Embolization of Peripheral Vascular Lesions Using theGuglielmi Detachable Coil (GDC).A.S. Gomes, UCLA Medical Center; Los Angeles, CA, USA• R. Jahan • P. Dong. G. Duckwiler • T. McNamara • F.Vinuela

onły modality, 13 of the patients had at least one surgicalattempt to control the bleeding, before being referred forembolic treatrnent, and the remaining patients had 2 ormoresurgeries. Five of the patients were hemodynamically unstableat the time of the embolization procedure. Blood transfusionwas necessary in alI patients, raging from 2 to 14 units.Transcatheter embolization was used to control the bleedingin al! patients, using coils and/or particles. Follow up rangedfrom 3 months to 9 years.

RESULTS: Control ofthe bleeding was achieved in all patientsby embolization alone. No further surgery was necessary inany of the patients. Except for groin hematomas in two patients,no major complication developed from the procedure.Discharge from the hospital was witrun 3 to 6 days of theembolization procedure, in alI patients.

CONCLUSION: Transcatheter embolization is effective inthe treatment of post partum bleeding, with control of thehemorrhage and maximum preservation of the uterus.Embolization al!owed rapid recovery wi th no further surgicaltreatrnent necessary.

PURPOSE: Coil embolization is a standard form of therapyfor vascular occlusion. Acrueving stable coił position is difficultwhen embolizing large lesions or lesions with high flow. TheGDC coil (Guglielmi detachable coil) was developed forembolization of large aneurysms. The detachable coil is placedand can be repositioned to obtain a stable position. They arethen used to provide a scaffolding into which smaller coils orother embolic agents can be placed without risk ofdisplacement.We describe the use of the GDC coił in treatment of largevascular lesions, which are not suitable for embolization withconventional coils and other embolic agents.

MATERIALS AND METHODS: Eleven patients withperipheral vascular lesions underwent embolization with theGDC coil. Four patients had large aneurysms of the celiacaxis, four had pulmonary AYMs and three had peripheralartery aneurysms in the extrerni ty associated with a vascularmalformation. In none of the cases was embolization withstandard techniques deemed feasible, either because of lesionlocation, size of the lesion or rapidity of flow.

RESULTS: In a1l 8 patients, with large peripheral aneurysmsor pulmonary arteriovenous malforrnations, complete closureofthe aneurysm was accomplished using the GDC coil. In thetwo patients with the aneurysms associated with a high flowarteriovenous malformation, the use of the GDC coił inconjunction with standard coils and with tissue adhesivefacilitated controI of the flow through the malformation.

CONCLUSION: GDC coils can facilitate embolization ofperipheral non-cerebral vascular lesions, which are too largefor embolization with standard embolization techniques.

Scientific Session 15New Frontiers in IR

Abstract No. 128

Abstract No. 127

5:16PM

FEATlJRED ABSTRACT

Commcntator: .James R. Duncan, MD

Technique for Creating Gastroenteric Anastomosis inSwine.C. Cope, Hospital ojthe University ojPennsylvania,Philadelphia, PA, USA. B. Uchida • D. Pavcnik • H.Timmerman

MATERIALS AND METHODS: Patients with type I DMwere selected Jor islet celi transplantation if they had metabolicinstability to such an extent that the risks of transplantationwere considered less than those of uncontrolled diabetes.Access to the PV was gained from a right percutaneousapproach and (he islets infused with intermittent pressuremonitoring. Nineteen patients had 2 transplants, 10 patients3 transplants and 8 patients a single transplant.

RESULTS;' Successful islet infusion was achieved in all cases.FluorQscopy was used as the primary guidance modality in65 procedures and ultrasound in 11. Totalflu0foscopic timevaried from 0.6-103 rninutes with a median of 6.7 minutes.The majority of patients demonstrated transient pOltaI veinpressure elevation. Procedure-related complications occurredin 10 patients: 2 developed PY branchthrombosis, 4 patientssuffered clinically significant hemorrhage (requiring transfusionin 3) and 4 patients had" symptoms related to biliary puncture.Ali patients who received >9000 islet equivalentslKg becameinsulin independent. Of sixteen patients who have reachedone year post transplant 13 (81 %) are insulin free, and of the4 who reached 3 years post transplant, 3 (75%) remain insulinindependent.

