Educational Exhibit Abstract No. 404 - CT-guided sacral and transsacral interventions for benign and malignant pathologies: a pictorial review

Abstract

No. 403 Long-term outcomes of endovascular treatment for aortic pseudoaneurysm in Behcet’s disease S. Lee, S. Kim, D. Lee, M. Kim, J. Won, S. Park, Y. Yoon, D. Choi, Y. Ko; Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea; Cardiothoracic Surgery, Cardiovascular Center, Yonsei University College of Medicine, Seoul, Republic of Korea; Internal Medicine, Cardiovascular Center, Yonsei University College of Medicine, Seoul, Republic of Korea Purpose: To evaluate the effectiveness of endovascular stentgrafting for surgical management of aortic pseudoaneurysm in patients with Behcet’s disease (BD). Materials and Methods: We present a single-institution retrospective cohort of patients with aortic pseudoaneurysm and BD treated with aortic stent-grafting. CT imaging was obtained preoperatively in all patients and once within two weeks postoperatively, and then annually. Clinical followup and erythrocyte sedimentation rate (ESR) were used to follow BD activity. Immunosuppressant therapy was instituted prior to endovascular treatment unless a contraindication existed. Results: From 1998 to 2012, 10 patients (eight male, two female; median age 39) with BD and aortic pseudoaneurysm were treated with endovascular stent-grafting at this institution. 90% of these patients received immunosuppressive therapy before and after surgical treatment. The median follow-up period was 57 months (interquartile range, IQR 43-72).The locations of the 12 pseudoaneurysms treated in this cohort were infrarenal abdominal aorta (seven), descending thoracic aorta (four), and aortic arch (one). Median pseudoaneurysm size was 4.5 cm (IQR 3.4-5.9). At long-term followup, complete resolution of the aortic pseudoaneurysm was noted in all patients. No endoleaks occurred. Newly developed pseudoaneurysm at the distal margin of the stentgraft was noted in one patient 17 months after the stentgraft procedure. One patient required a subsequent stentgraft placement for an expanding pseudoaneurysm of the subclavian artery. No patient deaths occurred during the follow-up period. Conclusion: Endovascular treatment of aortic pseudoaneurysm with stent-grafting in patients with BD is safe and effective with long-term durability. Educational Exhibit Abstract No. 404 CT-guided sacral and transsacral interventions for benign and malignant pathologies: a pictorial review J. Pinter, E. Santos, K. Ching, V. Gavrilovic; Interventional Radiology, UPMC, Pittsburgh, PA Learning Objectives: 1) Review pertinent anatomy of the sacrum and critical neurovasculature structures. 2) Outline relevant techniques for percutaneous ablation and cementoplasty of primary and metastatic sacral tumors. 3) Describe transsacral ablation for recurrent presacral malignancies. Background: Sacral tumors include a wide range of benign and malignant pathology. While these lesions are uncommon, they may lead to debilitating clinical symptoms and can be challenging to diagnose and manage. Numerous treatment options may be employed depending on the characteristics and location of the offending lesion. Patient comorbidities and life-expectancy should must be considered in these patients when determining the best treatment options. Interventional techniques are useful in both the diagnosis and management of sacral and presacral lesions. Appropriate patient selection, a multidisciplinary treatment approach, and careful review of diagnostic imaging are essential to achieve strong clinical outcomes. Clinical Findings/Procedure Details: This exhibit reviews the complicated neurovascular anatomy of the sacrum and pelvic structures. Image guided percutaneous techniques including transsacral biopsy, transsacral ablation, and sacral ablation and cementoplasty are presented. Image-rich cases include transsacral ablation for recurrent colorectal carcinoma, ablation and cementoplasty for painful neoplasms, and cementoplasty for pathologic sacral fractures. Conclusion and/or Teaching Points: While sacral tumors are rare, the complicated anatomy of the sacrum and tightquarters of adjacent neurovascular structures requires a multidisciplinary approach in order to achieve the best patient outcomes. Percutaneous image-guided techniques are often the treatment of choice for managing these complex patients. Educational Exhibit Abstract No. 405 An interactive educational website for interventional radiology S. Hanif, E. Matto, B.A. Bianco, A.E. Trebelev; Hahnemann University Hospital, Philadelphia, PA Learning Objectives: Online educational modules have proven to be an effective method of training medical students and new residents. We developed a website that describes interventional radiology (IR) procedures, demonstrates IR instruments, provides imaging correlates, and presents clinically oriented physics. Rigorous multiple choice assessments accompany each section and allow program directors to track a student’s performance and provide feedback. Background: A dedicated website was established on a secure internet hosting service. The website was developed using PHP, javascript, and MySQL programing languages. Clinical Findings/Procedure Details: Leading IR textbooks and journal articles are reviewed to accurately describe 58 IR JVIR ’ Posters and Exhibits S177