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Free Paper Session Embolisation
Date:
Mon, Sep 9, 2019
Time:
17:30 - 18:30
Room:
Room 134

2306.1 - Geniculate artEry embolisatioN in patiEnts with oSteoarthrItiS of the knee (GENESIS): preliminary results from the first European prospective study

Abstract

Purpose

Knee OA is an extremely common and debilitating condition. Recent work has elucidated the role of angiogenesis, which is increased in the synovium, osteophytes and menisci, leading to degenerative change. The GENESIS study is the first prospective European study to investigate the role of GAE in the treatment of mild to moderate knee OA.

Material and methods

Participants have knee MRI, which is repeated 1-year post procedure. Prior to embolisition, patients complete KOOS, and VAS questionnaires. These are repeated at 6weeks, 3months, 1&2 years post procedure. Participants also undergo brain fMRI and behavioural assessments pre embolization.GAE is performed as a day-case procedure.

Results

The study opened in June 2018, and as of abstract submission has recruited 25 of 50 patients. We will present the most up-to-date data. Thus far (n=10), the mean total KOOS score pre intervention was 42.5 (22-64). At mean 3month follow-up (to date of abstract), the mean total KOOS score post intervention is 70 (62-78). Thus far GAE in patients with mild to moderate knee OA significantly improves pain, function, and quality of life by 39% (p<0.05). We have had one complication of skin discoloration over the embolised territory that resolved spontaneously. The technique of GAE and cases will be discussed.

Conclusion

Mild to moderate OA of the knee resistant to conservative treatment, but not yet severe enough to merit joint replacement represents a specific challenge. If GAE is shown to provide a clinical benefit, this will change the way in which we view the pathophysiology and treatment of this common disease.

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2306.2 - Clinical outcomes of transcatheter arterial embolization for chronic knee pain: severe versus mild to moderate knee osteoarthritis

Presenter:
Authors:

Abstract

Purpose

To compare the clinical outcomes of transcatheter arterial embolization (TAE) for chronic knee pain in patients with severe vs mild to moderate knee osteoarthritis (OA).

Material and methods

This study included 41 knee OA patients, refractory to conservative treatments, who underwent TAE between June 2017 and July 2018. Clinical outcomes were compared in two groups: severe OA (n = 12) and mild-to-moderate OA (n = 59). Visual analog scale (VAS) scores were used to assess pain at the baseline and post-treatment (1 d, 1 wk, 1, 3, 6 mo, and 12 mo).

Results

There were no significant differences in age, body mass index or baseline VAS scores between the two groups. The mean VAS scores in the mild-to-moderate OA group were significantly decreased at one-day, one-week, one-month, three-months and six-months (5.5 at baseline versus 3.2, 3.1, 2.9, 2.2, and 1.9 after treatment; all P = .00). These improvements were maintained at a mean of 10 ± 3 months (range, 6–19 months) post-treatment. The VAS scores were significantly decreased in the severe OA group for one-month post-treatment (6.3 as baseline versus 4.1, 4.1, and 4.4 at one-day, one-week, and one-month; all P < .01). However, the decrease was not statistically significant from three to six-months (5.4 and 5.9 at three-months and six-months, respectively).

Conclusion

TAE effectively relieved pain in patients with mild-to-moderate osteoarthritis. In patients with severe osteoarthritis, pain was decreased for one-month. However, in these patients, pain was increased after three-months.

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2306.3 - Effects of transcatheter arterial embolization for persistent trapezius myalgia refractory to conservative treatment

Presenter:
Authors:

Abstract

Purpose

Trapezius myalgia (TM) is the most frequent type of neck-shoulder pain among office worker, characterized by pain, stiffness and tightness of the upper trapezius muscle. TM is a problem faced by people who do highly repetitive work and static contractions all day on the job. The effect of conventional treatment for this condition is limited. Transcatheter arterial embolization (TAE) of small abnormal vessels has appeared to be a method for the treatment of chronic painful conditions.

