Visceral Angiography Research Articles

Use of selective visceral angiography in surgical strategy planning for celiac artery aneurysm in the celiacomesenteric trunk

BackgroundThe celiacomesenteric trunk (CMT) is a common duct of the celiac artery (CA) and the superior mesenteric artery originating from the aorta, which is an uncommon anatomical variant of visceral artery circulation. Because of the variety of visceral circulation in those with CMT, the visceral circulation associated with each branch should be evaluated prior to surgical treatment of visceral artery aneurysm in the CMT.Case presentationA 64-year-old woman was diagnosed with a CA aneurysm in the CMT. Aneurysmectomy of the aneurysm was performed successfully. On preoperative selective visceral angiography, the CA was seen to bifurcate into the common hepatic and splenic artery. The left gastric artery was directly isolated from the aorta and perfused to the common hepatic and splenic artery through collateral circulation. These findings showed that celiac artery embolization is anatomically feasible, even in cases of celiac artery aneurysm rupture.ConclusionsSelective visceral angiography can contribute to surgical strategy planning for CA aneurysm with CMT.

Distal radial artery access is a safe and feasible technique in the anatomical snuffbox for visceral intervention.

Regarding the site of arterial access during the intervention, transracial intervention can reduce the risk of bleeding and vessel-related complications as well as improve patient comfort. Importantly, the distal radial artery (DRA) approach may reduce the incidence of radial artery occlusion and digital ischemia, but the feasibility and safety of DRA in performing subdiaphragmatic vascular interventions remain unclear. From January 2018 to December 2019, 106 patients were admitted to our department for visceral angiography and intervention by left distal radial artery accessing in an anatomical snuffbox. In total, 152 times of vascular interventions were performed during this period. Patients demographics, procedure details, technical success, and access site-related complications were recorded and evaluated. The mean age was 58.9 (range 22-86) years. Males accounted for 80.2%. Thirty-five patients (33%) had 2 or more procedures via the DRA approach. Technical success was achieved for 96.1% of procedures (146 cases) and 3.9% of cases failed to perform the intended procedure via the DRA approach (6 cases). The 4-Fr sheath was used in 86.8% of cases, and the 5 Fr sheath was used in the rest of the 13.2% of procedures. The rate of asymptomatic radial artery occlusion was 5.7% (6 of 106 patients). No patient suffered from distal limb ischemia after a long-time follow-up. Eight patients suffered postoperative local pain, transient numbness, or local bruised in the anatomical snuffbox without major complications. Patients with postoperative complications recovered quickly by using nonsteroidal anti-inflammatory drugs or without further treatment. Left distal radial artery access is safe and feasible as a new technique for visceral angiography and intervention.

Abstract No. 516 Risk of postcontrast acute kidney injury in patients with gastrointestinal (GI) bleeding undergoing computed tomography angiography (CTA) followed by visceral angiography within 24 hours

The use of iodine-based contrast agents may lead to nephropathy, and patients with underlying chronic kidney disease (CKD) are at increased risk for this complication. In a recent study of patients with stroke who underwent CTA followed by cerebral angiography, 9.5% of patients developed postcontrast acute kidney injury.1 The purpose of this study was to assess the risk of postcontrast acute kidney injury in patients with GI bleeding undergoing CTA followed by visceral angiography within 24 hours.

Successful conservative management of a large traumatic mesenteric hematoma: A case report.