CONCLUSION: Percutaneous catheterization of the portalvein for the purpose of islet celI infusion provides reliable andsafe access and together with islet celI separation techniquesand immunosuppressive regimen offers a significantdevelopment in the treatmeot of type l diabetes.

5:00PM

Saturday, March, 29, 20035:00 PM - 6:30 PMModerator(s): Ziv Haskal, MD

David M. Williams, MD

Percutaneous Islet CelI Transplantation in Type 1Diabetes.R.J. Owen, UniversityojAlberta Hospital, Edmonton, AB,Canada • D.M. McNally • E.A. Ryan • J.R. Lakey .1.Shapiro

PURPOSE: Between March 1999 and August 2002, Thirty­seven patients underwent seventy six trans-hepatic portal:vein (PY) islet celI transplantation procedures for type (diabetes mellitus (DM). Techniques and outcomes will bediscussed.

Abstract No. 1265:55PM

SM

PURPOSE: To develop a percutaneous transgastric procedurefor creating a functioning gastroenteric anastomosis(GEA).

MATERIALS AND METHODS: Preliminary acuteexperiments in 5 pigs led to the following preferred technique:two 10F gastrostomy sheaths were inserted: one fortransduodenal introduction of a 2-3cm balloon catheter for

Improved Localization oC Occult Parathyroid Adenomasthrough Selective Injections oC Sodium Citrate.R. Chang, Nationallnstitutes ofHealth, Bethesda, MD, USA• S. Marx • M. Skarulis • A. Kam. Z. Neeman • B. Wood,eta!.

RESULTS: Arteriograms provided localization in 36% ofpatients (9/25). Arteriography combined with venous samplingafter ioxilan provided localization in 52% of patients (13/25).Arteriography combined with venous sampling aftersodium citrate improved localization to 68% of patients ( 17/25) leaving only 8 patients (32%) still unlocalized. Transientdiscomfort or cramping is the only side effect seen at thisdilution and dose of sodium citrate.

use as a retrogastric jejunal target, the second for introductionof a 5.5F sheathed sharp trocar for catheterizing the jejunumthrough the backwaJl of the stornach. Special sliding pairedanchors were introduced through the 5.5F sheath to mobilizethe stornach to the jejunum. The GEA tracl was dilated to9mm for insertion of 12mm covered stents with everted ends.Three more pigs with GEA were foJlowed for l month. Alianimals were necropsied.

RESULTS: A large balloon provided the mostefficacious targetfor transgastric jejunal catheterization. Sandwiching the gastricand jejunal walls between anchors provided a leakproof GEA.Three pigs foJlowed for l month remained healthy gainingsignificant weighL There was l anesthetic death, l anastomoticbreakdown when no anchors were used, l obstructive ileusdue to multiple unsuccessful jejunal punctures.when nobaJloon target was used. Necropsy at l month in the last 3animals revealed a weJl developped patent GEA.

CONCLUSION: A GEA can be safely fashionedtransgastricaJly; tlus technique may have clinical applicationsfor managing gastric outlet obstruction.

S45

Abstract No. 130

Abstract No.13!

CONCLUSION: Localization of occult parathyroid adenomasduring arteriography is improved if nonselective venoussampling is performed with injection of an effectiveparathyroid hormone secretagogue. Sodium citrate appears tobe the best secretagogue yet evaluated, doubling the successrate of localization during arteriography.

5:38PM

Tracheobronchial Stenting in Malignant Airway Disease.E.M. Walser. University ofTexas Medical Branch,Galveston, TX, USA. BJ Robinson. O.S. Ozkan

PURPOSE: Tracheo-bronchial stenting is performed to relievelife threatening respiratory problems and prolong life inpatients with inoperable malignant airway obstruction. Inthis retrospective study, medical records were reviewed toevaluate improvement and survival time in 30 patients whounderwent stenting for malignant airway obstruction.

MATERIALS AND METHODS: Since 1993, 50 patients hadairway stenting procedures. Thirty patients had stents placedfor inoperable malignant strictures from bronchogeoiccarcinoma. Five of these 30 patients were stented oniy distalto the mainstem bronchi, 13/30 were stented in both theproximal and dis tal airways, and 12/30 were stented only inthe proxirnal airways. FoJlow-up was assessed clinical!y andradiographically.

