Vascular

254 Pages·2016·1.2 MB·English

Vascular
VI002-EB-X
What Radiologists Need to Know: From Wires and Catheters to Balloons and Stents
All Day Location: VI Community, Learning Center
Participants
Cheng Fang, MBBS, BSC, London, United Kingdom (Presenter) Nothing to Disclose
Mohammad A. Husainy, MD, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Jason Wilkins, MBBS, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The aim of this exhibit is to 1) review common types of wires, catheters, balloons and stents 2) to highlight their main
characteristics 3) to illustrate when and where to use them in different clinical scenarios.
TABLE OF CONTENTS/OUTLINE
Wires Detail different characteristics including diameter, length, tip shape and stiffness, core construction and coatings Explain
selection of wires in different clinical settings including support, exchange, lesion and chronic total occlusion crossing Catheters
Illustrate advantages of different catheters based on their characteristic shapes, construction and how this gives handling
characteristics such as trackability and pushability Discuss usage in specific clinical circumstances Balloon Present differences
between a compliant and a non-compliant balloon and their examples including moulding, scoring/cutting, high pressure, drug
eluting, micro-porous balloon Provide examples of their clinical application Stent Describe differences between self expandable,
balloon mounted and covered stents Explain why, when and where to use a stent
VI003-EB-X
The Concept of Flow Diversion for Intracranial Aneurysm Treatment
All Day Location: VI Community, Learning Center
Participants
Anna Luisa Kuhn, MD, PhD, Worcester, MA (Presenter) Nothing to Disclose
Francesco Massari, Worcester, MA (Abstract Co-Author) Nothing to Disclose
Juan Diego Lozano, MD, Worcester, MA (Abstract Co-Author) Nothing to Disclose
Mary Howk, Worcester, MA (Abstract Co-Author) Nothing to Disclose
Mary Perras, Worcester, MA (Abstract Co-Author) Nothing to Disclose
Christopher Brooks, Worcester, MA (Abstract Co-Author) Nothing to Disclose
Matthew J. Gounis, PhD, Worcester, MA (Abstract Co-Author) Research Consultant, Johnson & Johnson Research Grant, Stryker
Corporation Research Grant, Johnson & Johnson Research Grant, Medtronic, Inc Research Grant, sanofi-aventis Group Research
Grant, Neuravi, Ltd Research Grant, Neurointerventional Therapeutics, Inc Research Grant, Thrombolytic Science, LLC
Ajay K. Wakhloo, MD, PhD, Worcester, MA (Abstract Co-Author) Research Consultant, Johnson & Johnson Research Grant, Johnson
& Johnson Stockholder, Stryker Corporation Research Consultant, Koninklijke Philips NV Research Grant, Koninklijke Philips NV
Research Consultant, Stryker Corporation Research Grant, Stryker Corporation
Ajit Singh Puri, MD, New Delhi, India (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
-To appreciate and understand the new treatment concept of flow diversion -To understand important angiographic findings and
possible complications associated with the use of flow diverters
VI005-EB-X
Variceal Embolization: A Resident's Guide to the Many Options for Treating Varices Secondary to Portal
Hypertension
All Day Location: VI Community, Learning Center
Awards
Certificate of Merit
Participants
Ankaj Khosla, MD, Dallas, TX (Presenter) Nothing to Disclose
Benjamin White, MD, Dallas, TX (Abstract Co-Author) Nothing to Disclose
Anil K. Pillai, MD, Coppell, TX (Abstract Co-Author) Nothing to Disclose
Sanjeeva P. Kalva, MD, Dallas, TX (Abstract Co-Author) Consultant, CeloNova BioSciences, Inc
TEACHING POINTS
Varices are a common manifestation of portal hypertension that can result in severe morbidity and mortality. Important early
identification and coordination with clinical care teams can result in improved patient outcomes. Multiple options exist for the
treatment of varices which vary depending on indication and clinical scenario.
TABLE OF CONTENTS/OUTLINE
Underlying causes of varices; physiology and pathology Identifying the most common types of varices Treatment options TIPS
BRTO Direct embolization (glue, coil and others) Splenic embolization Treatment of portal vein thrombosis and/or stenosis Treatment
of hepatic vein thrombosis and/or stenosis Follow up and post treatment management.