Material and methods

This study comprised in 10 patients (7 women; mean age, 61y; range, 30-75y; mean duration of symptoms, 7.1 years) with TM that was resistant to conservative treatments for more than 1 year. Patients with cervical radiculopathy, cervical spinal stenosis, thoracic outlet syndrome, shoulder joint pathology, polymyalgia rheumatica, cervical osteoarthritis, or rheumatoid arthritis were excluded. TAE was performed for transverse cervical, suprascapular, and the scapular circumflex arteries according to the region of pain between Oct 2017 and July 2018.

Results

No major or minor adverse events were related to the procedures. The mean brief pain inventory (BPI) pain intensity score before TAE significantly improved at 1 and 6 months after TAE (8.8±1.3 vs. 6.3±3.5 and 5.8±3.5, respectively; P < 0.01). The mean pain BPI interference scores significantly decreased at 1 and 6 months after TAE (5.2±1.4 vs. 3.6±3.0 and 3.6±3.0, respectively; P < 0.01).

Conclusion

TAE could be a potential treatment option for the persistent TM. Further evaluation with a control group is needed to confirm the effects of TAE.

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2306.4 - Impact of uterine fibroids embolization on uterine contractility and female quality of life

Abstract

Purpose

To assess uterine contractility using ultrafast magnetic resonance imaging (cine MRI) before and after uterine fibroid embolization (UFE) and therefore evaluate the impact of uterine contractility patterns on the quality of life of women undergoing to uterine artery embolization for the treatment of symptomatic fibroids.

Material and methods

This is a prospective study of uterine contractility in 26 patients (age 30–41 years) undergoing UFE for symptomatic uterine fibroids. Cine MRI was performed before and 6 months after UFE. The uterine contractility was classified as absent, ordered, or disordered. Patients were then grouped into three distinct patterns of progression: unchanged contractility (group A), modified contractility (B), and loss of contractility (C). The health-related quality of life questionnaire was applied in person on first MRI exam day and one year after UFE.

Results

Of the 26 patients included, 38% had no change in contractility after UFE (group A), 50% had a positive change (group B), and 11% lost contractility (group C). All patients presented reduced in the mean score for symptoms and increase in mean scores on quality of life. Group B significant reduction in the mean symptom score and increase in the mean quality of life subscale score. Group A showed significantily higher average scores of activity and self-confidence than Group B.

Conclusion

In women of reproductive age with symptomatic fibroids, uterine contractility improved significantly after UFE. The functional recovery of uterine contractility after UFE may be one of the factors of positive interference under improvement of the quality of these patient's life.

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2306.5 - Comparison of embolization of the superior rectal arteries with conventional surgical correction in the treatment of internal hemorrhoidal disease: initial results

Abstract

Purpose

To compare embolization of the superior rectal arteries and surgical correction in the treatment of internal hemorrhoidal disease

Material and methods

Single-center, prospective, randomized in progress study approved by institutional review board with 22 included patients with indication for surgical treatment for internal hemorrhoidal disease(grades 2 and 3) started in April 2018.

Patients were randomized into two groups: embolization group with microcoils and conventional surgery group(ferguson technique), composed by 10 men and 12 women.

Postoperative symptoms were evaluated at 2, 7 and 30 days of posttreatment in both groups at a medical visit and through telephone evaluation(90 and 180 days).

Results

22 patients were included(11 in the embolization group and 11 in the surgery group). Until now 9 patients were submitted to embolization of the superior rectal arteries and 7 to the conventional surgical treatment until the moment. Among the patients in the embolization group the pain in the first 7 days ranged from 0 to 3, without need for analgesic and anti-inflammatory use. And in surgery group, pain varied from 0 to 10, requiring the use of analgesics and anti-inflammatories(2 to 3 daily doses) for pain control.

Regarding the control of symptoms(bleeding and hemorrhoidal prolapse), in the postoperative period of up to 10 months, all patients presented remission, without need for a new approach in both groups.

