pulmonary artery. No other ... on reduction in follow-up pulmonary artery pressure and resolution ... thrombectomy (MT), and pharmacomechanical thrombolysis.
JVIR
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Scientific Session
Sunday
Seattle Children’s Hospital, Seattle, WA; 3Interventional Radiology, University of Washington Medical Center, Seattle, WA; 4Neurointerventional Radiology, Harborview Medical Center, Seattle, WA; 5 Otolaryngology, Seattle Children’s Hospital, Seattle, WA
5:18 PM
Abstract No. 85
Use of liquid embolic agents in the treatment of aortopulmonary collaterals in pediatric patients with congenital heart disease S.M. Flanagan1, D. Hunter1, J. Bass2, D. Gruenstein2, B. Jagadeesan1; 1Interventional Radiology, University of Minnesota Medical Center, Minneapolis, MN; 2Pediatric Cardiology, University of Minnesota Medical Center, Minneapolis, MN Purpose: Describe the use of liquid embolic agents including Trufill NBCA and Onyx in the treatment of aortopulmonary collaterals (APCs) in pediatric patients with various congenital heart diseases (CHD). Materials and Methods: A retrospective review of APC embolizations performed with liquid embolic during the last
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3 years in symptomatic pediatric CHD patients was conducted to assess the efficacy of the procedure and complications. Results: A total of 16 intra-arterial embolizations were performed in 8 patients (1-5 embolization sessions per patient) for APCs in this time period. 4 males and 4 females from ages of 1 to 19 years underwent embolization. A total of 45 collateral vessels were treated (number of APCs embolized per procedure ranged from 1-6). Either 20-30% Trufill glue or Onyx 18 was used, and the volume of liquid embolic injected per APC ranged from 0.3 to 2 mL. Fluoroscopy time ranged from 24 to 67 minutes, which included the time needed for cardiac catheterization. Indications for embolization included hemoptysis, cyanosis, and elevated pulmonary arterial pressure. Of interest, 11 of the 45 arteries treated had previously failed coil embolization. The embolizations with liquid embolic were technically successful in 90% of the vessels. The current status of clinical response is limited by lack of long-term follow-up; however, the procedure was determined to be clinically successful in 4/6 patients based on reduction in follow-up pulmonary artery pressure and resolution of hemoptysis. Two procedural complications included a non-retrievable common iliac artery Onyx fragment without limb ischemia and small area of chest wall ischemia. Conclusion: Liquid embolization of APCs in pediatric CHD patients is technically achievable and shows promising clinical benefit. An advantage of using liquid embolic agent for treatment of APCs compared to coil embolization is improved penetration of the nidus at the level of communication between systemic and pulmonary artery. Long term efficacy will be known with further follow-up.
5:27 PM,
Abstract No. 86
Endovascular thrombolysis in management of iliofemoral thrombosis in children: a multiinstitutional experience M. Gaballah3, J. Shi4, K. Kukreja1,2, C. Obi3, J. Sola3, L. Raffini3,5, C. Tarango4, M. Patel4, M.S. Keller3,5, G. Krishnamurthy3,5, A. Cahill3,5; 1Texas Children’s Hospital, Houston, TX; 2Baylor College of Medicine, Houston, TX; 3Children’s Hospital of Philadelphia, Philadelphia, PA; 4Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; 5Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA Purpose: To evaluate the technical feasibility and complications of percutaneous endovascular venous thrombolysis for iliofemoral DVT at two large tertiary care children’s hospitals. Materials and Methods: IRB approved retrospective review of imaging and clinical databases over the last 7 years showed venous thrombolysis was performed in 68 patients (75 limbs) with a mean age of 15.5 years (range, 1.0 - 23.7). The thrombolysis techniques included catheter-directed thrombolysis (CDT), mechanical thrombectomy (MT), and pharmacomechanical thrombolysis (PMT), with adjunctive angioplasty and/or stent placement. Two-reader review of venograms was used to determine the thrombolysis grade for each limb1. The Modified Villalta scale was retrospectively applied to patient follow-up data to evaluate for the presence of post-thrombotic syndrome (PTS). Results: Technical success (Z50% thrombolysis) was 91%. Techniques used included: CDT with PMT (36%) or MT (33.3%), CDT alone (26.7%), PMT alone (4%), adjunctive
