pudendal or gonadal veins. 3 patients ... nary arteries was seen in 2 patients and managed conserva- ... persistent sciatic veins to the internal iliac veins. KTS.
and/or multiple arterial embolizations without radiological or clinical response. Complications from prior procedures included rectal perforation and sciatic neuropathy. All 5 patients had AVMs of the arteriolovenous subtype with direct arterial shunting into a large varix of the obturator, pudendal or gonadal veins. 3 patients had combined arterial and venous emblolization while 2 were treated with venous embolization only. Embolic and sclerosant agents used included endovascular coils, nBCA and ethanol. Venous outflow embolization techniques included direct percutaneous venous puncture using ultrasound guidance in 4 patients, trans-venous balloon occlusion in 2 patients and deployment of a Bird’s Nest filter into a large pelvic varix in 1 patient. Asymptomatic migration of nBCA to the pulmonary arteries was seen in 2 patients and managed conservatively without sequelae. 1 patient, not previously sexually active, experienced erectile dysfunction after a combined embolization. It is unclear whether this was due to arterial or venous embolization. Mean number of procedures performed was 2 (1-3). Mean follow up is 2.5 years, with follow up of over 5 years in 2 patients. None of the patients show radiological or clinical evidence of recurrent AVM. TEACHING POINTS: Most pelvic AVMs are of the arteriolovenous subtype and present in adult life. Established endovascular treatment of pelvic arteriovenous malformations (AVMs) is based primarily on trans-arterial embolization. Our small series shows arterial embolization alone is ineffective and associated with serious complications. Venous outflow occlusion, using embolic agents and techniques as described above, is an efficient and effective technique typically resulting in cure. Abstract No. 331 EE Lower Extremity Venography in Patients with Venous Malformations Using a Moving Table Top Technique Efficacy, Technique and Imaging Findings. J.W. McCann, P.E. Burrows; Roosevelt Hospital, New York, NY. PURPOSE: We describe our experience using Perivision (Siemens AG, Munich, Germany) during lower extremity venography in patients with venous malformations. We illustrate optimum techniques for opacification of the deep and superficial systems including directed venous cannulation and contrast infusion parameters. We describe commonly seen anomalies of the deep and superficial veins in this patient group. MATERIALS & METHODS: Perivision lower limb venography was performed 95 times in 46 patients with lower limb vascular malformations. Diagnoses included KlippelTrenaunay Syndrome (KTS)(n⫽13), venous malformations (VM)(n⫽30), capillary lymphatic venous malformation (n⫽2) and lymphatic malformations (n⫽1). Preferred access was antegrade in a superficial medial forefoot vein. Alternatively retrograde cannulation of a dorsal foot vein or antegrade cannulation of the anterior or posterior tibial veins was performed. Tourniquet control was usually not required. Injector rates varied from 2-5 mL/sec for a total of 15-60 mL. Minor complications included extravasation of contrast without clinical sequelae (n⫽5). Venographic quality was excellent with a non-diagnostic study performed in only 4 cases, usually related to contrast extravasation. Normal venographic findings were common with VMs (n⫽10). Common abnormal venographic findings in this group included deep venous irregularity, beading and stenoses, and large varices of the popliteal and femoral veins. Duplicated saphenous, popliteal and femoral veins were often seen but S124
interruption of either the superficial or deep systems was not commonly seen (n⫽2). Venography in KTS patients was never normal. Lower limb venous drainage was invariably through marginal veins in the calf and thigh and through persistent sciatic veins to the internal iliac veins. KTS patients commonly had interruption of the deep venous system or severe hypoplasia and in some cases complete absence of deep veins. TEACHING POINTS: Perivision venography is a safe, efficient and effective way of evaluating the veins of the lower extremities. Venous abnormalities are common in patients with venous and lymphatic malformations ranging from mild in patients with focal VMs to severe in patients with KTS. Abstract No. 332 EE Renal Trauma(Accidental and Iatrogenic) and Interventional Management. A. Merkulov, W. Bhatti, P. Kisza, S. Contractor; UMDNJ, Newark, NJ. PURPOSE: Review the clinical and radiological manifestations of blunt and penetrating injury to the kidneys and ureter and their IR management. MATERIALS & METHODS: IR logs from 1/05 to 9/08 were reviewed. Patients with renal trauma were studied. The most demonstrative cases were chosen for this poster. They include: 1) Patient with deceleration injury with dissection and occluson of the right renal artery, treated with endovascular stenting. 2) Patient with stab wound with renal hematoma and extravasation and pseudoaneurysm, treated with selective coil embolization. 3) Patient with stab wound with extrarenal contrast on Ct and perinephric collection, angiography negative, extravasation from collecting system. Patient treated with percutaneous diverting nephrostomy. 4) Patient post renal biopsy and gross hematuria, angiography demonstrates A-V fistula, treated with selective coil embolization. 5) Patient post laproscopic partial nephrectomy with peinephric collection, imaging reveals this to be urine leak, treated with nephrostomy catheter placement. 6) Patient with history of cervical cancer and ureteral stents, patient required subsequent nephrostomy and developed gross hematuria. Renal arteriogram negative, patient found to have a ureteric to common iliac artery fistula treated with a covered stent with cessation of hematuria. TEACHING POINTS: IR management plays an important role in managing patients post renal trauma. Endovascular treatment can be used to reestablish flow in occluded arteries as well as embolize bleeding vessels. Urine leaks on CT can be difficult to distinguish from arterial extravasation. Urine leaks can also be managed with draining the urinoma and diverting urine flow. Patients with long term ureteral stents can develop fistulae to iliac vessels. Abstract No. 333 Angiographic Cone Beam C-Arm Volume CT with a Flat Panel Detector Prior to TACE: Does It Add Useful Information on the Arterial Tumor Supply and Portal Veins? B.C. Meyer1, M. Witschel1, K. Wolf1, F.K. Wacker1,2; 1 Charite´ University Medicine - Campus Benjamin Franklin, Berlin, Germany; 2Johns Hopkins Medical School, Baltimore, MD.