RESULTS: Twenty-nine out of these 30 patients experiencedimprovement in their respiratory status witllin 2 weeks ofstenting. The overall mean survival time after stenting was261 days (Median: 130 days). Sixteen of the 30 patientssurvived ~ 90 days (Mean: 415 days, Median: 235 days).Eleven ofthe 30 patients survived < 90 days (Mean: 37 days,Median 29 days). Survival time could not be determined for 3patients. The location of stenting (Le. distal, proximal, orboth) was not associated with any significant differences inimprovement or survival. Eight of the 27 patients withcomplete records had segments of their airways stented, buthad additional stenotic segments that were too diffuselyinvolved to stenLThree out of 8 incompletely stented patientssurvived beyond 90 days, whereas, thirteen out of 19completely stented patients did so. A contingency tableanalysis indicates that a significant association exists betweencompleteness of stenting and survivorship beyond 90 days(G=6.22, P < 0.05).

5:49PM

CONCLUSION: Tracheo-bronchial stenting leads to rapidclinical irnprovement in patients with inoperable malignantairway obstruction and this improvement is independent ofthe location stented. When patients had diffuse or extensiveairway involvement and could not be completely stented, thesurvival was linlited.

Short-Term Evaluation oC the Fluency ePTFE CoveredStent Graft in Swine Bronchi.F. Aladham, St. Vincent's Hospital, Indianapolis, IN, USA.G. McLennan • P. Mathur

PURPOSE: To evaluate short-term effects of deploying theFluencyTM ePTFE covered nitinol Stents into normai bronchiof pigs.

MATERIALS AND METHODS: Nine bronchial stents weredeployed in six outbred pigs. Chest CT scan withreconstructed coronal and sagittal planes were acquired beforestent deployment and before the follow up bronchoscopy.Stents were deployed using a combination of fluoroscopic

Abstract No. 1295:27PM

PURPOSE: Patients with hyperparathyroidism who havefai led surgery are referred for arteriography if noninvasivestudies fai] to find the occult adenoma. Arteriography ispositive in only about a third of patients. Previous work hasshown that transient replacement of blood by arterial injectionof saline or nonionic contrast medium (iox.ilan) can stimulaterelease of parathyroid hormone (PTH) from an occultparathyroid adenoma that can be detected in blood sampiestaken from the superior vena cava (SVC). Assay of theseblood sampies for PTH can localize the occult adenoma evenwhen the arteriogram is negative. Sodium citrate, a całcium

chelating agent, nlight be a more effective PTH secretagoguethan ioxilan and this hypothesis was evaluated in 25 patients.

MATERIALS AND METHODS: Twenty five patients withhyperparathyroidism underwent arteriography supplementedwith selective hypocalcenlic stimulation and venous sampling.This procedure requires placement of an additional pigtailcatheter in the SVC to col!ect venous sampies prior to and at20, 40,and 60 seconds after each selective arterial injection ofsecretagogue. For each artery studied, a selective injection ofioxilan (required for the arteriogram) including SVC venoussampling was foJlowed a few nlinutes later by injection of anequal volume of 0.5% sodium citrate and repeat venoussampling. Parathyroid hormone assay was performed on al!the blood sampies and injections associated with a rise ofPTH level of 1.4 or greater was considered as positivelocalization.

ePTFE-Covered Biliary Stent in the Treatment of BiliaryMalignancies. -R. Uflacker, Medical University ojSouth Carolina,Charleston, SC, USA. J.B. Selby • C. Hannegan

PURPOSE: To present the initial experience with the ePTFE/FEP-covered biliary stent in the treatrnent of biliary malignantdisease.

MATERIALS AND METHODS: Sixteen patients, age rangefrom 47 to 92 years, 7 females and 9 males, with malignantbiliary strictures were treated with the ePTFE/FEP- coveredbiliary stent (Viabil). The stent is made of a nitinol framecovered with ePTFE/FEP lining. There are several retentionprongues in the proximal and distal segments of the device.Proximal side-holes are available. Clinical assessment andfollow up was performed at 1, 3, 6, and 9 months.

