Sci'entific Session 6Pelvic and Uterine Artery EmbolizationModerators: Lindsay Machan, MD

jon Moss, il1D

CONCLUSION: UAE using gel foam exclusively is a safealternative to surgical treatment in symptomatic fibroids.This procedure can be done cost effectively in develop­ing countries using simple angiographic catheter andgelfoam.

and p=.06, respectively). The rate of dislodgment, se­curement problems, occlusion, and leaks was similar inboth groups. Premature catheter removal for any reasonwas similar in both groups (Statlock 16179, 20.3%; su­ture 21/69, 30.4%; p=0.15)' There was one needle-stickinjury in the suture group.

CONCLUSION: StatLock demonstrated a statistically sig­nificant decrease in the rate of catheter infections. Stat­Lock securement was faster, and avoided the risk of aneedle-stick injury.

817

Abstract No. 43

Abstract No. 42

3:37 pm

Uterine Artery Embolization with Gelatin SpongeParticles Alone for Symptomatic Uterine Fibroids.T J(atsumori, Saiseikai Shiga Hospital, Shiga, japan •

K. Nakajima • M. Tokuhiro

PURPOSE: To assess the safety and effectiveness ofuterine artery embolization (UAE) with gelatin sponge

PURPOSE: To evaluate the effectiveness of intra-arteriallidocaine in controlling pain after uterine artery em­bolization for uterine leiomyomata.

RESULTS: Ten patients received intra-arterial lidocaineduring the procedure while eight patients receivedsaline. Among the 18 patients, moderate to severe va­sospasm was noted in seven patients immediately afterthe injection. Because of the vasospasm episodes, thestudy was terminated. All seven patients in whom va­sospasm occurred had received lidocaine (p=.0025). Novasospasm was noted in saline group. All patients hadtechnically successful embolization. Lidocaine grouphad significantly lower NRS pain scale (mean 3.5/10)than saline group (mean 7/10) (p=.012). Lidocaine hadno effect on attempted doses (p=.91), doses given(p=.86), and total dose (p=.52) of morphine comparedto controls. Peripheral lidocaine levels were well belowthe toxic level, and no complications referable to lido­caine toxicity occurred.

CONCLUSION: Injection of 1 % lidocaine into the uter­ine arteries is associated with moderate to severe va­sospasm. There is significantly lower subjective pain inlidocaine patients. The impact of lidocaine induced va­sospasm on fibroid ischemia and treatment response isbeing investigated.

MATERiALS AND MElliODS: Patients undergoing uter­ine artery emboli7.ation received 200 mg intra-arterialpreservative free 1 % lidocaine or saline (control) indouble blind fashion. Selective bilateral uterine arteryinjection was performed prior to embolization. Periph­eral lidocaine levels were then obtained on all patients.Postprocedure pain was managed with use of patient­controlled analgesia utiliZing intravenous morphinepump. Attempted doses, number of doses received,total morphine dose, and maximum pain numerical rat­ing scale (NRS) score during the 24 hr. postprocedurehospitalization were recorded. ANaYA was used to de­termine if patients receiving lidocaine had better paincontrol than the saline group. Chi-square was used todetermine if the incidence of spasm varied between thetwo groups.

3:26 pm

Initial Experience with Intra-arterial Lidocaine inControlling Pain after Uterine ArteryEmbolization for Leiomyomata.IA. Keyoung, Georgetown University Medical Center,Washington, DC, USA· E.B. Levy· A.R. Roth •

I Gomez-jorge • TC. Chang. IB. Spies

Abstract No. 413:15 pm

Sunday, Marc.h 4, 20013:15 pm-4:45 pm

Uterine Artery Embolisation for SymptomaticFibroids: Experience of a Cost Effective Approachin a Developing Country Using Gelfoam Only.TA. Rana, Sindh Institute of Urology and

T7'ansplantalion, Karachi, Pakistan

PURPOSE: Uterine Artery embolisation (UAE) is anemerging minimally invasivetechnique for alleviation ofsymptomatic fibroids. This study was done to assess theefficacy of this treatment modality in Pakistani womenusing gel foam only.

