Interventionell Radiologisches Olbert Symposium
FREE PAPER ABSTRACTS AND AUTHOR INDEX BERLIN, 15.– 17.1.2015 Dreiländertagung der Deutschen, Österreichischen und Schweizerischen Gesellschaften für Interventionelle Radiologie (DeGIR, ÖGIR & SSVIR)
Online Publication Number: 10.1007/s00270-014-1037-4
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Free Paper Abstracts
Editorial Office: ÖGIR Neutorgasse 9 1010 Vienna, Austria Tel.: +43 (0)1 904 2003-13 E-Mail: [email protected] Graphic Design: www.raum3.at ÖGIR does not accept responsibility for errors or misprints.
Free Paper Abstracts
2502.1
2502.2
CT-guided core biopsy in combination with imprint cytology in patients with lung cancer: diagnostic accuracy and risk of adverse events
Novel Real-time 4D X-ray-based Intervention Guidance – Early Stage Assessment of Applications
H. Kuehl, L. Balzen, D. Theegarten, S. Hahn, K. Darwiche, A. Wetter; Essen/DE Purpose: This retrospective study aimed to determine the diagnostic accuracy of lung biopsies performed as CT-guided core biopsy and imprint cytology with rapid reporting. The diagnostic accuracy of the imprint cytology was compared to histologic results, and adverse events were monitored to determine the risk profile. Material and Methods: All patients receiving a CT-guided diagnostic biopsy of pulmonary lesions between May 2009 and March 2014 were included. The biopsy was performed as CT-guided core biopsy with added imprint cytology of the biopsy specimen. The sensitivity, specificity and accuracy of the cytologic and histologic results were calculated. The clinical course or the pathology report after resection served as the gold standard. Procedure-related complications were monitored. Results: We included 226 patients (mean age 66 years, male 145, female 81). The imprint cytology showed a sensitivity and specificity of 89 % each, with 20 false negative and 4 false positive results. The accuracy of the cytologic results was calculated at 89 %, too. 75 % of the cytologic results were reported within 60 minutes. The histologic reports showed 4 false negative cases, resulting in sensitivity, specificity and accuracy of 98 %, 100 % and 98 %, respectively. 142 minor complications were observed in 108 patients. 1 of 7 hemoptysis was treated with bronchoscopy, 13 pneumothoraces received tube drainage. 7 procedures were stopped due to complications; 3 with parenchymal bleeding, and 4 with pneumothorax. Conclusions: The combination of CT-guided core biopsy with imprint cytology and rapid reporting allows for a fast diagnosis of malignant lung lesions with an acceptable risk profile.
S. Bartling, R. Kueres, J. Kuntz, M. Kachelrieß; Heidelberg/DE Purpose: It was experimentally demonstrated that, by implementing novel, tomographic reconstruction techniques (such as prior knowledge and compressed sensing), the dose of truly 4D, real-time tomographic intervention guidance can be similarly low as that in standard, projective, X-ray fluoroscopy. Here we provide an early-stage assessment of this novel technique for vascular interventions. Material and Methods: Using mathematical simulations, phantom experiments (vessel and aneurysm) and animal experiments (n=8 pigs) in a prototypical system (continuously rotating, gantry- and flat detector-based CT system), the novel intervention guidance method was evaluated by simulating challenging situations in vascular intervention. All data were highly sparse in angular direction and were reconstructed using prior images, compressed sensing and co-registration methods. Results: 4D intervention guidance provides a continuous 3D display of intervention instruments, such as catheters, stents and guidwires, within their surrounding anatomy, including contrast media-filled vessels. Volume rendering, ray-sum or other standard 3D methods can be used to display the current interventional situation. The spatial relationship of the instruments can be assessed precisely at all times, e.g. the relationship between guidewires, coils and stent struts in wide-neck aneurysm situations. Patient movements during interventions can be corrected with registration methods. Conclusions: The continuous display of the 3D situation might make radiological interventions safer, faster and easier to manage. Its implementation hurdle is much lower than with MRI-based intervention guidance. Furthermore, it may allow for the development of currently unforeseeable, innovative approaches to minimally-invasive medicine. Real-time 4D intervention guidance bears great potential to revolutionize interventional radiology.
Berlin, January 15 – 17, 2015
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Free Paper Abstracts
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2502.4
Functional and technical outcomes of patients treated with selective microcoil embolization due to pseudoaneurysms or arteriovenous fistulas after partial nephrectomy
The benefit of transradial artery approach in patients undergoing peripheral artery embolization
F.F. Strobl, M. D‘Anastasi, T. Waggershauser, C.G. Trumm, A. Graser, M.F. Reiser, P.M. Paprottka; Munich/DE Purpose: To report clinical and functional outcome of patients who underwent interventional transcatheter embolization of renal pseudoaneurysms or arteriovenous fistulas which occurred after nephron-sparing partial nephrectomy. Material and Methods: This retrospective analysis included all consecutive patients who received transcatheter embolization of renal pseudoaneurysm or arteriovenous fistula after partial nephrectomy in our department between 01/2003 and 09/2013. Technical success and functional outcome of all procedures were collected and analysed. Results: During observation period, 1425 patients underwent open, laparoscopic or robotic-assisted partial nephrectomy at our hospital. Of these, 39 patients (2.7 %) (mean age 65.7 years; 30 male) were referred to our department for transcatheter embolization of pseudoaneuryms or arteriovenous fistulas. In all patients, diagnosis of the arterial lesion was made by biphasic computed tomography or contrast-enhanced ultrasound and confirmed angiographically. Symptoms of arterial lesions occurred mean 15.3 days after the operation. In total, 35 patients (89.7 %) could be treated successfully using selective microcoil embolization, although in three patients a subsequent second angiographic intervention had to be performed. Four patients (10.3 %) still had to be operated on after embolization due to non-stopping haematuria; of these, three had to undergo nephrectomy. Pre- and post-interventional glomerular filtration rate did not differ significantly (p > 0.05). No major or minor complications related to the interventions were observed. Conclusions: Renal pseudoaneurysms and arteriovenous fistulas which occur after nephron-sparing surgery can be treated safely and successfully by selective transcatheter arterial embolization. Further investigation is warranted to define the exact role of interventional embolization in the treatment paradigm after nephron-sparing surgery.
E. Khayrutdinov 1, A. Arablinskiy1, I. Vorontsov2; 1Moscow/RU, 2Omsk/RU Purpose: We aimed to assess whether a radial approach (RA) is superior to a femoral approach (FA) in patients undergoing peripheral artery embolization. Material and Methods: 132 patients were enrolled in our study. Uterine fibroid embolization (UFE) was carried out in 50 patients, transarterial chemoembolization (TACE) in 62 patients, and prostate artery embolization (PAE) in 20 patients. RA was used in 64 patients and FA in 68 patients. The duration of the procedure, time needed for catheterization of target arteries, and radiation exposure were assessed during the procedure. Results: Embolization procedure was successfully performed in all patients. The duration of TACE (31.3 and 37.2 minutes, p > 0.05), the time needed for catheterization of target arteries (8.1 and 9.3 minutes, p > 0.05) and radiation exposure (0.36 and 0.46 mZv, p > 0.05) were comparable between the two groups. The duration of UFE and PAE (7.9 vs 15.2 minutes and 56.4 vs 77.2 minutes, p < 0.05), the time needed for catheterization of target arteries (7.9 vs 15.2 minutes and 37.2 vs 51.3 minutes, p < 0.05) and radiation exposure (0.32 vs 0.58 mZv and 0.51 vs 0.69 mZv, p < 0.05) were significantly lower in the RA group. In the RA group, major vascular complications were not seen and 8 (12.5 %) patients had local hematoma. In the FA group, 2 (2.95 %) patients had pseudoaneurysm and 11 (16.2 %) had local hematoma. Conclusions: The duration of TACE and radiation exposure are comparable between the two groups. RA is associated with a significant reduction in the duration of the UFE and PAE, time needed to catheterize target arteries, and radiation exposure.
