the statistics of multiple logistic regression.

RESULTS: The pseudoaneurysms were successfullytreated with UGCR in 37 (82.2%) patients. Another eight(17.8%) patients with unsuccessful UGCR required sur­gical repair. The frequency of UGCR failure was statisti-

cally significantly higher (P < .05) in those patients withhigh systolic blood pressure (;;" 160 mm Hg), anticoagu­lant therapy during UGCR procedure, and wide pseu­doaneurysmal neck (;;" 2 mm), in comparison with thecontrol patients.

CONCLUSION: Hypertension and anticoagulant usage aswell as the wide neck of pseudoaneurysm are three sig­nificant factors that contribute to failure of UGCR of post­catheterization femoral artery pseudoaneurysms.

Take Home Points: Hypertension should be managedfor a successful UGCR procedure.

3:40 pm

Changes in the Aortic Bifurcation Angle in thePresence of Abdominal Aortic Aneurysms

T. Fathy Massoud, MD, Los Angeles, CA •

G j. Hademenos, PhD • j. W Sayre, PhD •

E. W.l. Fletcher, MD

PURPOSE: To compare values of the aortic bifurcationangle (ABA) in the presence of abdominal aortic aneu­rysms (AAAs) with those from normal subjects.

MATERIALS AND METHODS: The ABA was measured onfrontal angiograms of 71 patients (37 males and 34 fe­males; mean age, 66 years) with nondiseased aortas andcommon iliac arteries, and 27 patients (17 males and 10females; mean age, 69 years) with angiographicallydocumented AAAs. Statistical analysis was performedwith multivariable (age, sex, and AAA presence) linearregression analysis and a two sample Kolomogorov­Smirnov test for equality of distributions.

RESULTS: The range of ABAs for normal subjects was15°-80° (mean, 39.0°) and that in the presence of AAAs

was 15°-120° (mean, 57.4°). The Kolomogorov-Smirnovtest yielded a statistical result D = 0.4674, which washighly significant (P < .00001). A strong bimodal distri­bution (with a peak at acute angles [mode 20°] and an­other peak at obtuse angles [mode 90°]) was observedfor values of ABAs in the presence of AAAs. The ABAs ofnormal subjects showed a unimodal distribution (mode40°). There was no statistical correlation between ABAand patient age or sex.

CONCLUSIONS: When compared to normal, the ABAchanges significantly in the presence of an AAA to as­sume either a markedly acute configuration or an obtusesplaying. Knowledge of these induced alterations in ABAis useful in understanding the morphogenesis of AAAs

and as reference values for endovascular procedurescentered on the aorto-iliac junction, including stent graftplacement.

Take Home Points:1. AAAs induce changes in the aortic bifurcation angle

(ABA), which becomes either very acute (- 20°) orobtuse (- 90°) compared to normal (- 40°).

Page 2: Poster Session 2

2. ABA reference values are presented for procedurescentered on the aorto-iliac junction.

3:50 pm

Percutaneous Treatment of Iliac Aneurysms Usinga Covered Stent: First Long-term ResultsE. Minar, MD, Vienna, Austria • A. Ahmadi, MD •

H. Ehringer, MD

PURPOSE: Infrarenal abdominal aortic aneurysms are of­ten extending into the iliac arteries. Otherwise, isolated

aneurysms of the iliac arteries are rare, and such aneu­rysms are mostly located in the common iliac artery. Thepotential complications (rupture, thrombus formationwith peripheral embolization) require the exclusion ofsuch aneurysms. The development of covered stents of­fered the possibility for percutaneous transluminal treat­ment of such aneurysms. We report our initial clinicalexperience and first long-term results with this treat­ment.

PA7JENTS AND METHODS: We treated five consecutivemale patients (mean age, 71; range, 66-78 years) with anisolated atherosclerotic iliac aneurysm (4 x common iliacartery, 1 x common and external iliac) by percutaneoustransluminal implantation of a self-expanding nitinolstent covered with polyester fabric (Cragg Endopro). Thediameter of the aneurysms was between 20-30 mm. Thestents had a diameter of 10-12 mm and a length of 6-8cm. The implantation was done in local anesthesia withuse of a 8 (9) F sheath.

