Abstract No. 512 Direct percutaneous treatment of peripheral vascular pathology

Abstract

PurposeEndovascular treatment is the mainstay of therapy for peripheral aneurysms, pseudoaneurysms, arteriovenous malformations, and arteriovenous fistulae. However, due to patient anatomy or clinical factors, endovascular treatment is not always possible and potentially morbid surgery may be required. An alternative to the endovascular approach is direct percutaneous puncture and embolization. In this study we report the efficacy and safety of direct percutaneous treatment of peripheral vascular pathology utilizing small gauge needles.Materials and MethodsA retrospective review of all patients (mean age, 59 years; 21% male) with peripheral aneurysms, pseudoaneurysms, arteriovenous malformations, or arteriovenous fistulae treated with direct percutaneous puncture between January 2013 and March 2020.Results14/14 identified patients achieved technical success utilizing 19- to 25-gauge needles percutaneously. 8/14 (57%) underwent failed prior endovascular intervention and 10/14 (71%) patients underwent simultaneous angiography. Targets were located in the liver (3), uterus (2), mesentery (2), abdominal wall (1), kidney (1), gluteal region (1), knee (1), chest wall (1), breast (1), and lung (1). Embolic material utilized included ethylene-vinyl alcohol copolymer (Onyx), detachable coils, or thrombin. Mean fluoroscopy time, dose area product, and air kerma was 19 minutes, 277 Gycm2, and 1.06 Gy, respectively. 4/14 (29%) patients were deceased at follow up. One patient suffered recurrent postoperative infection after prior partial nephrectomy, endovascular renal embolization with coils and microspheres, and direct percutaneous renal pseudoaneurysm embolization with Onyx. The infection resulted in mortality 187 days after direct percutaneous embolization. The other 3 mortalities were not treatment related. There was 1 minor complication where a patient had continued blood loss after the procedure. The patient was managed conservatively, and the bleeding resolved.ConclusionsDirect percutaneous embolization is a feasible method of treating peripheral vascular pathologies in multiple organ systems. It should be considered alongside endovascular management, especially when previous endovascular embolization failed. PurposeEndovascular treatment is the mainstay of therapy for peripheral aneurysms, pseudoaneurysms, arteriovenous malformations, and arteriovenous fistulae. However, due to patient anatomy or clinical factors, endovascular treatment is not always possible and potentially morbid surgery may be required. An alternative to the endovascular approach is direct percutaneous puncture and embolization. In this study we report the efficacy and safety of direct percutaneous treatment of peripheral vascular pathology utilizing small gauge needles. Endovascular treatment is the mainstay of therapy for peripheral aneurysms, pseudoaneurysms, arteriovenous malformations, and arteriovenous fistulae. However, due to patient anatomy or clinical factors, endovascular treatment is not always possible and potentially morbid surgery may be required. An alternative to the endovascular approach is direct percutaneous puncture and embolization. In this study we report the efficacy and safety of direct percutaneous treatment of peripheral vascular pathology utilizing small gauge needles. Materials and MethodsA retrospective review of all patients (mean age, 59 years; 21% male) with peripheral aneurysms, pseudoaneurysms, arteriovenous malformations, or arteriovenous fistulae treated with direct percutaneous puncture between January 2013 and March 2020. A retrospective review of all patients (mean age, 59 years; 21% male) with peripheral aneurysms, pseudoaneurysms, arteriovenous malformations, or arteriovenous fistulae treated with direct percutaneous puncture between January 2013 and March 2020. Results14/14 identified patients achieved technical success utilizing 19- to 25-gauge needles percutaneously. 8/14 (57%) underwent failed prior endovascular intervention and 10/14 (71%) patients underwent simultaneous angiography. Targets were located in the liver (3), uterus (2), mesentery (2), abdominal wall (1), kidney (1), gluteal region (1), knee (1), chest wall (1), breast (1), and lung (1). Embolic material utilized included ethylene-vinyl alcohol copolymer (Onyx), detachable coils, or thrombin. Mean fluoroscopy time, dose area product, and air kerma was 19 minutes, 277 Gycm2, and 1.06 Gy, respectively. 4/14 (29%) patients were deceased at follow up. One patient suffered recurrent postoperative infection after prior partial nephrectomy, endovascular renal embolization with coils and microspheres, and direct percutaneous renal pseudoaneurysm embolization with Onyx. The infection resulted in mortality 187 days after direct percutaneous embolization. The other 3 mortalities were not treatment related. There was 1 minor complication where a patient had continued blood loss after the procedure. The patient was managed conservatively, and the bleeding resolved. 14/14 identified patients achieved technical success utilizing 19- to 25-gauge needles percutaneously. 8/14 (57%) underwent failed prior endovascular intervention and 10/14 (71%) patients underwent simultaneous angiography. Targets were located in the liver (3), uterus (2), mesentery (2), abdominal wall (1), kidney (1), gluteal region (1), knee (1), chest wall (1), breast (1), and lung (1). Embolic material utilized included ethylene-vinyl alcohol copolymer (Onyx), detachable coils, or thrombin. Mean fluoroscopy time, dose area product, and air kerma was 19 minutes, 277 Gycm2, and 1.06 Gy, respectively. 4/14 (29%) patients were deceased at follow up. One patient suffered recurrent postoperative infection after prior partial nephrectomy, endovascular renal embolization with coils and microspheres, and direct percutaneous renal pseudoaneurysm embolization with Onyx. The infection resulted in mortality 187 days after direct percutaneous embolization. The other 3 mortalities were not treatment related. There was 1 minor complication where a patient had continued blood loss after the procedure. The patient was managed conservatively, and the bleeding resolved. ConclusionsDirect percutaneous embolization is a feasible method of treating peripheral vascular pathologies in multiple organ systems. It should be considered alongside endovascular management, especially when previous endovascular embolization failed. Direct percutaneous embolization is a feasible method of treating peripheral vascular pathologies in multiple organ systems. It should be considered alongside endovascular management, especially when previous endovascular embolization failed.