Free Paper Abstracts
2502.5
2502.6
A new strategy in interventional phlebology: Point-wise gluing combined with catheter microfoam including sidebranches and perforators
Stent diameter stability after transjugular portosystemic stent shunt (TIPS) creation – Does limited stent dilatation result in long term small diameter shunting?
J.C. Ragg; Berlin/DE
C.C. Pieper, A.M. Sprinkart, J. Nadal, C. Meyer, H.H. Schild, D. Thomas; Bonn/DE
Purpose: Thermo-occlusive techniques (laser, radiofrequency) or sclerotherapy may achieve vein closure, but the process of vein regression is gradual and entails inflammatory reactions, discoloration, and indurations. Gluing techniques may attach vein walls immediately and without these problems. However, recently-introduced techniques (VenaSeal®) use large amounts of aggressive cyanoacrylates (about 40 – 60 mg/cm), continuously placed and remaining as plastic implants for years, with results similar to ClosureFast® but at five times the price, and addressing saphenous veins only. In order to obtain knowledge about a new glue-saving technology, it was attempted, in a pre-clinical study, to combine foam catheter treatment with potential reach of sidebranches and perforators with point-wise gluing. Material and Methods: 32 vein segments of 10 – 20 cm in length and 6 – 12 mm in diameter (mean: 8.8 mm) in patients undergoing phlebectomy were closed on one side by ligature, and supplied with an access sheath on the other side. Using a coaxial double catheter system (ScleroGlue®), foam sclerotherapy (Aethoxysklerol 1 %) was first performed, and then, using negative pressure, point-wise gluing with butylcyanoacrylates, at distances of about 5 cm. The sample segments were then retrieved for histology. Results: In 29/32 vein segments, there was 100 % denaturation of endothelium, while in 3/32 segments, the degree of denaturation was 93 – 99 %. The glue spots were successful in 72/81 cases (88 %), with tight adhesion of the vein walls. Just 3 – 6 mg of glue were needed per cm vein-length. Conclusions: The ScleroGlue technique seems to provide effective occlusion and lumen reduction, despite glue volume savings of 80 – 90 %. Treatment quality will be determined using a fully bioresorbable glue in a clinical study starting in 2015.
Purpose: To investigate late passive TIPS-stent expansion in patients with intended under-dilatation (e.g. 10 mm diameter stent, 8 mm balloon) during TIPS-creation. Material and Methods: Patients undergoing TIPS placement with self-expanding stents and partial dilatation who received follow-up CT scans were included. Orthogonal views of the TIPS in the mid-tract were reconstructed from CTs and the area of the stent lumen quantified using custom in-house software. Measurements were validated with in-vitro experiments. Stent area changes over time were analysed. Data were entered into a general linear model (GLM) to test for interrelations between stent area changes and individual patient characteristics. Results: 39 patients (22 males, mean age 59.7 years, Viatorr stent graft n=29, Wallstent n=10) were included. Mean clinical follow-up time was 787 days (range 7 – 2450). At the time of intervention stents were dilated to an average of 65 % of their nominal diameter. At the last follow-up this value had increased to 86.4 % (± 12) in the mid-tract (p < 0.05). In-vitro validation measurements showed no case of overestimation of the stent lumen. The full model GLM revealed the time after intervention to be the only predictor of stent area in the TIPS-tract. There was no significant association between stent expansion and cause or grade of cirrhosis. Conclusions: The area of self-expanding stents implanted in the liver for TIPS-creation with dilation to less than nominal diameter, significantly increases over time. This has to be considered as an additional factor influencing long-term porto-systemic gradient.
Berlin, January 15 – 17, 2015
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Free Paper Abstracts
2502.7
2602.1
First experience with a novel bioabsorbable and non-synthetic vascular closure device: FISHing in the angio-suite
Initial Clinical Experience with the Cook Zenith Alpha® Stent Graft
M. Treitl, M.F. Reiser, K.M. Treitl; Munich/DE
Purpose: To assess safety and efficacy of endovascular repair of the thoracic aorta (TEVAR) with the new Cook Zenith Alpha stent graft.
Purpose: Synthetic vascular closure devices may induce access site scarring by a local inflammatory reaction. A novel femoral introducer sheath and haemostatic device (FISH) introduces small intestinal submucosa (SIS) as a closing agent to reduce scarring over. We present our first results on the usage of this novel closure device in daily routine. Material and Methods: 198 consecutive patients (132 m; mean age 71.7 yrs) with indication for therapeutic angiography of the lower limbs received the FISH device for access closure. The technical success rate, time to hemostasis, and time to ambulation were recorded. Clinical and sonographic access site control was done the following day. Small hematomas, pseudoaneurysms, and bleedings were assessed as minor complications, bleedings requiring surgical intervention, and device embolization as major complications. Results: Most patients were on ASA. Mean INR was 1.25. Technical success was achieved in 97.6 %. 4 minor complications were observed (2 pseudoaneurysms treated by manual compression). No major complication and no intravascular device loss were observed. Mean time to hemostasis was 45 +/− 91 sec, mean time to ambulation 60 min. Re-puncture of the vessel the next day was necessary and successful in 10 cases. Re-puncture after > 3 months was done in 40 cases without observation of relevant scarring of the access vessel. Conclusions: The novel FISH device is a safe and potent vascular closure device with excellent performance and a comparably low complication rate. It seems to induce less scarring of the access vessel and allows for immediate re-puncture without the risk of embolization.
G.F. Torsello; Münster/DE
Material and Methods: We report initial experience of TEVAR with the Zenith Alpha device in 33 patients (group A) treated in our center between August 2010 and May 2014. We compared these results with those of 34 patients treated in the same time period for the same pathologies with the Zenith TX-2 (group B). Primary endpoint was technical success. Moreover, we measured iliac tortuosity, minimum access vessel diameter and screened for previous unsuccessful treatment with other endografts. Results: Technical success was 93.9 % in group A and 91.2 % in group B (p=0.667). There was no case of surgical death or conversion to open repair in either groups. Two endoleaks type I occurred in group A, three in group B (6 % and 8.8 %, respectively, p=0.667). Three patients died within 30 days in group A, none in group B (p=0.072). Mean minimum access vessel diameter was significantly lower (5.07 vs. 6.65 mm, p=0.002) and iliac tortuosity indices significantly higher in group A (1.34 vs. 1.25, p=0.022). Access vessel complications occurred in one patient in group A and four patients in group B (3 % and 11.8 % respectively, p=0.174). Significantly more patients in group A (six) were previously unsuccessfully treated with other endografts, none in group B (18.2 %, 0 %, p=0.011). Conclusions: The new Zenith Alpha has shown to be equally safe and efficacious as the Zenith TX-2 while being utilized in patients with demanding access vessel morphology.