RESULTS: 5 patients had pancreatic Ca, 6cholangiocarcinomas, 5 metastatic disease (2 colon, 1 breast,1 gastric, 1 unknown). In S patients the approach wasunilateral, and in S it was bilateraI draining right and left ducts.In one patient 3 groups of ducts were drained with 12 monthssurvival. 45 devices were used in the 16 patients, ranging from1 to 6 stents. Occlusion of the stent developed in 2 patients,at 3 and 6 months, both were treated percutaneously and thestents remained patent. S patients are stil! alive. Total followup time is 26 months. The longest survival is 24 months andthe patient is still alive, the shortest survival was 1 month.Except for the occlusions, no major complications ocurred.

CONCLUSION: Preliminary results suggest that the Viabilcovered stent was effective in performing internal biliarydrainage in aU patients. The 2 occlusions and other minoradverse events were adequately managed by clinica1 andpercutaneous techniques, obviating surgery.

and bronchoscopic guidance. Five devices were deployed inthree animals and folIowed for 7-10 days; three animals weresacrificed acutely after stent deployment. CT scan,bronchoscopy, and Radiography evaluated Stent migration,apposition to tracheobronchiallumen, and granulation tissueformation. At sacrifice the bronchi were harvested, embeddedin methacrylate and stained with H&E. Histologicalmeasurements of device apposition and granulation tissuewere measured at 410cations around the device at its proximalend, distal end, and in the center of the device.

RESULTS: S of 9 stents were deployed at their intendedlocation. Stent retrieval was attempted in two animals. Inboth situations, the stent could not be removed through theendotracheal tube. There was no significant stent migration(1.4 ± 1.9 mm peripherally). The device expanded by 0.2 ±0.2 mm proximally and 1.4 ±0.6mm distally. 1.4 ± 0.9 mm ofgranulation tissue formed on the proximal end of the devicewhile 1.3 ± 1.4 mm formed distally as seen on CT. Luminalarea decreased by 14.6% proximally due to granulation tissueand increased by 63.8% clistally due to expansion ofthe device.Blood gas chang'es were not significant but P02 was 141.4 ±54.0S at baseline and 129 ± lS.S at follow-up. The deviceswere nearly completely apposed to the bronchial wall with agap of lOS.4 ± 216.1 /lm proximally, 84 ± 227.4 /lm in themiddle, and 33.6 ± 165.6 /lm distally. Granulation tissue wasthickest at the ends ofthe device (234.7 ± 275.5 /lm proximal,6.S ±lS.2 /lm mid, and 211.7 ± 404.2 /lm distal) measuredhistologicaUy.

CONCLUSION: The Fluency tracheobronchial can be easilydeployed in the bronchial tree. Expansion of the deviceovercomes the effects ofthe smali amount ofgranulation tissuethat forms at the ends of the device.

Complementary Treatment Modality of AorticDissection: Percutaneous Stent-Graft Placement andSurgical Repair.KB. Lee, University ojYonsei College ojMedicine, Seoul,South Korea. D. Y. Lee • J. Y. Won

PURPOSE: To evaluate the effectiveness of complementarytreatrnent by percutaneous stent-graft placement and surgicalrepair for the treatment of aortic dissection.

Abstract No. 134

Abstract No. 133

6:22PM

RESULTS: The percutaneous stent-graft placement wastechnically successfu1 in all four patients with failed surgicalrepair. Surgical repair in four patients with failed percutaneousstent-graft placement was successful as well. Ofthose receivedcomplementary percutaneous stent-graft placement, completeresolution ofdescencling thoracic aortic clissection was achievedin two patients and stabilization of false lumen with thrombusformation was achieved in two patients. Surgical repair infour patients with failed percutaneous stent-graft placementwas successful as well. There were no procedure related deathor instance of paraplegia, stroke, side-branch occlusion, orinfection during the subsequent mean follow-up period of21.9 months (range 1 to 91 months).

CONCLUSION: Percutaneous stent-graft placement andsurgical repair are effective complementary treatment modalityin selective patients of aortic dissection.

