{"paper_id":"75a4b8d5-5a87-4ed9-8d42-16763233aa68","body_text":"Abstracts\nS30 The Arab Journal of Interventional Radiology | Volume 4  | PAIRS  Abstracts  | February 2020\nNottingham University Hospitals NHS Trust, Nottingham, 1Royal Derby \nHospital, Derby, United Kingdom.  \nE-mail: asimshah83@gmail.com\nEducational Poster Background: Visceral artery aneurysm \n(V AA) and visceral artery pseudoaneurysm (V APA) rupture can \nlead to catastrophic hemorrhage with high mortality. Diagnosis \nis with computed tomographic angiogram. Management is \nendovascular and aims to exclude the aneurysm from the \ncirculation. We describe the treatment of three patients (mean age \n74) with asymptomatic and ruptured V AA/V APA presenting to a \nUniversity Teaching Hospital. Patient A –30 mm gastroepiploic  \naneurysm: Angiogram confirmed a tortuous GA arising from \nthe gastroduodenal artery (GDA). This aneurysm was excluded \nfrom the circulation by placement of embolization coils in front \nand back door arteries with angiographic success maintained \nduring 2 years’ imaging follow-up. Patient B – Ruptured 11 mm \nSMA branch pseudoaneurysm: DSA confirmed SMA branch \npseudoaneurysm, tight coeliac axis (CA) stenosis, and right hepatic \nartery replacement to the GDA. The pseudoaneurysmal SMA \nbranch also perfused the CA territory retrogradely via the GDA. \nArterial inflow to the pseudoaneurysm was a tiny vessel with \na high angle to the SMA branch. Covered stentgraft placement \nin the pseudoaneurysm neck was used to exclude it from the \ncirculation while maintaining retrograde perfusion of the CA via \nthe SMA. Patient C – 9 mm ruptured GDA branch aneurysm: \nDSA demonstrated CA occlusion and a pseudoaneurysm with a \nnarrow neck supplied by a tortuous submillimeter GDA branch. \nCA occlusion and tortuosity prevented stent-graft placement. \nEmbolization of the pseudoaneurysm feeding vessel would have \ncompromised retrograde CA perfusion. The pseudoaneurysm \nneck was cannulated with 0.021” microcatheter and 0.014” wire \nand embolized using Histacryl glue and lipiodol (2:1 ratio). \nAngiogram showed exclusion of the pseudoaneurysm and \nmaintained retrograde (via GDA) CA perfusion. Conclusion: In \nthis educational poster, we show how our optimal treatment of \nthese three patients presenting to our institution was determined \nby the clinical scenario and locoregional arterial anatomy.\nP514\nImaging Pathway for the Diagnosis and \nTreatment for Pelvic Congestion Syndrome\nBhavna Pitrola, Neeral Patel, Micheal \nJenkins, Elika Kashef\nImperial College Healthcare NHS Trust, London, United Kingdom.  \nE-mail: bhavnapitrola@gmail.com\nEducational Poster Background:  Pelvic congestion syndrome \n(PCS) is a known (and underdiagnosed) cause of chronic pelvic \npain in the female population. There is an increased incident \nin the postpartum cohort and in patients with recurrent lower \nlimb varicose veins. Although the pathophysiology is poorly \nunderstood, pelvic venous incompetence is defined by the \npresence of pelvic varicoceles and reflux within the ovarian veins. \nThe clinical presentation is often nonspecific; thus, the causes of \npelvic pain such as pelvic inflammatory disease, endometriosis, \nadenomyosis, and uterine fibroids must be excluded before \ndiagnosis. We describe the clinical aspects of PCS including the \ncommon presentations, examination findings, and etiology. Our \nimaging pathway for patients clinically suspected of PCS includes \ntransabdominal/transvaginal ultrasound, duplex ultrasound, \nand magnetic resonance imaging pelvis features (with specific \nexamples). The treatment options will be considered, with a \nspecific focus on ovarian vein embolization (OVE). The technical \nconsiderations of OVE and the pearls and pitfalls with example \ncases from our tertiary center are also demonstrated. PCS can be \na debilitating condition in the symptomatic patient population. \nThe importance of correct diagnosis and treatment with OVE with \na multidisciplinary approach can lead to good clinical outcomes \nin the vast majority of cases.\n1.  To demonstrate clinical presentation and imaging findings of \npelvic congestion syndrome (PCS).\n2.  To demonstrate our local imaging pathways for patients with \nPCS.\n3.  To understand the treatment options available for PCS and \nspecifically the work up for ovarian vein embolization, \nfocusing on pearls and pitfalls.\nP515\nSelective Uterine Artery Embolization in \nPostpartum Hemorrhage; Updates on 5 Years’ \nSingle-Center Experience\nNadine Mohamed, Rana Tarek Khafagy, Hend \nGamal Abd Elgalil, Mark Michael, Karim \nAhmed Abd El Tawab\nAin Shams University, Cairo, Egypt.  \nE-mail: dmm_dandoona_92@hotmail.com\nObjectives:  Postpartum uterine hemorrhage is one of the \nmost important causes of maternal mortality worldwide and \nas well in Egypt. Causes are variable, the most important of \nwhich are uterine atony and birth canal lacerations. Uterine \nartery embolization (UAE) is very effective if local measures \nfailed to stop bleeding. Methods: In the period between \nJanuary 2015 and December 2019, 200 women (mean age 26 \nyears) with postpartum hemorrhage underwent embolization \nin Ain Shams University Hospitals after failure to achieve \nhemostasis after conservative treatments. Clinical success \nwas defined as stabilization of vital data of the patient and \nobviation of hysterectomy. Gel foam hand-cut pledges were the \nembolic agents used. Results: Bleeder whether extravasation \nor pseudoaneurysm could be identified angiographically \nin 120 patients. In 80 patients, no definite bleeder or just \ndiffuse hyperema could be identified, so bilateral UAE was \ndone empirically. Clinical success rate was 85% (170 patients \nincluding 117 patients with angiographically identified bleeder). \nHysterectomy was needed in 30 patients after rebleeding \npost-UAE. No major procedural-related complications were \nrecorded. Conclusion:  Transcatheter arterial embolization of \nthe uterine artery is a feasible treatment option in management \nof postpartum bleeding with low rates of complications. \nAngiographic identification of the bleeding source was \nassociated with higher clinical success rates decreasing the need \nfor hysterectomies.\nArticle published online: 2021-04-26","source_license":"CC0","license_restricted":false}