Free Paper Abstracts
2602.2
2602.3
Dynamic flow evaluation in fluoroscopy-guided balloon fenestration of aortic dissections
Patency rates of self-expandable bare metals stents after endovascular treatment of peripheral occlusive artery disease
F. Wolfschmidt, A. Dierks, A. Sauer, T.A. Bley, R. Kickuth; Wuerzburg/DE
K.M. Treitl, B. Wörner, M.F. Reiser, M. Treitl; Munich/DE
Purpose: To retrospectively demonstrate improvement of true lumen perfusion by means of syngo iFlow in patients with malperfusion syndrome due to aortic dissection who were treated with fluoroscopy-guided balloon fenestration of dissection flaps.
Purpose: The risk of restenosis after femoro-popliteal stenting varies and may be related to stent design. Aim of study was to retrospectively analyse the patency rates of femoro-popliteal stenting with three different self-expandable stent designs.
Material and Methods: DSA of 11 patients (4 female; median age 54) with aortic dissection and spinal, renal, mesenterial and/or iliofemoral malperfusion syndrome were retrospectively analyzed. 4 patients presented with type A, 7 with type B dissection. All patients received technically successful fluoroscopy-guided balloon fenestration of the dissection membrane using a re-entry catheter for accurate puncture of the target lumen. 3 patients with iliofemoral malperfusion required additional stent implantation. Syngo iFlow software (Siemens, Germany) visualized pre- and post-interventional true lumen DSA in one single picture by color-coding of time to maximal contrast medium flow (s) as well as by flow curves for single pixel markers. Pre- and post-interventional time to peak shortly distal to the fenestration site was analyzed (mean value of three measurements for each ROI). Flow curves were compared visually.
Material and Methods: In total, 239 patients (154 m; age 72.3 ± 11.3 yrs; 39.7 – 95.0) with symptomatic PAOD of the femoro-popliteal vasculature underwent PTA and stenting with a self-expandable stent (Supera Veritas SV; n=86; Sinus Repo SR; n=68; Astron Pulsar AP; n=85). Follow-up examination included measurement of the ABI and duplex ultrasound the next day and 3, 6, and 12 months after intervention. One-year post-procedural target lesion revascularization (TLR_12M) rates were investigated using Chi2-test with regard to the comorbidity of diabetes, the degree of calcification (evaluated on a three-point-score), and the length and localization of the target lesion.
Results: Median pre- and post-interventional time to maximal contrast medium flow was 6.4 s and 4.6 s, respectively. Median reduction of time to maximal contrast medium flow was 1.6 s, range 0.7 s to 3.4 s. Time reduction and improvement of flow curves were significant (p < 0.01). Conclusions: Dynamic flow evaluations confirmed reduction of peak flow time in the true aortic lumen and thereby improvement of blood flow in malperfused aortic branches. The applied algorithm proved useful for peri-procedural quality control in endovascular aortic fenestrations.
Results: The TLR_12M rate of SV differed from SR (SV: 14.3 %; SR: 23.5 %; P=0.3) and from AP (AP: 24.7 %; P=0.2), but the difference was not significant. In diabetics (n=119), the TLR_12M rate of SV significantly differed from AP (SV: 15.8 %; AP: 31.0 %; P=0.1). In popliteal target lesions (n=80), the TLR_12M rate of SV significantly differed from SR (SV: 11.1 %; SR: 50.0 %; P=0.05). In strongly calcified lesions (n=72), the TLR_12M rate of SV significantly differed from SR (SV: 10.5 %; SR: 27.8 %; P=0.1). Conclusions: In our observation the interwoven stent design exhibited lower TLR_12M rates than standard open and closed cell stent designs. However, this was only significant for popliteal lesions, in diabetic patients, and with strongly calcified lesions.
Berlin, January 15 – 17, 2015
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Free Paper Abstracts
2602.4
2602.5
Endovascular stentgraft-based treatment of femoropopliteal peripheral artery disease: results from the literature versus real life experience
Impact of patient and lesion characteristics on DEBPTA of the femoropopliteal artery – a meta-analysis of three randomised controlled trials
G. Krupski-Berdien, H. Wenk, R. Königstein, A. Koshty, V. Reichert, T. Schmitz-Rixen, T. Stojanovic, A.H. Mahnken; Reinbek/DE
T. Albrecht1, A. Ukrow1, G. Tepe2, M. Werk1, T. Zeller3, M. Kutschera1, U. Speck1; 1Berlin/DE, 2Rosenheim/DE, 3Bad Krotzingen/DE
Purpose: How to select and treat patients with femoropopliteal occlusive disease using a Viabahn® endovascular stentgraft: Personal experience from > 1000 procedures vs. results from 1062 published procedures
Purpose: Several studies have shown that DEB-PTA of the femoropopliteal artery is superior to conventional PTA (POBA). The purpose of this meta-analysis of three RCTs was to investigate the influence of various patient and lesion characteristics on the outcomes of POBA and DEB-PTA.
Material and Methods: A review of published data revealed 17 peer-reviewed studies including 1062 cases. 8 trained physicians (2 interventional radiologists/6 vascular surgeons) who took part in a consensus meeting, with combined experience of more than 1000 Viabahn®-implantation procedures, were asked to comment on procedural and post-procedural aspects. Results: The mean overall 1, 2, 3 and 4 year patency rates from peer-reviewed publications were 74.7 (+/− 6.7), 68.4 (+/− 6.5), 62.4 (+/− 16.3) and 57.0 (+/− 9.7) %. The literature contained no analysis of patency rates vs. diameter. All experts agreed on the following: long de novo lesions and in-stent restenoses are indications; inflow and outflow obstructions have to be treated; device diameter should be > 5 mm, and oversizing should not exeed 10 %; collaterals should not be covered, lesions close to collaterals should be treated, otherwise septicemia/bacterial infection is an absolute contraindication; HIT-syndrome (off label) and impossibility of dual platelet inhibition are relative contraindications; close follow up is mandatory. Conclusions: The stentgraft treament of TASC C and D lesions is feasible, but the authors recommend – in contrast to the IFU – limited oversizing and sparing collaterals; a HIT syndrome might be a relative contraindication. Surgical hygiene standards including iv antibiotics must apply, and follow-up is mandatory because of the biology of probable edge stenoses. There is a need for more data from studies. The Viabahn®-IFU needs a revision.
Material and Methods: Original data from the THUNDER, PACIFIER und FEMPAC studies (223 patients in total) were analysed in terms of the impact of various patient variables (age, sex, smoking, diabetes, hypertension, hypercholesterolaemia, coronary artery and cerebrovascular disease, Rutherford stage) and lesion variables (localisation, diameter, stenosis versus occlusion, lesion length intraluminal versus subintimal recanalisation, calcification, dissection, bail-out stenting) on the primary endpoint late lumen loss (LLL) at 6 months. Results: DEB-PTA resulted in lower LLL than POBA in all subgroups except for the bail-out stenting group. None of the patient variables had a significant impact on LLL after DEB-PTA or POBA. The following lesion characteristics had a significant impact: dissections and stent implantation; non-flow-limiting dissections showed a higher LLL after POBA (p=0.02), but not after DEB-PTA. Stent implantation led to a reduced LLL after POBA (p=0.015), but not after DEB-PTA. All other lesion variables had no impact. Conclusions: DEB-PTA resulted in a better outcome than POBA in almost all subgroups. None of the assessed patient variables had an effect on this, nor did most of the lesion variables. Only patients with iatrogenic non-flow-limiting dissections benefitted more from DEBPTA than the remainder of the patients, while the results of POBA were better with stenting than without it.