Endovascular Management of Non-AAA Lesions in theAortic Bifurcation Region Using the Excluder.M. Maynar, Hospiten Rambla, Las Palmas de CranCanaria Univ, Santa Cruz, Tenerije, Spain • Z. Qian • R.Llorens • A. Romero • R. Lopez .l. Zerolo

PURPOSE: To report single-institution experience withendovascular placement of the Excluder in the management ofnon-AAA lesions in the aortic bifurcation region.

MATERIALS AND METHODS: From August 2000 to June2002, twelve patients were treated with endovascularplacement of bifurcated Excluder Endoprostheses (W.L.Gore,Flagstaff, AZ) due to bilaterai common iliac aneurysm withoutneck (n=2), unilateral common iliac aneurysm (n=2), silentcommon iliac aneurysm (n=l), common iliac occlusion (n=l),abdominal aortic dissection (n=2), diffuse aorto-iIi acatheromatosis (n=3), or distal cholesterol embolism (n=l).Patients were angiographically folIowed up for up to 26months with an average of 15.3 months.

RESULTS: Technical and immediate clinical success wereachieved in all patients. There were no significant

6:11PM

MATERIALS AND METHODS: Forty-six patients with aorticdissection who underwent sten t-graft placement wereevaluated. Eight of them underwent complementarypercutaneous stent-graft placement and surgical repair. Fourpatients with failure of surgical repair were re-treated bypercutaneous stent-graft, and the remained four patients whofailed treatrnent by percutaneous stent-graft were re-treatedby surgical repair. The reason for complementary percutaneousstent-graft placement in patients with failed surgical repairwas new development of type III descending thoracic aorticdissection after surgical graft interposition for previous typeI ascending thoracic aortic dissection. The reasons forcomplementary surgical repair in patients with failedpercutaneous stent-graft placement were failed exclusion ofentry tear, graft torsion, stent-induced marginalpseudoaneurysm, and stent-induced retrograde type Adissection.

Abstract No. 1326:00PM

S46

Scientific Session 16Cardiac/Pulmonary IR

CONCLUSION: Tbis study indicates that in patients withhigh coronary calcium scores the vast majority (75%) willundergo changes in lifestyle to haJt or slow progression ofcoronary artery disease. Changes include adding or increasingstatin medication, altering their diet, and exercise. Mostpatients (69%) will undergo further testing leading tointervention (9%) and most (90%) will report lower and near­normai cholesterollevels post-scan.

complications, except for one that developed femoralthrombosis in the access site. During follow-up, allendoprostheses remained patent without endoleak. Patientshave remained asymptomatic and free from recurrence up tothe present time.

CONCLUSION: This single-institution experience indicatesthat endovascular techniques may play a role in the treatmentof non-AAA lesions in the bifurcation region.

S47

Abstract No. 136

Abstract No. 137

1:16PM

1:27PM

'FEATliREDAłłSTRAl'T

Commcntator: Charles Selllha. 'ID

Comparison ol EBCT and MDCT scoresEBCT MDCT p-value

Averagescore 274±644 514±1185 J)=O.OO3%ditfinseare 31±35 15±22 1'<0.001Abs ditf in seare 33.9 ±90.6 78.3± 175.6 p<O.OOlditf =ditference; Abs =absolute

PURPOSE: To compare interscan variation in coronary arterycalcium scores between electron beam (EBCT) andmultidetector (MDCT) computed tomography inasymptomatic subjects undergoing coronary calcium screening.

MA TERlALS AND METHODS: The coronary calcium scoresof 536 subjects (123 women and 413 men) who underwentcoronary calcium imaging with an EBCT scanner (GE MedSystems, Milwaukee, WI) were compared with the scores of248 subjects (59 women and 189 men) who underwent irnagingwith a MDCT (Mx8000, Philips Med. Systems, BothelI,WA). Ali subjects were asymptomatic for coronary arterydisease. Each subject had two scans of the heart perforrnedusing prospective gating. Scoring was perforrned with anattenuation threshold of 130 Hounsfield Units and a sizethreshold of 0.50 mm2.