VI008-EB-X
Necessity for Real-time Measurement of the Occupational Radiation Dose in Interventional Radiology
All Day Location: VI Community, Learning Center
Participants
Yohei Inaba, PhD, Sendai, Japan (Presenter) Nothing to Disclose
Koichi Chida, PhD, Sendai, Japan (Abstract Co-Author) Nothing to Disclose
Ryota Kobayashi, MSc, Sendai, Japan (Abstract Co-Author) Nothing to Disclose
Masakatsu Tano, Minato-Ku, Japan (Abstract Co-Author) Nothing to Disclose
Yutaka Dentou, Sendai, Japan (Abstract Co-Author) Nothing to Disclose
Shigeru Tachibana, Sendai, Japan (Abstract Co-Author) Nothing to Disclose
Isao Yanagawa, Sendai, Japan (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
-To understand the importance of radiation protection for interventional radiology(IR) staff, given the recent regulatory changes in
the dose limit for the eye lens(from 150mSv to 20mSv per year) -To understand the need for managing the occupational dose -To
understand the fundamental characteristics of a real-time occupational dosimetry and display system(i2 system)
TABLE OF CONTENTS/OUTLINE
Fundamental performance of an i2 system Energy dependence, dose linearity, and dose-rate dependence were compared. Clinical
benefits of the i2 system The i2 system provides real-time dose measurement and visualization. The dose information is sent
wirelessly to the base station. Comparison of fundamental performance among several occupational real-time dosimeters(i2 system,
pocket dosimeter, etc.) SUMMARY: Real-time monitoring of the radiation doses received by IR staff has become highly desirable.
However, occupational doses are rarely measured in real time, due to the lack of a feasible method for use in IR. In general, the i2
system exhibited excellent performance. In occupational dose measurements, the fundamental performance of the i2 system was
equivalent to those of other occupational dosimeters. Furthermore, the i2 system demonstrated real-time visualization of the dose
rate, which other occupational dosimeters cannot provide.
VI009-EB-X
Embolisation Materials - What Interventional Radiologists Need to Know
All Day Location: VI Community, Learning Center
Participants
Mohammad A. Husainy, MD, London, United Kingdom (Presenter) Nothing to Disclose
Cheng Fang, MBBS, BSC, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
C. Jason Wilkins, MD, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Farhina Sayyed, MRCS, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The aim of this exhibit is to 1) review indications for embolisation 2) to highlight the common types of embolization materials
available 3) to discuss when and where to use them in different clinical scenarios.
TABLE OF CONTENTS/OUTLINE
Indications for embolisation therapy• Review common clinical conditions where embolisation therapy is indicated ie. control of
various type of haemorrhages, treatment of benign and malignant tumours, endoleaks, arterio-venous malformations (AVMs) and as
a pre operative step to devascularise the surgical bed.Embolisation Materials• Highlight physical properties of coils, particles, glue,
gel foam, liquid embolics and plugs • Illustrate various types of embolic agents available and their biophysical properties. Explain
why, when and where to use different agents. Clinical scenarios• Describe various clinical scenarios and techniques to illustrate
practical real world use of different embolics
VI010-EB-X
Lymphatic Intervention for Various Kinds of Lymphorrhea: How to Access and Treat
All Day Location: VI Community, Learning Center
Participants
Masanori Inoue, MD, Shinjuku-Ku, Japan (Presenter) Nothing to Disclose
Seishi Nakatsuka, MD, Shinjuku-Ku, Japan (Abstract Co-Author) Nothing to Disclose
Yosuke Suyama, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Masashi Tamura, Shinjuku-Ku, Japan (Abstract Co-Author) Nothing to Disclose
Jitsuro Tsukada, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Sota Oguro, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Hideki Yashiro, MD, Shinjuku-Ku, Japan (Abstract Co-Author) Nothing to Disclose
Masahiro Jinzaki, MD, Tokyo, Japan (Abstract Co-Author) Support, Toshiba Corporation; Support, General Electric Company
Nobutake Ito, MD, Yokohama, Japan (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Techniques of lymphangiographyThe lymphatic intervention consist of diagnostic lymphangiography followed by embolization or
sclerotherapy. Intranodal lymphangiography is technically feasible. An inguinal node was directly accessed under ultrasound
guidance using a needle followed by lipiodol injection. Intrahepatic lymphangiography is the only method, which could visualize
lymphorrhea from hepatic lymphatics. We puncture the liver close to the right portal vein using a needle under ultrasound guidance
. We withdraw the chiba needle slowly while injecting small volumes of Urografin until hepatic lymphatic channels are opacified. This
usually needs multiple-puncture of the liver.How to access thoracic duct Access from the cistern chyli : Following
lymphangiography, the cistern chyli/thoracic duct is punctured under fluoroscopic or CT guidance. A guidewire was inserted into the
thoracic duct, then 2.0-Fr micro catheter was advanced over the wire. Access from venous angle : 4-Fr sheath is inserted from
left cephalic vein. A 4-Fr catheter is advance near the venous angle and cannulated the lymphatic vessel flowing into the
subclavian vein. Then, microcatheter is advanced into the thoracic duct coaxially.
TABLE OF CONTENTS/OUTLINE
Target of lymphatic intervention Management of lymphorrhea Procedure details Embolization and Sclerotherapy
VI011-EB-X
Not all Colic is Calculi: Ureteric Obstruction from Mycotic Aneurysm
All Day Location: VI Community, Learning Center
Participants
Anthony M. Cox VI, MBBS, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Jeevan Kumaradevan, MBChB, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Saurabh Singh, MBBCHIR, MA, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Shian Patel, london, United Kingdom (Presenter) Nothing to Disclose
TEACHING POINTS
1. Renal colic is a common presenting complaint, but in this case occurring secondary to a rare pathology- mycotic aneurysm.2.
