Abstracts
S30 The Arab Journal of Interventional Radiology | Volume 4 | PAIRS Abstracts | February 2020
Nottingham University Hospitals NHS Trust, Nottingham, 1Royal Derby
Hospital, Derby, United Kingdom.
E-mail:
[email protected]
Educational Poster Background: Visceral artery aneurysm
(V AA) and visceral artery pseudoaneurysm (V APA) rupture can
lead to catastrophic hemorrhage with high mortality. Diagnosis
is with computed tomographic angiogram. Management is
endovascular and aims to exclude the aneurysm from the
circulation. We describe the treatment of three patients (mean age
74) with asymptomatic and ruptured V AA/V APA presenting to a
University Teaching Hospital. Patient A –30 mm gastroepiploic
aneurysm: Angiogram confirmed a tortuous GA arising from
the gastroduodenal artery (GDA). This aneurysm was excluded
from the circulation by placement of embolization coils in front
and back door arteries with angiographic success maintained
during 2 years’ imaging follow-up. Patient B – Ruptured 11 mm
SMA branch pseudoaneurysm: DSA confirmed SMA branch
pseudoaneurysm, tight coeliac axis (CA) stenosis, and right hepatic
artery replacement to the GDA. The pseudoaneurysmal SMA
branch also perfused the CA territory retrogradely via the GDA.
Arterial inflow to the pseudoaneurysm was a tiny vessel with
a high angle to the SMA branch. Covered stentgraft placement
in the pseudoaneurysm neck was used to exclude it from the
circulation while maintaining retrograde perfusion of the CA via
the SMA. Patient C – 9 mm ruptured GDA branch aneurysm:
DSA demonstrated CA occlusion and a pseudoaneurysm with a
narrow neck supplied by a tortuous submillimeter GDA branch.
CA occlusion and tortuosity prevented stent-graft placement.
Embolization of the pseudoaneurysm feeding vessel would have
compromised retrograde CA perfusion. The pseudoaneurysm
neck was cannulated with 0.021” microcatheter and 0.014” wire
and embolized using Histacryl glue and lipiodol (2:1 ratio).
Angiogram showed exclusion of the pseudoaneurysm and
maintained retrograde (via GDA) CA perfusion. Conclusion: In
this educational poster, we show how our optimal treatment of
these three patients presenting to our institution was determined
by the clinical scenario and locoregional arterial anatomy.
P514
Imaging Pathway for the Diagnosis and
Treatment for Pelvic Congestion Syndrome
Bhavna Pitrola, Neeral Patel, Micheal
Jenkins, Elika Kashef
Imperial College Healthcare NHS Trust, London, United Kingdom.
E-mail:
[email protected]
Educational Poster Background: Pelvic congestion syndrome
(PCS) is a known (and underdiagnosed) cause of chronic pelvic
pain in the female population. There is an increased incident
in the postpartum cohort and in patients with recurrent lower
limb varicose veins. Although the pathophysiology is poorly
understood, pelvic venous incompetence is defined by the
presence of pelvic varicoceles and reflux within the ovarian veins.
The clinical presentation is often nonspecific; thus, the causes of
pelvic pain such as pelvic inflammatory disease, endometriosis,
adenomyosis, and uterine fibroids must be excluded before
diagnosis. We describe the clinical aspects of PCS including the
common presentations, examination findings, and etiology. Our
imaging pathway for patients clinically suspected of PCS includes
transabdominal/transvaginal ultrasound, duplex ultrasound,
and magnetic resonance imaging pelvis features (with specific
examples). The treatment options will be considered, with a
specific focus on ovarian vein embolization (OVE). The technical
considerations of OVE and the pearls and pitfalls with example
cases from our tertiary center are also demonstrated. PCS can be
a debilitating condition in the symptomatic patient population.
The importance of correct diagnosis and treatment with OVE with
a multidisciplinary approach can lead to good clinical outcomes
in the vast majority of cases.
1. To demonstrate clinical presentation and imaging findings of
pelvic congestion syndrome (PCS).
2. To demonstrate our local imaging pathways for patients with
PCS.
3. To understand the treatment options available for PCS and
specifically the work up for ovarian vein embolization,
focusing on pearls and pitfalls.
P515
Selective Uterine Artery Embolization in
Postpartum Hemorrhage; Updates on 5 Years’
Single-Center Experience
Nadine Mohamed, Rana Tarek Khafagy, Hend
Gamal Abd Elgalil, Mark Michael, Karim
Ahmed Abd El Tawab
Ain Shams University, Cairo, Egypt.
E-mail:
[email protected]
Objectives: Postpartum uterine hemorrhage is one of the
most important causes of maternal mortality worldwide and
as well in Egypt. Causes are variable, the most important of
which are uterine atony and birth canal lacerations. Uterine
artery embolization (UAE) is very effective if local measures
failed to stop bleeding. Methods: In the period between
January 2015 and December 2019, 200 women (mean age 26
years) with postpartum hemorrhage underwent embolization
in Ain Shams University Hospitals after failure to achieve
hemostasis after conservative treatments. Clinical success
was defined as stabilization of vital data of the patient and
obviation of hysterectomy. Gel foam hand-cut pledges were the
embolic agents used. Results: Bleeder whether extravasation
or pseudoaneurysm could be identified angiographically
in 120 patients. In 80 patients, no definite bleeder or just
diffuse hyperema could be identified, so bilateral UAE was
done empirically. Clinical success rate was 85% (170 patients
including 117 patients with angiographically identified bleeder).
Hysterectomy was needed in 30 patients after rebleeding
post-UAE. No major procedural-related complications were
recorded. Conclusion: Transcatheter arterial embolization of
the uterine artery is a feasible treatment option in management
of postpartum bleeding with low rates of complications.
Angiographic identification of the bleeding source was
associated with higher clinical success rates decreasing the need
for hysterectomies.
Article published online: 2021-04-26
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