MATERiALS AND MElliODS: During December 1998 toAugust 2000, 50 women underwent UAE. The mean agegroup was 25-30 years. Menorrhagia in isolation orcombination was the principal indication. The proce­dure was carried out through a right sided femoral arte­rial puncture. Both uterine arteries were super selec­tively cannulated and complete embolisation tocessation of flow was performed using gelfoam in theform of particles and/or slurry. Adequate pre proce­dural antibiotics Onj Ciproxin O.lgrni/v stat) and ade­quate pain control. The patients were followed everythree months onultrasound for a period of 1-18 months.

RESULTS: The procedure was techn!callysuccessful in allthe patients. There was complete cessation of menor­rhagia in all but one patient with in 2 months. Themean decrease in the uterine volume was 30% at 3months, 40% at six months and to normal level by 12months. 3 patients had in utero sloughing of fibroidwhich were removed trans vaginally. One patient gotpregnant 3 months after the procedure with return tonormal menstrual cycle in all pre menopausal womenwith in 3 months.

(GS, SpongeD particles alone for symptomatic uterinefibroids.

MATERIALS AND METHODS, During 33 months, 48 pa­

tients (age range, 35 to 52 years, mean 43.7 years) with

symptomatic uterine fibroids underwent UAE with only

GS particles approximately 500 to 1000 micrometers in

diameter. We made GS particles from GS sheet with a

scalpel and small scissors. The improvement of clinical

symptoms was assessed by questionnaire at the time of4 months and 1 year after UAE. The dominant (largest)

tumor and uterine volume reductions were assessedwith plain and enhanced MRls obtained before UAE

and 1 week, 4 months, and 1 year after UAE. Follow-up

period ranged from 1 to 33 months (mean ] 1.7months).

Gynecologist's Opinion of Uterine FibroidEmboUzation (UFE): The Patient's Perspective.M.G. Wysoki, Yale University Hospital, New Haven, cr,USA • BP. Byrd. K. Onze • M. Rosenblatt. ]. PoUak

• C. Burdge, et a/.

PURPOSE: To evaluate the opinion of the gynecologist

to UFE, as perceived by the patients.

MA7ERlALS AND METHODS.· Of 50 Women thal under­

went UFE berv.reen 8/98 to 7100, 21 completed a tele­

phone survey thus ·far. They were asked what their gy­

necologists' opinions were toward UFE both before andafter the procedure. In addition, they were asked if they

see the same gynecologists that they saw before the

procedure, what treatment options were offered to

them and whether they or their gynecologist initiated

discussion of UFE.

RESULTS: In all patients, bilateral uterine arteries em­bolization was successfully performed without any

major complications. Menorrhagia improved markedly

or moderately in 100% (35/35) of patients 4 months

after UAE and in 100% (17/17) 1 year after UAE. Theother symptoms associated wirh fibroids improved

markedly or moderately in 97% (34/35) of patients 4

months after UAE and in 94% (16117) of patients 1 year

after UAE. MRI revealed that the mean tumor volumereduction rates of the dominant uterine fibroids were

58% at 4 months and 69% at 1 year after UAE, and uter­

ine volume reduction rates were 43% at 4 months and61% at ] year after UAE. Enhanced MRI obtained 1week after UAE revealed that of the total 248 fibroid,;,

100% infarction was achieved in 240 fibroids (97%), and

the myometorium was well enhanced without any in­

farction in all patients. No rumors have regrown duringthe follow-up period. No major complications after UAEhave occurred. Ninety-seven percent (34/35) of patientswere markedly or moderately satisfied with the' proce­

dure and the outcome 4 months after UAE, and 94%(16/17) of patients 1 year after UAE.

CONCLUSION UAE with GS particles alone is a safe andeffective treatment for symptomatic uterine fibroids.

Abstract No. 45

CONCLUSION: The vast majority of gynecologists have anegative initial opinion toward UFE. Patients who un­

derwent UFE did not continue seeing most of the gyne­cologists who maintained their negative opinion toward

the procedure.

3:59 pm

RESULTS. Twenty four percent (5/21) of the gynecolo­

gists had an initial favorable opinion towards UFE. Sev­

enty six percent 06/21) of the gynecologists initially

opposed or strongly opposed UFE. Of them, 43'10(7/16) changed their minds and were indifferent or fa­

vorable after their patients underwent the procedure.