RESULTS: The implantation was successful in all five pa­tients with immediate exclusion of the aneurysm. Therewere no complications. Follow-up investigations (colourduplex sonography; spiral-CT; intravenous DSA) at 6-15months demonstrated optimal results (correct stent­position, patency, no leaks, complete thrombosis of theaneurysm) in all patients.

CONCLUSION The isolated iliac aneurysm is an optimalindication for implantation of a covered stent. This treat­ment should be considered as the primary therapy ofchoice in such patients.

Take Home Points: Iliac aneurysms can be easilytreated by percutaneous implantation of a covered stent.Our first long-term results indicate definite exclusion ofthe aneurysm. Therefore, this treatment modality shouldbe considered as the primary therapy of choice.

4:00 pm

Percutaneous Pulmonary ThrombectomyE. V Lang, MD, Iowa City, L4 • WH. Barnhart, RTR •

DL Walton, RTR

PURPOSE: To present a system for efficient percutaneouspulmonary thrombectomy that uses readily availablecomponents.

MATERIALS AND METHODS: A thrombectomy systemwas developed in the laboratory and was refined duringuse in three patients with massive severely symptomaticpulmonary thromboembolism underwent. Componentsinclude a 14-F stationary sheath, a 14-F ultrathane suc­tion catheter, and a coaxially loaded 6-F guiding cath­eter.

RESULTS: Thrombolysis and mechanical clot macerationfailed in the two patients in whom it was tried. A three to8-cm-long elastic clot with histologic signs of maturationwas aspirated, reducing the clot burden more than 90%in each case. Best results were obtained when the 14-Fsuction catheter was advanced coaxially over the guid­ing catheter compacting, trapping, and propelling theclot distally until it halted at a vascular bifurcation. Am­putation of the clot during retrieval was minimized bythe use of a tear-away sheath that was inserted into thestationary sheath. Hemodynamics improved significantlyand immediately after clot suction. Two patients recov­ered during their hospital stay; the third died of rightheart failure the following day.

CONCLUSION Percutaneous thrombectomy can be anattractive alternative to open surgery for patients who failmedical management of massive pulmonary thrombo­embolism.

Take Home Points:1. Mature pulmonary emboli may resist thrombolysis

and mechanical maceration, but can be suctionedeasily

2. Percutaneous pulmonary thrombectomy is fast andsafe

3. Readily available components can be used for pul­monary thrombectomy

4:10 pm

A Ne-w Expanded-Tip Vascular Catheter for

Percutaneous Thrombectomy-Preliminary InVivo Results

j. Brossmann, MD, Kiel, Germany • K. Arun, MD •

Jj. Bookstein, MD

PURPOSE: To test the safety and efficacy of an ex­panded-tip vascular catheter (EVC) designed for percu­taneous transcatheter balloon thrombectomy.

MATERlALS AND METHODS: Nine French EVC proto­types (Applied Medical, Laguna Hills, CA) were percu­taneously introduced into the femoral arteries of four 20kg dogs. The funnel-shaped tips were deployed in theiliac arteries to simulate embolectomy maneuvers. His­tologic alterations secondary to deployment were evalu­ated in two dogs acutely, and in two dogs after 3 weeks.

Supported by: Applied Medical, Laguna Hills, CA253

Page 3: Poster Session 2

254

Efficacy of thrombic extraction was evaluated in a rabbitsubacute inferior vena cava thrombosis model, using 2day (n = 8) and 7 day (n = 4) old thrombus.

RESULTS: Histologic examination at the site of funneland balloon deployment immediately after the proce­dure revealed areas of minimal endothelial disruptionand subtle hemorrhage and injury. Three weeks after theintervention, subintimal myointimal hyperplasia waspresent at each site, and in two of four sites, hemorrhagicresidua were found in the media. In the rabbit model,2-day-old thrombus was completely removed from theinferior vena cava by two or three extraction maneuvers.With 7-day-old thrombus, embolectomy was successfulin only two of four rabbits.

CONCLUSION Preliminary in vivo experience suggeststhe feasibility of percutaneous thrombectomy using anew EVC device. Efficacy of the device may be limitedby age of thrombus.

Take Home Points: New device for percutaneousthrombectomy; safe introducibility in animal model;good extraction rate in vivo.