SUNDAY: Scientific Sessions
Purpose: To assess the technique and clinical outcomes for pre-operative n-butyl cyanoacrylate glue embolization of pediatric head and neck venous malformations. Materials and Methods: A retrospective analysis was conducted over a 9-year period at a tertiary care pediatric hospital to identify cases of head and neck venous malformations that were embolized with n-BCA prior to resection. 24 embolizations were performed in 22 patients. 7 patients were male, and mean age was 12.4 years (range 2-25). Primary clinical symptoms included pain (65%), swelling (61%), cosmetic disfigurement (87%), and bleeding (9%). 41.7% of patients had received prior intervention including surgical resection, laser ablation therapy, or sclerotherapy. Sites treated included cheek (n¼7), perimandibular regions (n¼5), lip (n¼4), neck (n¼4), tongue (n¼3), periorbital regions (n¼2), and temporalis muscle (n¼1). Mean volume of n-BCA used was 2.69mL; all embolizations were performed through direct percutaneous punctures via 21 or 23 gauge needles, using a range of 1:1 to 1:5 dilutions of n-BCA in ethiodized oil. Prior to injecting the embolization mixture, biplane digital subtraction venography was performed. Same-day pre-operative glue embolization and surgical resection took place for 21 out of 22 patients. Results: All patients were transported to the OR under stable conditions. Technical success rates for both embolization and resection were 100%. One patient had clinically insignificant embolization of a small amount of glue to a subsegmental pulmonary artery. No other complications were recorded. Adjunctive sclerotherapy or further glue embolization with resection was performed in 3 out of 22 patients who had large lesions. Average hospital stay was 1.5 days, with follow up scheduled for 1 week, 1 month, and 6 months. Follow-up indicated successful alleviation of primary symptoms for all patients based on clinical findings. Conclusion: Pre-operative n-BCA glue embolization of pediatric head and neck venous malformations is a safe and effective treatment option for these lesions. Advantages include the ability to achieve a more complete resection with diminished surgical blood loss. Technical and clinical success rates in this series were 100%.
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SUNDAY: Scientific Sessions
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Scientific Session
angioplasty (50.7%), and stent placement in (8%). The mean duration of CDT was 36.3 hours (range, 2.9 - 89.6 hours). Thrombolysis grades were: grade 3 (100% thrombolysis) in 25 limbs; grade 2 (50-99% thrombolysis) in 43 limbs, and grade 1 (o50% thrombolysis) in 7 limbs.Major complications (7.4%) included bleeding requiring transfusion (4.4%); retroperitoneal hematoma secondary to IVC filter placement (1.5%); and symptomatic pulmonary embolism (1.5%). Minor bleeding occurred in 10.3% of patients.PTS outcomes for children with Z6 month follow-up (n¼49) were: no PTS (53.1%), mild PTS (38.8%), and moderate PTS (8.2%). Conclusion: Endovascular thrombolysis is a technically feasible treatment for iliofemoral thrombosis in children, with acceptable complications. The majority of patients who developed PTS had very mild signs with no pain or functional limitations, and there were no cases of severe PTS. Reference
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JVIR
preserved in all 9 patients and technical success was 100%. Ipsilateral DVT recurrence was found in no patients. Imaging follow-up was available in 6 of 9 patients (mean imaging follow-up: 351 ⫾ 208 days); clinical follow-up was available in all patients (mean clinical follow-up: 613 ⫾ 498 days). There were no major complications. Conclusion: Pharmacomechanical thrombolysis/thrombectomy for catheter-associated upper-extremity DVT is safe and effective at preserving central venous access. Endovascular treatment should be considered in children with catheterassociated DVT in whom long-term venous access is needed.
5:45 PM
Abstract No. 88
Percutaneous varicocele embolization in the pediatric population: an effective outpatient treatment
1. Mewissen MW, Seabrook GR, Meissner MH, Cynamon J, Labropoulos N, Haughton SH. Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry. Radiology. April 1999;211(1):39–49.