Eighty nine percent (8/9) of the patients did not return

to the gynecologists that remained opposed to the pro­

cedure and are now seeing other gynecologists. Whileall gynecologist offered hysterectomy as the initial trear­

ment, only 5'10 0/21) offered UFE. Ninety percent(J9121) of the patients initiated discussion of UFE with

their gynecologist.

PURPOSE: Menorrhagia due to uterine fibroids in pa­tients requiring chronic anticoagulation is extremely dif­

ficult to manage. We evaluated the effects of anticoagula­tion on the efficacy of uterine artery embolization (UAE).

RESULTS: Five patients with UAE and coumadin ther­apy comprise rhe study cohorr. Coumadin therapy fol­

lowing UAE ranged from six weeks ro a life-long re­

quiremenl. The telephone survey was conducted from

1] to 87 weeks after UAE. A follow-up MRI was ob­

tained from four days to four months after UAE. All

five patients responded to the telephone survey, andthree of the five (60%) had a follow-up MRJ. All five

patients reported decreases in bOlh the amount ofand the duration of bleeding, and assumption of a

regular menstrual cycle follOWing UAE. None of the

parients underwent a hysterectomy. One patient who

had been anemic because of excessive menstrual

bleeding was able to discontinue dietary iron supple­

ments. One patient had an expulsion of a large sub-

The Effects of Chronic Anticoagulation on theEfficacy of Uterine Artery Embolization.

R. T Harvey, Hospital 0/ the University ofPennsylvania, Philadelphia, PA, USA • R. W. Tureck •RD. Shlansky-Goldberg

MATERIALS AND METHODS.· Among 110 patientstreated with UAE, we identified five parients with men­

orrhagia requiring chroniC anticoagulation after UAE forthe foHowing reasons: brachial artery thrombosis (N =

2), Sr. Judes mitral valve replacement (N = 1), pul­

monary embolism (N = 1), and brachial artery embolism(N - 1). The efficacy of UAE was assessed through bothclinical and radiological follow-up. Clinical follow-up

consisted of a telephone survey regarding the character­istics of the patient'S menstrual cycles before and afterUAE. Radiological follow-up consisted of a review ofpre- and post-procedure MR imaging.

Abstract No. 443,48 pm

818

PURPOSE This study was undertaken to examine theclinical predictors of the need for pelvic arterial em­bolization in trauma patients with pelvic fractures.

Clinical Predictors of Active Arterial Injury inPatients with Pelvic Fracture.

A. V. Rao, ursw, DALLAS, TX., USA • B.L. Dolmatch •

IG. Champine • Aj. Starr

519

Abstract No. 47

Abstract No. 48

4:21 pm

Recanalization of the Uterine Arteries FollOWingPVA Embolization for Treatment of UterineFibroids.M. C Farner, Hospital of the University ofPennsylvania,

Philadelphia, PA, USA • DA. Roberts • A. Gu.pta •

R. W Tureck • RD. Shlansky-Goldberg

PURPOSE To evaluate the recanalization of uterine ar­teries using gadolinium enhanced MRI after PYA em­bolization for symptomatic uterine fibroids. The correla­tion of uterine artery recanalization and patientoutcome was also evaluated.

4:32 pm

MATERIALS AND MEIHODS: Sixty-nine women under­went uterine fibroid embolization with 355-500 micronPYA particles between FebllJalY 1998 and January 2000.Gadolinium enhanced MRI and MRA was performedbefore and after embolization. Follow up MRI was avail­able in 23 women to date. Patient outcome was evalu­ated by telephone survey using a four-point scale.

RESULTS: Embolization to stasis of flow was achieved inall patients. Post embolization MRI demonstrated nor­mal myometrial enhancement in all 23 patients. AverageMRI follow up time was 18 weeks. Patient outcome wasdetermined in 18/23C78%)patients. There was recanal­ization of uterine arteries in 10/23 (43%) patients. Sevenpatients (7/23, 30%)had bilateral UA recanalization.There was no statistically significant difference betweenmean follow up time in recanalized (24 weeks) and oc­cluded groups (14 weeks), (p=0.09). There was no sta­tistically significant correlation between patient out­come and uterine artery recanalization at an average of18 weeks follow up (p=0.49).