Free Paper Abstracts
2602.6
2602.7
Long-term Results after Balloon Angioplasty of the Crural Arteries: Which Variables Influence Limb Salvage and Patient Survival?
Endovascular placement of an extra-anatomical arterial bypass graft – in vitro feasibility study
I.K. Tesdal, C. Krzemien, C. Weiss; Friedrichshafen/DE Purpose: To evaluate the technical and clinical success rates, procedure-related complications, and long-term results of patients who underwent angioplasty of the crural arteries. Material and Methods: We evaluated all patients who underwent angioplasty of the crural arteries in the time period from 1/2002 to 12/2005. These patients were contacted up to 2011, and a follow-up examination including angiography was performed or telephone interviews were conducted with patients, relatives and referring doctors. The primary end points were the limb salvage rate and patient survival rate. The secondary end points included the complication rate, technical success rate, and patency rate. The prognostic relevance of treatment and selected variables with respect to limb salvage and patient survival were analyzed with multiple logistic regression. Results: 212 patients, with a mean age of 77.8 years, underwent crural angioplasty on 239 limbs. The technical success rate was 98.4 %. After a mean follow-up of 3.7 years, 48 patients (22.6 %) experienced minor or major amputation on 53 legs (22.2 %). The limb salvage rate (Kaplan-Meier estimation) was 85.4 % after 5 years. The mean survival rate according to Kaplan-Meier was 79.7 %, 72.2 %, 67.3 % and 51.4 % after 1, 2, 3 and 5 years, respectively. Results of multiple logistic regression analysis showed that negative prognostic variables with respect to patient survival were amputation (p=0.0017) and dialysis (p=0.0011) and, with respect to limb salvage, dialysis (p < 0.0001) and non-patent peroneal artery (p < 0.0001). Conclusions: Dialysis and non-patent peroneal artery are negative prognostic variables for the clinical long-term success.
M. Zimmermann, J. Pfeffer, H.-S. Na, M.F. Schulze-Hagen, M. Liebl, C. Kuhl, P. Bruners, P. Isfort; Aachen/DE Purpose: A novel approach to placing an extra-anatomical arterial bypass graft using exclusively endovascular techniques was established in a phantom model. The long term goal is to develop an alternative, minimally invasive treatment option for peripheral artery disease. Material and Methods: A technique for the endovascular placement of an extra-anatomical bypass under fluoroscopic control was evaluated in vitro. The experimental setting consisted of a gel-wax phantom with two embedded, parallel running fluid-filled silicon tubes (simulating the superficial femoral vessels). Through a 6-French sheath, an OUTBACK® Re-Entry catheter (Cordis) was placed in the simulated artery and used to puncture the vascular wall. A .014-inch guide wire was then advanced into the extra-vascular space. With the curved needle of the Re-entry catheter, the guide wire was steered on a course parallel to the vessel wall in the extra-vascular space for 5 – 10 cm. At the desired reentry site, the Re-Entry catheter and the guide wire were used to puncture the vascular wall again in order to regain access to the endovascular space. Once the tip of the guide wire had safely been placed in the vascular lumen, a VIABAHN® endoprosthesis (GORE®) was deployed to complete the extra-anatomical bypass. Experiments were performed 10 times. Results: Endovascular placement of an extraluminal bypass was successfully achieved in all 10 attempts. Procedure time varied between 15 and 25 minutes. Conclusions: This in-vitro study suggests that endovascular placement of an extravascular arterial bypass graft is technically feasible. Further evaluation is needed to evaluate the safety and efficacy of this technique.
Berlin, January 15 – 17, 2015
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Author Index
AUTHOR INDEX Albrecht T. ............................................................. 2602.5
Pieper C.C. ............................................................. 2502.6
Arablinskiy A. .........................................................2502.4
Ragg J.C. ................................................................ 2502.5
Balzen L. ................................................................. 2502.1
Reichert V. ..............................................................2602.4
Bartling S. .............................................................. 2502.2
Reiser M.F. .................................... 2502.3, 2502.7, 2602.3
Bley T.A. ..................................................................2602.2
Sauer A. ..................................................................2602.2
Bruners P. ............................................................... 2602.7
Schild H.H. ..............................................................2502.6
D‘Anastasi M. ..........................................................2502.3
Schmitz-Rixen T. ....................................................2602.4
Darwiche K. ............................................................ 2502.1
Schulze-Hagen M.F. ............................................... 2602.7
Dierks, A. ................................................................2602.2
Speck U. .................................................................2602.5
Graser A. .................................................................2502.3
Sprinkart A.M. ........................................................2502.6
Hahn S. ................................................................... 2502.1
Stojanovic T. ...........................................................2602.4
Isfort P. ................................................................... 2602.7
Strobl F.F. ............................................................... 2502.3
Kachelrieß M. .........................................................2502.2
Tepe G. ....................................................................2602.5
Khayrutdinov E. .................................................... 2502.4
Tesdal I.K. ............................................................. 2602.6
Kickuth R. ...............................................................2602.2
Theegarten D. ......................................................... 2502.1
Königstein R. ..........................................................2602.4
Thomas D. ...............................................................2502.6
Koshty A. ................................................................2602.4
Torsello G.F. ............................................................2602.1
Krupski-Berdien G. ................................................ 2602.4
Treitl K.M. ..................................................2502.7, 2602.3
Krzemien C. ............................................................2602.6
Treitl M. ......................................................2502.7, 2602.3
Kuehl H. ..................................................................2502.1
Trumm C.G. .............................................................2502.3
Kueres R. ................................................................2502.2
Ukrow A. ................................................................2602.5
Kuhl C. .................................................................... 2602.7
Vorontsov I. ............................................................2502.4
Kuntz J. ...................................................................2502.2
Waggershauser T. ..................................................2502.3
Kutschera M. ..........................................................2602.5
Weiss C. ..................................................................2602.6
Liebl M. ................................................................... 2602.7
Wenk H. ..................................................................2602.4
Mahnken A.H. .........................................................2602.4
Werk M. ..................................................................2602.5
Meyer C. ..................................................................2502.6
Wetter A. ................................................................ 2502.1
Na H.-S. ................................................................... 2602.7
Wolfschmidt F. ...................................................... 2602.2
Nadal J. ...................................................................2502.6
Wörner B. ...............................................................2602.3
Paprottka P.M. ........................................................2502.3
Zeller T. ....................................................................2602.5
Pfeffer J. ................................................................. 2602.7
Zimmermann M. ......................................................2602.7
Free Paper Abstracts
Berlin, January 15 – 17, 2015
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Free Paper Abstracts
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online.org ÖGIR Neutorgasse 9 1010 Wien, Österreich Tel.: +43 (0)1 904 2003-13 E-Mail: [email protected]
FREE PAPER ABSTRACTS AND AUTHOR INDEX BERLIN, 15.– 17.1.2015 Dreiländertagung der Deutschen, Österreichischen und Schweizerischen Gesellschaften für Interventionelle Radiologie (DeGIR, ÖGIR & SSVIR)
Online Publication Number: 10.1007/s00270-014-1037-4
2
Free Paper Abstracts
Editorial Office: ÖGIR Neutorgasse 9 1010 Vienna, Austria Tel.: +43 (0)1 904 2003-13 E-Mail: [email protected] Graphic Design: www.raum3.at ÖGIR does not accept responsibility for errors or misprints.