4:20 pm

Increasing Activity of rt-PA Induced Fibrinolysisat Hyperthermia: In Vitro Results and PossibleClinical Impacts

H. Schwarzenberg, MD, Kiel, Germany •

S. Mueller-Huelsbeck, MD • j. Brossman, MD •F. Wesner, MD • M. Heller, MD

PURPOSE: To investigate the influence of hyperthermiaon activity of rt-PA induced fibrinolysis.

MATERIAL AND METHODS: Standardized fibrin-clotswere incubated for 5 hours either with rt-PA or sodiumchloride and blood plasma at temperatures of 30°C to45°C in a water bath. Concentrations of D-dimers andtime until complete clot lysis were measured.

RESULT'S: No temperature-optimum of rt-PA activity wasfound. Lysis time continued to decrease even at the high­est temperature tested in the study. The activity of fibri­nolysis with rt-PA showed an exponential rise with in­creasing temperature (r = 0.99) and approximatelydoubled from 30°C to 40°C. Concentrations of D-dimerapproximately trebled between 30°C and 40°C. In thecontrol group clot-size did not change under addition ofsodium chloride.

CONCLUSIONS: The activity of rt-PA induced fibrinolysisdistinctly increases with higher temperatures up to 45°C.Especially in patients with occlusive artery disease anddecrease of body temperature of the afflicted extremity,reduced activity of fibrinolysis with rt-PA can be ex­pected.

Take Home Points: Activity of rt-PA induced fibrinoly­sis is increased at hyperthermia up to 45°C. Decreasedactivity of rt-PA can be expected at the peripheral site.

4:30 pm

Thrombectomy Time and Embolization Rate ofDifferent Hydrodynamic Thrombectomy Devices:In Vitro Results

S. Mueller-Huelsbeck, MD, Kiel, Germany • H.

Schwarzenberg, MD • j. Link, MD • C. Bangart, MD •M. Heller, MD

PURPOSE: To compare the hydrodynamic thrombec­tomy devices Hydrolyser™ (HL) and S.E.T.™(SED in anin-vitro model.

MATERIALS AND METHODS: In a flow-model (flow 1Umin), made of silicone tubes femoral artery with severestenosis was simulated. Thrombectomy of clots (n = 40)from 8 days old porcine blood (7.33 ± 0.41 g) was per­formed with either HL or SET. The catheters were bothused without, the HL also with guide wires (0.018-0.025inch). Ten thrombuses were treated in each group.Thrombectomy time, dosages of applied and aspiratedsaline were measured. Emboli were counted in 10, 100,and 1000 pm porus filter.

RESULTS: Mean thrombectomy time was similar for SET(35.3s) and HL (34.5s). It was prolonged, if HL was usedwith giude wires (55.1 s/72 s). Quotients of applied andaspirated saline were 0.59/0.85/1/1.23 (P < 0.01). Embolimeasuring 1000 pm appeared 1/10, 4/10, 3/10, 3/10 (P <.08). More than six emboli greater than 100 pm werecounted 1/10, 2/10, 6/10, 5/10 (P < .08), Significant 10pm emboli were not observed.

CONCLUSIONS: The HL causes slightly more embolismsthan the SET, emboli rate increases with the use of guidewires. Disadvantageous of the SET is that more saline isaspirated than applied. In-vivo this leads to hemolysisand a decrease of hemoglobin.

Take Home Points:1. The described embolectomy devices are different in

embolization rate and aspirated saline, which mightprovide clinical complications.

2. Time of thrombectomy is equal.

4:40 pm

Percutaneous Treatment of Procedure-relatedComplications of TIPS

j. Maass, MD, Novara, Italy • P. Fonio, MD •G. Gandini, Prof· A. Scarrone, MD • C. Ferro, Prof

PURPOSE: Aim of the present paper is to present ourexperience in the percutaneous treatment of complica­tions during TIPS.

Page 4: Poster Session 2

MATERIAL AND METHODS: During the past 4 years, inthe Radiology Departments of the Novara and the CuneoHospital, 106 patients underwent TIPS. Eleven immedi­ate complications occurred: six cases of stent displace­ment, all resolved by transferring the stents elsewhere;one occlusion, resolved by performing another anasto­mosis; one case of displacement of a coil into the portaltrunk, which was retrieved through the introducersheath; one pseudoaneurysm of the gastroduodenal ar­tery, embolized angiographically; one artero-portalshunt, occluded by a distachable balloon; and one he­mobilia resolved by application of a biliary drainagecatheter.