RESULTS: There was no significant difference in the agedistribution between the subjects who underwent EBCT andMDCT imaging of their coronary arteries (EBCT 56.6 ± 11.2years versus MDCT 56. I ± 11.7 years, p=0.56). There wasno significant difference in the gender distribution betweengroups (c2=0.29, p=O.87). As shown in the table, there weresignificant differences in the average calcium score, thepercentage difference in score, and the absolute difference inscore between subjects imaged by EBCT and MDCT.However, the coefficient of variation was similar between thetwo subject groups (EBCT = 24.9% versus MDCT = 26.3%).Bland Altrnann plots revealed no significant difference betweenthe subject groups of the effect of the magnitude of the scoreon interscan variation (EBCT slope = -0.054, 95% CJ. = ­0.062 to -0.045 and MDCT slope = -0.072. 95% C.I. = ­0.086 to -0.058).

CONCLUSION: Coronary calcium scores from MDCTdemonstrate significantly less interscan variation than EBCT.Therefore. MDCT may provide a more precise method ofmeasuring coronary caIcium in subjects who may requiresequential studies for atherosclerotic disease monitoring.

Deep Vein Thrombosis oC Lower Extremity: EvaluationoC Underlying Anatomie Problems Using Spiral CTVenography.J. W Chung, Seoul National University Hospital. Seoul,Seoul, Korea • e.J. Yoon • S. 1.1. Jung. J.H. Park

PURPOSE: To evaluate tbe spectrum of underlying anatomicproblems in deep vein thrombosis (DVT) of lawer extremityusing spiral CT venography.

MATERIALS AND METHODS: During the past 4 years, 30patients with acute DVT have been evaluated with CTvenography. Twenty-six patients had left-sidedDVT and fourhadright-sided DVT. CT venography was performed with 3mm x-ray beam collimation and 2 mm reconstruction interval.

Comparison oC Electron Beam and Multidetector CT inthe Evaluation oC Coronary Calcium.H.e. Yoon, Kaiser Foundation Hospital, Honolulu, HI, USA• A. Haroldsen • D.L. Parker

Abstract No. 135

FEATURED ABSTl~ACT

COllllllcntator: .J. Baync Sclby. 'ID

Sunday, March, 30, 20031:00 PM - 2:30 PMModerator(s): Antoinette S. Gomes, MD

1:00PM

Coronary Artery Calcium Scores Greater Than 75thPercentile: Follow-Up Indicates Significant LifestyleChanges.M.F Mastromatteo, Beth Israel Deaconess Medical Center,Boston, MA, USA. F Welty • M.E. Clouse

PURPOSE: To evaluate ifhigh coronary artery calcium scoresare related to significant vessel narTowing; to observe whetherpatients ::omplied with reconunendations to undergo furthertesting; and to detect lipid level and lifestyle changes pre- andpost-scanning.

MATERIALS AND METHODS: We examined 1600asymptomatic patients (1206 males, 394 females) ,ages 25 to65 years of age and evaluated coronary artery calcium usingthe Evolution 150 XP EBCT (Imatron Inc., San Francisco,CA) and the GE Lightspeed Ultra 8 slice MRD. The FOVwas 35 cm wi th imaging matrix 5 I2 x 512 and pixel size 0.46squared. Calcification was considered when there were fourcontiguous pixels over the coronary artery. The calcium scorewas determined on an Insight workstation (NeoImageryTechnologies, Los Angeles, CA), using the Agatston scoringsystem. At the initial visit all patients completed aquestionnaire related to past medical history, diet, amount ofexercise and lipid levels. We then focussed on 230 patientswith calcium scores greater than the 75th percentile.Questionnaires included the following: symptoms expeliencedsince the scan; if they underwent any further recommendedtesting; and if steps were taken to lower their lipid levels andstop progression of atherosclerosis.

RESULTS: 69 (30%) of the questionnaires were returned.69% underwent treadmiU tests. 6 patients (9%) underwentcoronary arteriography with PTNstent, or CABG. The totalcholesterol (TC) was elevated in 73% pre- and 25% post­scan. The LDL-C was elevated in 84% pre- and 31 % post­scan. 25% were on statin therapy before and 58% post-scan.75% reported lifestyle changes in diet, exercise and weightreduction and 30% reduced their TCILDL by lifestyle changesa1one.