CONCLUSION Uterine artery recanalization on MRAdoes not correlate with patient outcome after fibroidembolization. There is preservation of myometrial en­hancement on MRI after UFE, which may have implica­tions for fertility. Long-term follow up of uterine arterypatency is needed.

Chronic Pelvic Pain: Impact of TranscatheterEmbolotherapy on MenstnJal Cycle andClinical Perception of Pain sing a Visual

. Analog Scale.A n. Chang, Thejohn5 Hopkins Hospital. Baltlm 'e,

MD, USA • IC Robillsoll • P Rowe • D. Barron.D. LClmtxm • A.C. l'<mbrux

PURPO E: Clu-onic pain j non-crclic and longerthan, ix months in dUf"dtj n. \'arian/p Ivic v, ricesare a known .cau e of chronic pel ic pain, and tr3.n-catheter embolotherapy can b u, d to treat the e

varices. The aurhor r port their exp'ricnce usingthis minimally mvasive technique and its impact onpain perception and m nstrual cye! .

Abstract No. 464:10 pm

CONCLUSION Pelvic angiography with embolization isan integral part of the management of trauma patientswith pelvic fracture. However, the exact algorithm fortri~ge to angiography remains controversial. Many clini­cal factors were significantly different between patientswith pelvic fractures who were referred for angiographyversus those who were not. Clinical predictors for theneed for pelVic arterial embolization would be usefulfor the appropriate triage of these patients to angiogra­phy. However, we could identify no clinical factorswhich correlated with the need for therapeutic em­bolization in the angiography group.

MATERIALS AND ME1HODS: The data from 392 patientswith pelvic fractures in a prospectively collected data­base were reviewed. Factors examined included:l)mechanism of injury, 2)pelvic fracture pattern, 3)sys­tolic blood pressure on arrival, 4)shock during hospital­ization, 5)transfusion requirements in the first 24 hours,6)patient's age 7)revised trauma score, 8)injury severityscore. Patient sub-groups examined were l)all patientsversus patients referred for angiography, and 2)angiog­raphy patients requiring embolization versus angiogra­phy patients without the need for embolization.

CONCLUSION Coincident anticoagulation therapy withcoumadin does not appear to limit the efficacy of UAE.Rather, UAE remains a vible option for women who re­quire chronic anticoagulation, and it allows initiation ofanticoagulation therapy immediately after the emboliza­tion procedure.

RESULTS: Patients referred for pelvic angiography were0Ider(p=.002), had a higher transfusion need (p<.OOl),higher injury severity score (p<.OOl), were more likelyto die with 24 hours of presentation (p=.004), weremore likely to experience shock during hospitalization(p<.OOI), and had a longer hospital stay (p=.012) andICU stay (p=.004) than patients nOl referred for angiog­raphy. In the angiographic sub-group, there were nosignificant differences between patients who reqUiredembolization and those who did not.

mucosal fibroid. All three follow-up MRI examina­tions demonstrated successfu I fibroid embolization,characterized by a decrease in size and/or non-en­hancement of the fibroid, with preservation of uterineenhancement.

CONCLUSION the results are promising in terms of pri­mary success, complication rate, re-intervention rate, andin-patient stay. Our results support the published data ofa low incidence of renal infarction follOWing SRGF.

played for all subsequent 25 EYAR's (23 bifurcated, 2uni-iliac) using a proximal bare wire design. Post-oper­ative assessment consisted of a pre-discharge Duplexscan, cr or Duplex al 1 month, and cr at 3 months andyearly thereafter.

RESULTS: the median in-patiem stay was 7.0 days (range4-63). Stent implantation was successful in all cases.The primary success rate (no endoleak, no reinterven­tion) was 84%. There was no mortality in the first 30days. The 1 year survival rate is 94%. 12 complicationsoccurred in 10 patients in the first 30 days. Applying theSYS/ISCYS c1assifkation there were 8 mild events, in­cluding 5 endoleaks (4 in the first 10 patients), and 1segmental renal infarction (SRGF). There were 4 moder­ate events consisting of 2 myocardial infarcts, a case oftmnsient renal dysfunction, and thrombosis of the shortlimb of a bifurcated device requiring surgical thrombec­tomy. Four early endoleaks (3 Type 1, 1 Type 2) sealedspontaneously by 3 months. One patient with a proxi­mal Type 1 leak did not attend for follow up and diedat 3 months of unknown cause. There were two casesof caudal migration of infra-renal bifurcated devices,one being converted to open repair, the other being re­stented using a supra-renal graft. One patient requiredendovascular revision for a fabric tear that had devel­oped in an iliac limb.