Conclusion

the initial results of treatment of hemorrhoidal disease through embolization of the superior rectal arteries demonstrate clinical improvement of symptoms, with less pain and need for analgesic use when compared to conventional technique.

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2306.6 - Assessment of angiographic outcome using 2D parametric parenchymal blood flow (2D-PPBF) technique in patients with hypersplenism undergoing partial spleen embolization (PSE)

Abstract

Purpose

To analyze the feasibility of 2D-PPBF for the assessment of angiographic outcome following PSE.

Material and methods

Overall, 15 PSE procedures in 14 patients were included in this study (2015/2018). Outcome was the platelet response (PR), calculated as the percentual increase of platelet count (PLT) following PSE. To assess angiographic outcome via perfusion quantification following PSE, the acquired digital subtraction angiography (DSA) series were post-processed. A reference region-of-interest (ROI) in the splenic artery and a target ROI outlining the splenic embolization territory were placed in corresponding areas on DSA pre- and post-PSE. The ratios to the reference ROI were calculated for the Wash-In-Rate (WIR), the Time-To-Peak (TTP) and the Area-Under-the-Curve (AUC). Comparisons between pre- and post-embolization data were made using a Wilcoxon signed-rank test and correlated to the outcome parameter using Spearman’s rank correlation coefficient (r). Additionally, the study population was subdivided according to the median of the most significant 2D-PPBF parameter. PR between subgroups was compared using Mann-Whitney U test. Level of significance was p<0.05.

Results

Following PSE, PLT increased significantly from 41.200±19.468/µL to 111.133±69.286/µL with a PR of +209%±237%(p=0.002). In the embolized splenic territory, the pre-/post-embolization 2D-PPBF parameter changed significantly: WIRpre-PSE1.05±2.18/WIRpost-PSE0.09±0.07(p=0.03), TTPpre-PSE4.28±0.93/TTPpost-PSE5.98±1.86(p=0.012) and AUCpost-PSE0.81±0.79/AUCpost-PSE0.13±0.08(p=0.01). Correlations of the 2D-PPBF parameters with PLT were: WIRpre-PSE/PLTpre-PSEr=0.236(p=0.396), TTPpre-PSE/PLTpre-PSEr=-0.585(p=0.022) and AUCpre-PSE/PLTpre-PSEr =-0.39(p=0.889). PR between patients with TTPpre-PSE≤4.065vs.>4.065 was significant different with +80%±87%[n=8] and +358%±273%[n=7](p=0.040).

Conclusion

2D-PPBF is an objective approach to assess angiographic outcome via perfusion quantification following PSE. Further, TTP derived from 2D-PPBF has the potential to predict response to PSE.

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2306.7 - Identifying active extravasation on arteriograms using artificial intelligence

Abstract

Purpose

To use artificial intelligence to identify extravasation on arteriograms.

Material and methods

Forty-seven positive and 23 negative digitally subtracted arteriogram series, containing 548 positive and 577 negative images, were used as a ground truth data set. Arteriogram series from consecutive embolization procedures with definitive sites of bleeding and findings concordant with final dictations were selected for the positive images. An attending interventional radiologist with 3 years of experience placed bounding boxes around the sites of extravasation using ImageJ 1.52a. A two-stage method was used to solve the extravasation detection problem, where the first stage was used to classify whether a bleed was present and the second stage where an object detector was trained to identify the site of bleeding. ResNet-152 was used as the first stage classifier and Faster R-CNN was used as the second stage object detector. Eighty percent of the data was used for training and twenty percent was used to validate the first stage of the algorithm. Ten unique positive arteriogram images from new series were used to test the second stage of the algorithm.

Results

The first stage of the algorithm was 86% accurate. The second stage of the algorithm correctly identified 5 of the 10 sites of bleeding.

Conclusion

The algorithm was able to correctly classify if a bleed was present on 86% of the validation images and was able to identify the site of extravasation on 50% of the test images. These preliminary results show significant promise for detection of bleeding on arteriograms using deep-learning methods.

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