Free Paper Abstracts
2502.1
2502.2
CT-guided core biopsy in combination with imprint cytology in patients with lung cancer: diagnostic accuracy and risk of adverse events
Novel Real-time 4D X-ray-based Intervention Guidance – Early Stage Assessment of Applications
H. Kuehl, L. Balzen, D. Theegarten, S. Hahn, K. Darwiche, A. Wetter; Essen/DE Purpose: This retrospective study aimed to determine the diagnostic accuracy of lung biopsies performed as CT-guided core biopsy and imprint cytology with rapid reporting. The diagnostic accuracy of the imprint cytology was compared to histologic results, and adverse events were monitored to determine the risk profile. Material and Methods: All patients receiving a CT-guided diagnostic biopsy of pulmonary lesions between May 2009 and March 2014 were included. The biopsy was performed as CT-guided core biopsy with added imprint cytology of the biopsy specimen. The sensitivity, specificity and accuracy of the cytologic and histologic results were calculated. The clinical course or the pathology report after resection served as the gold standard. Procedure-related complications were monitored. Results: We included 226 patients (mean age 66 years, male 145, female 81). The imprint cytology showed a sensitivity and specificity of 89 % each, with 20 false negative and 4 false positive results. The accuracy of the cytologic results was calculated at 89 %, too. 75 % of the cytologic results were reported within 60 minutes. The histologic reports showed 4 false negative cases, resulting in sensitivity, specificity and accuracy of 98 %, 100 % and 98 %, respectively. 142 minor complications were observed in 108 patients. 1 of 7 hemoptysis was treated with bronchoscopy, 13 pneumothoraces received tube drainage. 7 procedures were stopped due to complications; 3 with parenchymal bleeding, and 4 with pneumothorax. Conclusions: The combination of CT-guided core biopsy with imprint cytology and rapid reporting allows for a fast diagnosis of malignant lung lesions with an acceptable risk profile.
S. Bartling, R. Kueres, J. Kuntz, M. Kachelrieß; Heidelberg/DE Purpose: It was experimentally demonstrated that, by implementing novel, tomographic reconstruction techniques (such as prior knowledge and compressed sensing), the dose of truly 4D, real-time tomographic intervention guidance can be similarly low as that in standard, projective, X-ray fluoroscopy. Here we provide an early-stage assessment of this novel technique for vascular interventions. Material and Methods: Using mathematical simulations, phantom experiments (vessel and aneurysm) and animal experiments (n=8 pigs) in a prototypical system (continuously rotating, gantry- and flat detector-based CT system), the novel intervention guidance method was evaluated by simulating challenging situations in vascular intervention. All data were highly sparse in angular direction and were reconstructed using prior images, compressed sensing and co-registration methods. Results: 4D intervention guidance provides a continuous 3D display of intervention instruments, such as catheters, stents and guidwires, within their surrounding anatomy, including contrast media-filled vessels. Volume rendering, ray-sum or other standard 3D methods can be used to display the current interventional situation. The spatial relationship of the instruments can be assessed precisely at all times, e.g. the relationship between guidewires, coils and stent struts in wide-neck aneurysm situations. Patient movements during interventions can be corrected with registration methods. Conclusions: The continuous display of the 3D situation might make radiological interventions safer, faster and easier to manage. Its implementation hurdle is much lower than with MRI-based intervention guidance. Furthermore, it may allow for the development of currently unforeseeable, innovative approaches to minimally-invasive medicine. Real-time 4D intervention guidance bears great potential to revolutionize interventional radiology.
Berlin, January 15 – 17, 2015
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Free Paper Abstracts
2502.3
2502.4
Functional and technical outcomes of patients treated with selective microcoil embolization due to pseudoaneurysms or arteriovenous fistulas after partial nephrectomy
The benefit of transradial artery approach in patients undergoing peripheral artery embolization
F.F. Strobl, M. D‘Anastasi, T. Waggershauser, C.G. Trumm, A. Graser, M.F. Reiser, P.M. Paprottka; Munich/DE Purpose: To report clinical and functional outcome of patients who underwent interventional transcatheter embolization of renal pseudoaneurysms or arteriovenous fistulas which occurred after nephron-sparing partial nephrectomy. Material and Methods: This retrospective analysis included all consecutive patients who received transcatheter embolization of renal pseudoaneurysm or arteriovenous fistula after partial nephrectomy in our department between 01/2003 and 09/2013. Technical success and functional outcome of all procedures were collected and analysed. Results: During observation period, 1425 patients underwent open, laparoscopic or robotic-assisted partial nephrectomy at our hospital. Of these, 39 patients (2.7 %) (mean age 65.7 years; 30 male) were referred to our department for transcatheter embolization of pseudoaneuryms or arteriovenous fistulas. In all patients, diagnosis of the arterial lesion was made by biphasic computed tomography or contrast-enhanced ultrasound and confirmed angiographically. Symptoms of arterial lesions occurred mean 15.3 days after the operation. In total, 35 patients (89.7 %) could be treated successfully using selective microcoil embolization, although in three patients a subsequent second angiographic intervention had to be performed. Four patients (10.3 %) still had to be operated on after embolization due to non-stopping haematuria; of these, three had to undergo nephrectomy. Pre- and post-interventional glomerular filtration rate did not differ significantly (p > 0.05). No major or minor complications related to the interventions were observed. Conclusions: Renal pseudoaneurysms and arteriovenous fistulas which occur after nephron-sparing surgery can be treated safely and successfully by selective transcatheter arterial embolization. Further investigation is warranted to define the exact role of interventional embolization in the treatment paradigm after nephron-sparing surgery.
E. Khayrutdinov 1, A. Arablinskiy1, I. Vorontsov2; 1Moscow/RU, 2Omsk/RU Purpose: We aimed to assess whether a radial approach (RA) is superior to a femoral approach (FA) in patients undergoing peripheral artery embolization. Material and Methods: 132 patients were enrolled in our study. Uterine fibroid embolization (UFE) was carried out in 50 patients, transarterial chemoembolization (TACE) in 62 patients, and prostate artery embolization (PAE) in 20 patients. RA was used in 64 patients and FA in 68 patients. The duration of the procedure, time needed for catheterization of target arteries, and radiation exposure were assessed during the procedure. Results: Embolization procedure was successfully performed in all patients. The duration of TACE (31.3 and 37.2 minutes, p > 0.05), the time needed for catheterization of target arteries (8.1 and 9.3 minutes, p > 0.05) and radiation exposure (0.36 and 0.46 mZv, p > 0.05) were comparable between the two groups. The duration of UFE and PAE (7.9 vs 15.2 minutes and 56.4 vs 77.2 minutes, p < 0.05), the time needed for catheterization of target arteries (7.9 vs 15.2 minutes and 37.2 vs 51.3 minutes, p < 0.05) and radiation exposure (0.32 vs 0.58 mZv and 0.51 vs 0.69 mZv, p < 0.05) were significantly lower in the RA group. In the RA group, major vascular complications were not seen and 8 (12.5 %) patients had local hematoma. In the FA group, 2 (2.95 %) patients had pseudoaneurysm and 11 (16.2 %) had local hematoma. Conclusions: The duration of TACE and radiation exposure are comparable between the two groups. RA is associated with a significant reduction in the duration of the UFE and PAE, time needed to catheterize target arteries, and radiation exposure.