Introduction and importanceIn blunt abdominal trauma, small bowel and mesentery injury (SBMI) is the third most common organ injury with an estimated incidence of 1–5%. Traumatic mesenteric injuries are difficult to diagnose and their undiagnosed complications are severe with high mortality rates.Case presentationA 21-year-old male presented to the emergency room with severe colicky pain in the right-hypochondrium 2 h after dinner. He gave history of nausea, vomiting and diarrhea after dinner and before the pain started. The morning after admission, a Contrast Enhanced Computed Tomography (CECT) scan was done which showed a large mesenteric hematoma. On subsequent questioning, the patient then recalled a blow to the abdomen while playing basketball two days ago. Since the patient was hemodynamically stable, non-operative management (NOM) was chosen with close monitoring. Regular follow-up ultrasonography (USG) scans showed progressive spontaneous resolution of the hematoma.Clinical discussionNonspecific symptoms of mesenteric hematoma make it difficult to reach a diagnosis. It is usually identified by history or medical imaging. Mesenteric hematoma can be managed conservatively if there is no active bleeding. In stable patients, selective visceral angiography should be performed and bleeding vessels should be embolized where possible.ConclusionThis case highlights a successful conservative management of a large traumatic mesenteric hematoma. It also emphasizes the importance of eliciting a detailed history of major or minor trauma for any patient with abdominal pain. Previous cases have also highlighted the importance of non-operative management and avoidance of emergency laparotomy in stable patients.

A118 UPPER GASTROINTESTINAL HEMORRHAGE SECONDARY TO SUPERIOR MESENTERIC ARTERY PSEUDOANEURYSM: CASE REPORT AND REVIEW OF LITERATURE

BackgroundVisceral artery pseudoaneurysms (VAPAs) are rare with an estimated incidence of 0.1%-0.2%. Due to various etiologies, a tear occurs in the vessel wall with subsequent formation of a peri-artery hematoma. A ruptured VAPA is a clinical emergency due to life-threatening hemorrhage and is associated with mortality rates of 25%-75%.AimsWe report a case of upper gastrointestinal (GI) hemorrhage secondary to a ruptured superior mesenteric artery (SMA) pseudoaneurysm. A review of the literature regarding management of VAPAs and SMA pseudoaneurysms was performed using relevant medical subject headings on PubMed.MethodsA 66-year-old woman presented to hospital with sudden large volume hematemesis and melena. Her daily medications included Aspirin and Atorvastatin. She had no prior history of peptic ulcers or chronic liver disease. She was found to be tachycardic and hypotensive. Initial investigations demonstrated a hemoglobin of 42g/L and a blood urea nitrogen of 17.5mmol/L. She was resuscitated and referred for an emergent upper endoscopy. On endoscopy, in the third portion of the duodenum, a 4cm solid-appearing subepithelial lesion with central umbilication and an apparent visible vessel was identified. Upon inspection of the lesion, the umbilicated area spontaneously began spurting blood (Image 1). A hemoclip was immediately placed next to the lesion for localization, then hemostatic powder was applied to the area. An immediate computerized tomography (CT) angiography of the abdomen revealed a 3.9 x 2.1 cm pseudoaneurysm arising from the superior mesenteric artery impressing upon the duodenum.ResultsTranscathether arterial embolization of the SMA pseudoaneurysm was performed, during which two Nester coils were deposited in the ileocolic outflow vessel. A covered endovascular stent was also deployed across the culprit arterial branch to exclude the pseudoaneurysm. Following the procedure, the patient stabilized and had no further GI bleeding. Traditionally, visceral angiography has been the gold standard diagnostic test for VAPAs, but has now been supplanted by CT angiography. Treatment strategies of VAPAs can be broadly separated into endovascular methods (coils, vascular plugs, stents, liquid embolic agents) and surgical methods (aneurysmectomy with patching, end-to-end anastomosis, bypass grafting).ConclusionsSMA pseudoaneurysms are a rare yet life-threatening cause of GI bleeding. Endoscopically, they resemble solid subepithelial masses, such as GI stromal tumor, nerve sheath tumor or a lipoma, which may lead to inappropriate attempts to biopsy the lesion or apply direct endoscopic therapy. Prompt diagnosis with imaging, such as CT angiography, is paramount with a view to definitive treatment of the pseudoaneurysm via endovascular methods. Actively hemorrhagic SMA pseudoaneurysmFunding AgenciesNone

Abstract No. 125 Endovascular versus percutaneous treatment of pancreatic pseudoaneurysms