The case considers the complex challenges faced when treating multiple mycotic aneurysms, including the role of
diagnostic/interventional radiology.
TABLE OF CONTENTS/OUTLINE
1. Presentation of mycotic aneurysm as renal colic on imaging. No previously described cases of common iliac mycotic aneurysm,
presenting as renal colic, were found in the literature. The patient presented as left renal colic with blood in the urine, a 6 month
history of arthralgia, visual disturbances and low grade pyrexia and a background of blood culture positive bacteraemia post
bilateral breast augmentation. 2. Imaging review in advanced bacterial endocarditis causing mycotic aneurysms. 3. Management of
mulitple mycotic aneuryms, including images from interventional procedures. A high index of suspicion is essential for the diagnosis
of this rare condition, since septic emboli cause devastating sequelae and all untreated infected aneurysms eventually rupture.
Furthermore, although aneurysmectomy and antibiotics is the treatment of choice, complicating factors prohibited this gold
standard and necessitated immediate aneurysm exclusion by endovascular treatment.
VI012-EB-X
Preparing for Call by IR Residents: Perspectives from a Large Urban Academic Medical Center
All Day Location: VI Community, Learning Center
Participants
Stephen Fisher, MD, Dallas, TX (Presenter) Nothing to Disclose
Stephen P. Reis, MD, Dallas, TX (Abstract Co-Author) Nothing to Disclose
Mark Reddick, MD, MS, Dallas, TX (Abstract Co-Author) Nothing to Disclose
Matthew E. Anderson, MD, Dallas, TX (Abstract Co-Author) Nothing to Disclose
Sanjeeva P. Kalva, MD, Dallas, TX (Abstract Co-Author) Consultant, CeloNova BioSciences, Inc
TEACHING POINTS
1. Potential structures of call coverage over a 5 year IR residency. Benefits and drawbacks of each.2. Understand barriers to
establish a separate interventional radiology call pool.3. Discuss unique challenges to resident preparation for IR call in the
upcoming residency programs.4. Familiarize with possible methods to prepare IR residents for independent diagnostic and
interventional call.
TABLE OF CONTENTS/OUTLINE
1. Review a 5 year plan for IR resident call coverage.2. Review potential didactic and case based IR pre-call curriculum to
administer during the PGY4 year prior to beginning IR call during the PGY5 year.3. IR residents will naturally desire early, advanced
procedural training, but development of clinical patient management skills should be a priority during the first dedicated IR year,
PGY5. Explore how to best layer skill sets throughout earlier DR and IR rotations to best prepare residents for call.4. An ICU month
is required in the new structure, so the optimal timing of this experience will be discussed. A logical place in the curriculum is early
during the PGY5 year to facilitate higher level clinical education during the first dedicated year of IR training.
VI013-EB-X
Changes in Visceral Abdominal Arteries: Pictorial Essay
All Day Location: VI Community, Learning Center
Participants
Carlos A. Ventura, PhD, MD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Thiago D. Saraiva, Sao Paulo, Brazil (Presenter) Nothing to Disclose
George C. Dantas, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Lelivaldo A. Britto Neto, MD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Rafael L. Nascif, MD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Daniel C. Luz, MD, Brazil, Brazil (Abstract Co-Author) Nothing to Disclose
Miguel J. Neto, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Marcelo B. Funari, MD, Ribeirao Pires, Brazil (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Diagnosis of changes in visceral andominal arteries (VAA) is unusual, but has become more common due to the increased number of
performing exams and ultrasound plays an important role. Aneurysms are more common in splenic artery, which affects more middle-
aged women, most isolated and asymptomatic, with risk of rupture when greater than 2 cm, and hepatic, which may have
atherosclerotic or fungal origin, with no gender preference and about 80% extrahepatic, and up to 1/3 present epigastric pain,
hemobilia and obstructive jaundice triad. The spontaneous dissection of the superior mesenteric artery (SMA) affects more middle-
aged men and can occur isolated or associated with aortic dissection. The most common symptom is vague abdominal pain. Renal
artery stenosis is the most common cause of secondary hypertension, caused by atherosclerosis with a location proximal to the
ostium in middle-aged patients, or fibromuscular dysplasia affecting the middle or distal third in young patient. The proper
recognition of major changes in VAA allows the early diagnosis and appropriate treatment, which are fundamental in the setting of a
higher number of tests ordered by other causes even non-vascular.
TABLE OF CONTENTS/OUTLINE
Diagnosis of changes in VAA Aneurysms in splenic and hepatic arteries Spontaneous dissection of the SMA Renal artery stenosis