Free Paper Abstracts
2502.5
2502.6
A new strategy in interventional phlebology: Point-wise gluing combined with catheter microfoam including sidebranches and perforators
Stent diameter stability after transjugular portosystemic stent shunt (TIPS) creation – Does limited stent dilatation result in long term small diameter shunting?
J.C. Ragg; Berlin/DE
C.C. Pieper, A.M. Sprinkart, J. Nadal, C. Meyer, H.H. Schild, D. Thomas; Bonn/DE
Purpose: Thermo-occlusive techniques (laser, radiofrequency) or sclerotherapy may achieve vein closure, but the process of vein regression is gradual and entails inflammatory reactions, discoloration, and indurations. Gluing techniques may attach vein walls immediately and without these problems. However, recently-introduced techniques (VenaSeal®) use large amounts of aggressive cyanoacrylates (about 40 – 60 mg/cm), continuously placed and remaining as plastic implants for years, with results similar to ClosureFast® but at five times the price, and addressing saphenous veins only. In order to obtain knowledge about a new glue-saving technology, it was attempted, in a pre-clinical study, to combine foam catheter treatment with potential reach of sidebranches and perforators with point-wise gluing. Material and Methods: 32 vein segments of 10 – 20 cm in length and 6 – 12 mm in diameter (mean: 8.8 mm) in patients undergoing phlebectomy were closed on one side by ligature, and supplied with an access sheath on the other side. Using a coaxial double catheter system (ScleroGlue®), foam sclerotherapy (Aethoxysklerol 1 %) was first performed, and then, using negative pressure, point-wise gluing with butylcyanoacrylates, at distances of about 5 cm. The sample segments were then retrieved for histology. Results: In 29/32 vein segments, there was 100 % denaturation of endothelium, while in 3/32 segments, the degree of denaturation was 93 – 99 %. The glue spots were successful in 72/81 cases (88 %), with tight adhesion of the vein walls. Just 3 – 6 mg of glue were needed per cm vein-length. Conclusions: The ScleroGlue technique seems to provide effective occlusion and lumen reduction, despite glue volume savings of 80 – 90 %. Treatment quality will be determined using a fully bioresorbable glue in a clinical study starting in 2015.
Purpose: To investigate late passive TIPS-stent expansion in patients with intended under-dilatation (e.g. 10 mm diameter stent, 8 mm balloon) during TIPS-creation. Material and Methods: Patients undergoing TIPS placement with self-expanding stents and partial dilatation who received follow-up CT scans were included. Orthogonal views of the TIPS in the mid-tract were reconstructed from CTs and the area of the stent lumen quantified using custom in-house software. Measurements were validated with in-vitro experiments. Stent area changes over time were analysed. Data were entered into a general linear model (GLM) to test for interrelations between stent area changes and individual patient characteristics. Results: 39 patients (22 males, mean age 59.7 years, Viatorr stent graft n=29, Wallstent n=10) were included. Mean clinical follow-up time was 787 days (range 7 – 2450). At the time of intervention stents were dilated to an average of 65 % of their nominal diameter. At the last follow-up this value had increased to 86.4 % (± 12) in the mid-tract (p < 0.05). In-vitro validation measurements showed no case of overestimation of the stent lumen. The full model GLM revealed the time after intervention to be the only predictor of stent area in the TIPS-tract. There was no significant association between stent expansion and cause or grade of cirrhosis. Conclusions: The area of self-expanding stents implanted in the liver for TIPS-creation with dilation to less than nominal diameter, significantly increases over time. This has to be considered as an additional factor influencing long-term porto-systemic gradient.
Berlin, January 15 – 17, 2015
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Free Paper Abstracts
2502.7
2602.1
First experience with a novel bioabsorbable and non-synthetic vascular closure device: FISHing in the angio-suite
Initial Clinical Experience with the Cook Zenith Alpha® Stent Graft
M. Treitl, M.F. Reiser, K.M. Treitl; Munich/DE
Purpose: To assess safety and efficacy of endovascular repair of the thoracic aorta (TEVAR) with the new Cook Zenith Alpha stent graft.
Purpose: Synthetic vascular closure devices may induce access site scarring by a local inflammatory reaction. A novel femoral introducer sheath and haemostatic device (FISH) introduces small intestinal submucosa (SIS) as a closing agent to reduce scarring over. We present our first results on the usage of this novel closure device in daily routine. Material and Methods: 198 consecutive patients (132 m; mean age 71.7 yrs) with indication for therapeutic angiography of the lower limbs received the FISH device for access closure. The technical success rate, time to hemostasis, and time to ambulation were recorded. Clinical and sonographic access site control was done the following day. Small hematomas, pseudoaneurysms, and bleedings were assessed as minor complications, bleedings requiring surgical intervention, and device embolization as major complications. Results: Most patients were on ASA. Mean INR was 1.25. Technical success was achieved in 97.6 %. 4 minor complications were observed (2 pseudoaneurysms treated by manual compression). No major complication and no intravascular device loss were observed. Mean time to hemostasis was 45 +/− 91 sec, mean time to ambulation 60 min. Re-puncture of the vessel the next day was necessary and successful in 10 cases. Re-puncture after > 3 months was done in 40 cases without observation of relevant scarring of the access vessel. Conclusions: The novel FISH device is a safe and potent vascular closure device with excellent performance and a comparably low complication rate. It seems to induce less scarring of the access vessel and allows for immediate re-puncture without the risk of embolization.
G.F. Torsello; Münster/DE
Material and Methods: We report initial experience of TEVAR with the Zenith Alpha device in 33 patients (group A) treated in our center between August 2010 and May 2014. We compared these results with those of 34 patients treated in the same time period for the same pathologies with the Zenith TX-2 (group B). Primary endpoint was technical success. Moreover, we measured iliac tortuosity, minimum access vessel diameter and screened for previous unsuccessful treatment with other endografts. Results: Technical success was 93.9 % in group A and 91.2 % in group B (p=0.667). There was no case of surgical death or conversion to open repair in either groups. Two endoleaks type I occurred in group A, three in group B (6 % and 8.8 %, respectively, p=0.667). Three patients died within 30 days in group A, none in group B (p=0.072). Mean minimum access vessel diameter was significantly lower (5.07 vs. 6.65 mm, p=0.002) and iliac tortuosity indices significantly higher in group A (1.34 vs. 1.25, p=0.022). Access vessel complications occurred in one patient in group A and four patients in group B (3 % and 11.8 % respectively, p=0.174). Significantly more patients in group A (six) were previously unsuccessfully treated with other endografts, none in group B (18.2 %, 0 %, p=0.011). Conclusions: The new Zenith Alpha has shown to be equally safe and efficacious as the Zenith TX-2 while being utilized in patients with demanding access vessel morphology.