D.R. Marker1, T. Schlachter1, F. Ul Haq1, J. Gearhart2, S. Mitchell1; 1The Johns Hopkins Department of Radiology, Baltimore, MD; 2Department of Pediatric Urology, Johns Hopkins University, Baltimore, MD
5:36 PM
Purpose: To assess the efficacy, complications, recurrence rates, and clinical outcomes of percutaneous gonadal vein embolization in the pediatric varicocele population. Materials and Methods: Between 1997 and 2013, 71 male pediatric patients (mean age, 13 years; range 8-18) underwent percutaneous gonadal vein embolization for clinically relevant varicoceles. The pediatric urology department evaluated relative testicular size and consistency before and after treatment. Poor testicular growth was defined as testicular size at least 20% smaller on the side of the varicocele and/or soft testicular consistency. Ultrasound was used to confirm presence and size of the varicoceles. Outcomes were retrospectively assessed by noting any intra- or postoperative complications, changes in testicular size and consistency, and any evidence of recurrent varicocele. Results: The majority of patients (n ¼ 61) presented with poor testicular growth. There were 10/71 patients who had pain. The testicle ipsilateral to the varicocele was 20-50% smaller in 53 (75%) patients compared to the unaffected side. Testicular consistency was soft in 53 (75%). Mean diameter of venous dilatation on ultrasound measured 4.6 mm (range, 3-26 mm). Coils, plugs, and sclerosants were used for embolization. There were no intraoperative complications. 1 major and 6 minor complications were reported postoperatively. All patients were discharged the day of the procedure.The mean follow up was 1.9 years (range, 2 days to 11 years). Because of residual varicocele suspected on short term (1 week) followup exam, 13/ 71 (18%) patients underwent venography to assess for residual varicocele and 8/71 (11%) demonstrated true recurrence by collaterals that were then embolized. On clinical follow up 46 months post embolization, 92% (33/36) of patients had a relative increase in testicular size and 97% (30/31) had normalization of testicular consistency. Conclusion: Percutaneous varicocele embolization is a safe and effective treatment for clinically relevant pediatric varicoceles with subsequent normalization of testicular size and consistency. This procedure can be done as an outpatient, with minimal complications in the pediatric age group.
Abstract No. 87
Pharmacomechanical thrombectomy to salvage central venous access in children with catheterassociated upper extremity deep vein thrombosis: technique and initial results T.J. Ward1, M.P. Lungren1, R. Ristagno2, J. Racadio2, K. Kukreja2; 1Interventional Radiology, Stanford University, Stanford, CA; 2Interventional Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH Purpose: The incidence of upper extremity deep vein thrombosis (DVT) is increasing in the pediatric population, with catheter-associated DVT responsible for the majority of upper extremity DVT. Still, little data exists about endovascular treatment for children in whom preserving central venous access is imperative, e.g., children with congenital cardiac anomalies, transplants, or chronic lifetime illness. The purpose of this study is to describe our technique and report our initial results after pharmacomechanical thrombectomy for catheterassociated upper extremity (UE) DVT in children. Materials and Methods: Medical records of upper extremity venous thrombolysis procedures performed for catheterassociated UE-DVT between January 2009 and January 2014 were retrospectively reviewed. The primary endpoint was the ability to preserve central venous access. Secondary endpoints included technical success, defined as 480% lysis of the thrombosed vein, recurrence of DVT, and major complications, including bleeding and pulmonary embolism. Results: During the study period, 9 patients (8 males, 1 female; average age: 8.3 years, range 20 days to 20 years); average weight: 31kg, range 2.7kg - 79 kg) had pharmacomechanical thrombolysis/thrombectomy for a catheter-associated UE DVT with the intent to salvage central venous access. Catheter directed therapy with tPA and adjunctive balloon angioplasty and pharmacomechanical thrombectomy was used in all cases. No stents or IVC filters were used. The mean total dose of TPA was 15mg (range 1-40mg). Venous access was