RESULTS: Percutaneous treatment was successful in allcomplications.

CONCLUSION Complications during TIPS can be re­solved percutaneously by skilled operators if the re­quired material is available.

Take Home Points: Eleven immediate complications ofTIPS were resolved percutaneously: six stent displace­ments; one occlusion; one displacement of a coil; onepseudoaneurysm; one hemobilia; and one artero-portalshunt.

4:50 pm

Anchoring Coil Embolization in a High-FlowArterial Model: A Pilot StudyA. K6nya, MD, PhD, Houston, IX.

KG. Wright, PhD. S. Wallace, MD*

PURPOSE To devise and test an occluding coil anchor­ing system to improve the safety of coil embolization.

MA TERlALS AND METHODS: A newly devised anchoringsystem was attached to Gianturco coils and investigatedin 15 pigs. In an acute study, an anchored coil wasplaced in the infrarenal portion of the abdominal aorta in12 pigs by means of the carotid approach. Aortographywas performed before and after coil placement. In achronic study, anchored coils of the appropriate sizewere placed in the left femoral and the right carotidarteries in three pigs by means of the right femoral ap­proach. One week later, the animals were evaluated forvascular occlusion and coil migration.

RESULTS: Radiographically, the coil created a compactconglomerate. In the acute group, necropsy confirmedcompact arrangement of the coils within the aortic lu­men and containing an anchored coil were completelyobstructed and no coil migration was noted.

CONCLUSION The newly devised anchoring system ef­fectively prevented migration of vascular occluding coilseven in high flow conditions.

Take Home Points: An anchoring system makes vas­cular embolization with coils safer by preventing coilmigration. This in tum could extend the scope of coilembolization.

Wednesday, March 12, 19973:30-5:00 pm

Poster Session 3

3:30 pm

Intraarterial Infusion of Zinostatin Stimalamerfor Hepatocellular Carcinoma: PredisposingFactors for ComplicationsA. Nakatsuka, MD, Tsu, japan • K Yamakado, MD •

N. Tanaka, MD • K Matsumura, MD •K Takeda, MD • T. Nakagawa, MD

PURPOSE: To assess predisposing factors for complica­tions after intra-arterial infusion of zinostatin stimalamer(SMANCS), which is a new oily anticancer drug to treathepatocellular carcinoma (HCC).

MATERIALS AND METHODS: Sixty patients with HCCreceived intraarterial infusions of SMANCS in 92 proce­dures. The injected dose ranged 1-6 mg 0-4 mg; 69procedures, 4-6 mg; 23 procedures). Injection was doneat segmental branches in nine procedures, at lobarbranches in 37 procedures and at proper hepatic arteriesin 46 procedures. Gelatin sponge embolization wasadded in 22 procedures. Patients' clinical stage classifi­cation was as follows, according to the rules establishedby Liver Cancer Study Group of Japan; I in 33 proce­dures, II in 52 procedures and III in seven procedures.Change of serum bilirubin level and evidence of asciteswere evaluated before and within 3 weeks after the treat­ment.

RESULTS: Hyperbilirubinemia (~ 3.0 mg/dO or newlydeveloped ascites appeared 12% of stage I patients (fourof 33 procedures), 29% of stage II patients OS of 52procedures), and 86% of stage III patients (six of sevenprocedures). Of seven patients with stage III, three pa­tients died of liver failure within 1 month. There were nosignificant relationships between the injected dose orinjection site of SMANCS, or the combination use of em­bolization and adverse of liver profiles.

CONCLUSION Occurrence of the adverse effect afterSMANCS injection depends on the basis of clinical stageclass degree.

Take Home Points: Adverse of liver function afterSMANCS injection is closely related to the clinical stageclass.

3:40 pm

Management of Guide Wires Entrapped By VenaCava Filters during Central VenousCatheter PlacementR. T. Andrews, MD, Baltimore, MD •

j.F. Gerschwind, MD • Sf. Savader, MD •FA. Osterman, jr, MD

INTRODUCTION Vena cava filters have been used asprophylaxis against pulmonary embolism since 1967 andit is estimated that 20,000-30,000 filters are placed annu­ally in the United States. The presence of a vena cava

255


Recommended