Free Paper Abstracts
2602.2
2602.3
Dynamic flow evaluation in fluoroscopy-guided balloon fenestration of aortic dissections
Patency rates of self-expandable bare metals stents after endovascular treatment of peripheral occlusive artery disease
F. Wolfschmidt, A. Dierks, A. Sauer, T.A. Bley, R. Kickuth; Wuerzburg/DE
K.M. Treitl, B. Wörner, M.F. Reiser, M. Treitl; Munich/DE
Purpose: To retrospectively demonstrate improvement of true lumen perfusion by means of syngo iFlow in patients with malperfusion syndrome due to aortic dissection who were treated with fluoroscopy-guided balloon fenestration of dissection flaps.
Purpose: The risk of restenosis after femoro-popliteal stenting varies and may be related to stent design. Aim of study was to retrospectively analyse the patency rates of femoro-popliteal stenting with three different self-expandable stent designs.
Material and Methods: DSA of 11 patients (4 female; median age 54) with aortic dissection and spinal, renal, mesenterial and/or iliofemoral malperfusion syndrome were retrospectively analyzed. 4 patients presented with type A, 7 with type B dissection. All patients received technically successful fluoroscopy-guided balloon fenestration of the dissection membrane using a re-entry catheter for accurate puncture of the target lumen. 3 patients with iliofemoral malperfusion required additional stent implantation. Syngo iFlow software (Siemens, Germany) visualized pre- and post-interventional true lumen DSA in one single picture by color-coding of time to maximal contrast medium flow (s) as well as by flow curves for single pixel markers. Pre- and post-interventional time to peak shortly distal to the fenestration site was analyzed (mean value of three measurements for each ROI). Flow curves were compared visually.
Material and Methods: In total, 239 patients (154 m; age 72.3 ± 11.3 yrs; 39.7 – 95.0) with symptomatic PAOD of the femoro-popliteal vasculature underwent PTA and stenting with a self-expandable stent (Supera Veritas SV; n=86; Sinus Repo SR; n=68; Astron Pulsar AP; n=85). Follow-up examination included measurement of the ABI and duplex ultrasound the next day and 3, 6, and 12 months after intervention. One-year post-procedural target lesion revascularization (TLR_12M) rates were investigated using Chi2-test with regard to the comorbidity of diabetes, the degree of calcification (evaluated on a three-point-score), and the length and localization of the target lesion.
Results: Median pre- and post-interventional time to maximal contrast medium flow was 6.4 s and 4.6 s, respectively. Median reduction of time to maximal contrast medium flow was 1.6 s, range 0.7 s to 3.4 s. Time reduction and improvement of flow curves were significant (p < 0.01). Conclusions: Dynamic flow evaluations confirmed reduction of peak flow time in the true aortic lumen and thereby improvement of blood flow in malperfused aortic branches. The applied algorithm proved useful for peri-procedural quality control in endovascular aortic fenestrations.
Results: The TLR_12M rate of SV differed from SR (SV: 14.3 %; SR: 23.5 %; P=0.3) and from AP (AP: 24.7 %; P=0.2), but the difference was not significant. In diabetics (n=119), the TLR_12M rate of SV significantly differed from AP (SV: 15.8 %; AP: 31.0 %; P=0.1). In popliteal target lesions (n=80), the TLR_12M rate of SV significantly differed from SR (SV: 11.1 %; SR: 50.0 %; P=0.05). In strongly calcified lesions (n=72), the TLR_12M rate of SV significantly differed from SR (SV: 10.5 %; SR: 27.8 %; P=0.1). Conclusions: In our observation the interwoven stent design exhibited lower TLR_12M rates than standard open and closed cell stent designs. However, this was only significant for popliteal lesions, in diabetic patients, and with strongly calcified lesions.
Berlin, January 15 – 17, 2015
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Free Paper Abstracts
2602.4
2602.5
Endovascular stentgraft-based treatment of femoropopliteal peripheral artery disease: results from the literature versus real life experience
Impact of patient and lesion characteristics on DEBPTA of the femoropopliteal artery – a meta-analysis of three randomised controlled trials
G. Krupski-Berdien, H. Wenk, R. Königstein, A. Koshty, V. Reichert, T. Schmitz-Rixen, T. Stojanovic, A.H. Mahnken; Reinbek/DE
T. Albrecht1, A. Ukrow1, G. Tepe2, M. Werk1, T. Zeller3, M. Kutschera1, U. Speck1; 1Berlin/DE, 2Rosenheim/DE, 3Bad Krotzingen/DE
Purpose: How to select and treat patients with femoropopliteal occlusive disease using a Viabahn® endovascular stentgraft: Personal experience from > 1000 procedures vs. results from 1062 published procedures
Purpose: Several studies have shown that DEB-PTA of the femoropopliteal artery is superior to conventional PTA (POBA). The purpose of this meta-analysis of three RCTs was to investigate the influence of various patient and lesion characteristics on the outcomes of POBA and DEB-PTA.
Material and Methods: A review of published data revealed 17 peer-reviewed studies including 1062 cases. 8 trained physicians (2 interventional radiologists/6 vascular surgeons) who took part in a consensus meeting, with combined experience of more than 1000 Viabahn®-implantation procedures, were asked to comment on procedural and post-procedural aspects. Results: The mean overall 1, 2, 3 and 4 year patency rates from peer-reviewed publications were 74.7 (+/− 6.7), 68.4 (+/− 6.5), 62.4 (+/− 16.3) and 57.0 (+/− 9.7) %. The literature contained no analysis of patency rates vs. diameter. All experts agreed on the following: long de novo lesions and in-stent restenoses are indications; inflow and outflow obstructions have to be treated; device diameter should be > 5 mm, and oversizing should not exeed 10 %; collaterals should not be covered, lesions close to collaterals should be treated, otherwise septicemia/bacterial infection is an absolute contraindication; HIT-syndrome (off label) and impossibility of dual platelet inhibition are relative contraindications; close follow up is mandatory. Conclusions: The stentgraft treament of TASC C and D lesions is feasible, but the authors recommend – in contrast to the IFU – limited oversizing and sparing collaterals; a HIT syndrome might be a relative contraindication. Surgical hygiene standards including iv antibiotics must apply, and follow-up is mandatory because of the biology of probable edge stenoses. There is a need for more data from studies. The Viabahn®-IFU needs a revision.