lvlATERlAlS AND MEtHODS: From 7/98 - 8/00, 56patients ag 16 to 66 years (mean 32.3 yrs. weretreaLed for chronic pelvic pain. Diagno tic venogra­phy of th ovarian vein. wa' followed by tran­scatheter emboloth rapy via clero lng ag nl andoil. second ion wa ompleted in 43 of 56

patients to emholiz the internal iliac veins. j ualanalog cales (VA) used to measure pain were ad­ministered pre-embolization. post-embolization, atoi charge, and at 3, 6, 9. and 12 mo . follow-up.Questionnaire regarding menstrual hi tory w reused as pan f th post-procedure analysi .

RESULTS: Percutaneous transcathetcr embolotherapyof ovarian/pelvic van ' tva technically-successfulin 56 of 56 patients 100%); two patienL'i developedrecurrent varices and were retr ated. Two pati ntshad complications in whi h coils placed in the inter­nal iliacs emboliz J LO the pulmonary circulation;the coils w r nar d ithout clinical sequelae. R ­suits of the VA : mean baseline pain level was 7.8(range 3.2 - 9.8), po t-embolization while edated4. ,and at di harg .. Follow-up cores tv 're 4.2at:3 rno .. 3.8 at6 mos., and 2.7 at 12 mo.. TIle m and crea e in :AS was 5.] 65 % de r a ).

Regarding the impact f embolization on m n trua­tion, all 24 patients r ponding to qu tionnair s incdi ated no change in menstrual cycle.

CO CLU. JON for patients with ovarian/internalilia varice, transcatherer mbolotherapy provides anon- urgicaJ trealm nt option. There ia ignifj antd crea e in pain based on , without any notableimpa t on mensll1tal y Ie.-----------' 12:41 pm Abstract No. 50

Scientific Session 7Endovascular Repair of Abdominal AorticAneurysms: OutcomesModeratol': Alan Nlatsumoto, MD

Repair of Abdominal Aortic Aneurysms with theTalent System in a Low Risk Population: InterimReport of U.S. TriaLR. Uflacker, Medical University ofSouth Carolina,

Charleston, SC, USA· I Robison • lB. Selby

Endovascular Aneurysm Repair Using the Talent

Stent Graft.A.G. COllJie, Withington Hospital, Manchester, United

Kingdom • RJ. Ashleigh • RE England •CN. McCollum

PURPOSE: a prospective evaluation of the early andmid-term results of endovascular aneurysm repair(EVAR) of infra-renal abdominal aortic aneurysms(AAA) using the Talent (Medtronic) stem grafl system.

MATERlALS AND METHODS: 38 patients with a meanage of 70 were treated by EYAR between February 1998and September 2000. The initial ]3 repairs utilised ei­ther modular bifurcated (11), or, uni-iliac (2), infra-renalstem grafts. Supra-renal graft fixation (SRGF) was em-820

Monday, March 5, 200112:30 pm-2:00 pm

12:30 pm Abstract No. 49

PURPOSE: To present the interin1 report of AAA repairwith the Talent stem-grafl (TSG) system in a group ofpatients with low conventional surgical risk. For the in­vestigators of the Talent device trial.

ivlATERlALS AND METHODS: The bifurcated TSG devicewas used in 251 patients with AAA, with low surgicalrisk, (mean age 74 yrs). Ninety-one percent of the pa­tients were men. 151 patients were treated with a ]stgeneration device, and 120 surgical conrrols were en­roled in the study (mean age 69 yrs) for comparison.318 patients were treated with a 2nd generation lowprofile device (LPS) (mean age 70 yrs). The procedureswere performed by teams of interventional radiologistsand vascular surgeons in most institutions. Follow-upincluded cr scan before discharge, at ] month, at 6months, and at 12 months. Angiograms were performedonly when necessary.

RESULTS: Both devices were successfully delivered in97-99% of the cases. 1st generation device was techni-