Material and Methods: Original data from the THUNDER, PACIFIER und FEMPAC studies (223 patients in total) were analysed in terms of the impact of various patient variables (age, sex, smoking, diabetes, hypertension, hypercholesterolaemia, coronary artery and cerebrovascular disease, Rutherford stage) and lesion variables (localisation, diameter, stenosis versus occlusion, lesion length intraluminal versus subintimal recanalisation, calcification, dissection, bail-out stenting) on the primary endpoint late lumen loss (LLL) at 6 months. Results: DEB-PTA resulted in lower LLL than POBA in all subgroups except for the bail-out stenting group. None of the patient variables had a significant impact on LLL after DEB-PTA or POBA. The following lesion characteristics had a significant impact: dissections and stent implantation; non-flow-limiting dissections showed a higher LLL after POBA (p=0.02), but not after DEB-PTA. Stent implantation led to a reduced LLL after POBA (p=0.015), but not after DEB-PTA. All other lesion variables had no impact. Conclusions: DEB-PTA resulted in a better outcome than POBA in almost all subgroups. None of the assessed patient variables had an effect on this, nor did most of the lesion variables. Only patients with iatrogenic non-flow-limiting dissections benefitted more from DEBPTA than the remainder of the patients, while the results of POBA were better with stenting than without it.
Free Paper Abstracts
2602.6
2602.7
Long-term Results after Balloon Angioplasty of the Crural Arteries: Which Variables Influence Limb Salvage and Patient Survival?
Endovascular placement of an extra-anatomical arterial bypass graft – in vitro feasibility study
I.K. Tesdal, C. Krzemien, C. Weiss; Friedrichshafen/DE Purpose: To evaluate the technical and clinical success rates, procedure-related complications, and long-term results of patients who underwent angioplasty of the crural arteries. Material and Methods: We evaluated all patients who underwent angioplasty of the crural arteries in the time period from 1/2002 to 12/2005. These patients were contacted up to 2011, and a follow-up examination including angiography was performed or telephone interviews were conducted with patients, relatives and referring doctors. The primary end points were the limb salvage rate and patient survival rate. The secondary end points included the complication rate, technical success rate, and patency rate. The prognostic relevance of treatment and selected variables with respect to limb salvage and patient survival were analyzed with multiple logistic regression. Results: 212 patients, with a mean age of 77.8 years, underwent crural angioplasty on 239 limbs. The technical success rate was 98.4 %. After a mean follow-up of 3.7 years, 48 patients (22.6 %) experienced minor or major amputation on 53 legs (22.2 %). The limb salvage rate (Kaplan-Meier estimation) was 85.4 % after 5 years. The mean survival rate according to Kaplan-Meier was 79.7 %, 72.2 %, 67.3 % and 51.4 % after 1, 2, 3 and 5 years, respectively. Results of multiple logistic regression analysis showed that negative prognostic variables with respect to patient survival were amputation (p=0.0017) and dialysis (p=0.0011) and, with respect to limb salvage, dialysis (p < 0.0001) and non-patent peroneal artery (p < 0.0001). Conclusions: Dialysis and non-patent peroneal artery are negative prognostic variables for the clinical long-term success.
M. Zimmermann, J. Pfeffer, H.-S. Na, M.F. Schulze-Hagen, M. Liebl, C. Kuhl, P. Bruners, P. Isfort; Aachen/DE Purpose: A novel approach to placing an extra-anatomical arterial bypass graft using exclusively endovascular techniques was established in a phantom model. The long term goal is to develop an alternative, minimally invasive treatment option for peripheral artery disease. Material and Methods: A technique for the endovascular placement of an extra-anatomical bypass under fluoroscopic control was evaluated in vitro. The experimental setting consisted of a gel-wax phantom with two embedded, parallel running fluid-filled silicon tubes (simulating the superficial femoral vessels). Through a 6-French sheath, an OUTBACK® Re-Entry catheter (Cordis) was placed in the simulated artery and used to puncture the vascular wall. A .014-inch guide wire was then advanced into the extra-vascular space. With the curved needle of the Re-entry catheter, the guide wire was steered on a course parallel to the vessel wall in the extra-vascular space for 5 – 10 cm. At the desired reentry site, the Re-Entry catheter and the guide wire were used to puncture the vascular wall again in order to regain access to the endovascular space. Once the tip of the guide wire had safely been placed in the vascular lumen, a VIABAHN® endoprosthesis (GORE®) was deployed to complete the extra-anatomical bypass. Experiments were performed 10 times. Results: Endovascular placement of an extraluminal bypass was successfully achieved in all 10 attempts. Procedure time varied between 15 and 25 minutes. Conclusions: This in-vitro study suggests that endovascular placement of an extravascular arterial bypass graft is technically feasible. Further evaluation is needed to evaluate the safety and efficacy of this technique.
Berlin, January 15 – 17, 2015
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Author Index
AUTHOR INDEX Albrecht T. ............................................................. 2602.5
Pieper C.C. ............................................................. 2502.6
Arablinskiy A. .........................................................2502.4
Ragg J.C. ................................................................ 2502.5
Balzen L. ................................................................. 2502.1
Reichert V. ..............................................................2602.4
Bartling S. .............................................................. 2502.2
Reiser M.F. .................................... 2502.3, 2502.7, 2602.3
Bley T.A. ..................................................................2602.2
Sauer A. ..................................................................2602.2
Bruners P. ............................................................... 2602.7
Schild H.H. ..............................................................2502.6
D‘Anastasi M. ..........................................................2502.3
Schmitz-Rixen T. ....................................................2602.4
Darwiche K. ............................................................ 2502.1
Schulze-Hagen M.F. ............................................... 2602.7
Dierks, A. ................................................................2602.2
Speck U. .................................................................2602.5
Graser A. .................................................................2502.3
Sprinkart A.M. ........................................................2502.6
Hahn S. ................................................................... 2502.1
Stojanovic T. ...........................................................2602.4
Isfort P. ................................................................... 2602.7
Strobl F.F. ............................................................... 2502.3
Kachelrieß M. .........................................................2502.2
Tepe G. ....................................................................2602.5
Khayrutdinov E. .................................................... 2502.4
Tesdal I.K. ............................................................. 2602.6
Kickuth R. ...............................................................2602.2
Theegarten D. ......................................................... 2502.1
Königstein R. ..........................................................2602.4
Thomas D. ...............................................................2502.6
Koshty A. ................................................................2602.4
Torsello G.F. ............................................................2602.1
Krupski-Berdien G. ................................................ 2602.4
Treitl K.M. ..................................................2502.7, 2602.3
Krzemien C. ............................................................2602.6
Treitl M. ......................................................2502.7, 2602.3
Kuehl H. ..................................................................2502.1
Trumm C.G. .............................................................2502.3
Kueres R. ................................................................2502.2
Ukrow A. ................................................................2602.5
Kuhl C. .................................................................... 2602.7
Vorontsov I. ............................................................2502.4
Kuntz J. ...................................................................2502.2
Waggershauser T. ..................................................2502.3
Kutschera M. ..........................................................2602.5
Weiss C. ..................................................................2602.6
Liebl M. ................................................................... 2602.7
Wenk H. ..................................................................2602.4
Mahnken A.H. .........................................................2602.4
Werk M. ..................................................................2602.5
Meyer C. ..................................................................2502.6
Wetter A. ................................................................ 2502.1
Na H.-S. ................................................................... 2602.7
Wolfschmidt F. ...................................................... 2602.2
Nadal J. ...................................................................2502.6
Wörner B. ...............................................................2602.3
Paprottka P.M. ........................................................2502.3
Zeller T. ....................................................................2602.5
Pfeffer J. ................................................................. 2602.7
Zimmermann M. ......................................................2602.7
Free Paper Abstracts
Berlin, January 15 – 17, 2015
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Free Paper Abstracts
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