To compare outcomes after endovascular versus percutaneous treatment of pancreatic pseudoaneurysms The research subjects review board approved this retrospective cohort study. Angiograms performed between June 2013 through June 2019 were evaluated. In patients who underwent visceral angiography, a subset of patients with suspected pancreatic pseudoaneurysms were identified. Multiple factors were evaluated including age, hemodynamic status, grade of injury, initial imaging result, angiographic result, vessel embolized, embolic agent used, technical outcome and complication rates in the following 90 days. 17 unique visceral artery pseudoaneurysms were identified in 16 patients (7F). 16 pseudoaneurysms were secondary to chronic pancreatitis and one pseudoaneurysm was secondary to an abscess adjacent to the pancreatic tail after splenectomy. Six patients were treated with endovascular embolization. Four patients were treated with percutaneous embolization, of which three were treated with thrombin and one with a 50/50 mixture of n-BCA/lipiodol. Seven patients underwent no embolization. Technical success was 100% for both embolization techniques. When comparing endovascular versus percutaneous embolization there was no difference in average age (57.2 ± 13.9 years vs 53 ± 13.4 years) or volume of the active core measured on prior CT (30.6 mL ± 27.8cc vs 30 mL ± 30.2 cc). One of the patients in the percutaneous group had rebleeding, which was treated successfully with endovascular coiling. No patients treated with endovascular embolization had rebleeding. One patient treated with percutaneous embolization died 22 days after embolization due to respiratory failure. One patient died 13 days after endovascular embolization of uncertain etiology. Overall, mortality among treated patients was 20%. Mortality rate after interventional radiology treatment of pancreatic pseudoaneurysms was 20% in treated patients. This is lower than prior reported studies. Post treatment rate of rebleeding was 10% and did not result in increased mortality. Percutaneous treatment of pancreatic pseudoaneurysms had a higher rate of mortality and rebleeding than endovascular treatment.

S1494 Gastroduodenal Artery Pseudoaneurysm in the Setting of Necrotizing Pancreatitis

INTRODUCTION: Gastroduodenal artery (GDA) pseudoaneurysms are a rare but fatal condition, representing about 1.5% of all visceral artery aneurysms.. If ruptured, mortality rate is high as 75%, particularly from severe upper gastrointestinal bleeding. Fortunately, the availability of imaging studies allows for early detection of these vascular events. Historically, they used to be treated either through surgical ligation or resection. Currently, minimally invasive endovascular procedures can be performed, resulting in a significant reduction in morbimortality. CASE DESCRIPTION/METHODS: 41 year old female with a history of Roux en Y gastric bypass, pancreatic divisum, chronic pancreatitis complicated by necrotic fluid collections was admitted for severe protein calorie malnutrition. She had a G tube place that persistently leaked, requiring a J arm for nutrition. Her hospital course was further complicated by peritonitis and serratia bacteremia, for which she received intravenous antibiotics. Six days after placement of her J arm, she began to have worsening epigastric pain. She became tachycardic up to the 140s. Abdominal exam was soft with epigastric tenderness without rebound or guarding. Labs were notable for new leukocytosis to 23 and a hemoglobin reduction from 8 to 6.6. CT imaging showed gastrostomy tube migration outside the stomach remnant, with spillage of gastric contents in the peritoneum. In addition to the known complicated necrotizing pancreatitis, the scan revealed a new development of a GDA pseudoaneurysm, 2 cm in size. Surgery was consulted to reposition the gastrostomy tube. Interventional radiology was also consulted for urgent GDA pseudoaneurysm coiling. Patient’s hemoglobin stabilized to her baseline the following days. DISCUSSION: Hemorrhagic complications of pancreatitis are rarely seen. Typically, patients with GDA pseudoaneurysms are asymptomatic or have non-specific abdominal pain. If ruptured, mortality rate is high as 75%. Fortunately, the availability of imaging studies allows for early detection of these vascular events. Gold standard diagnostic test is visceral angiography which provides both diagnostic and therapeutic value and has a 100% sensitivity. CT imaging is noninvasive and has a 67% sensitivity. Historically, they used to be treated either through surgical ligation or resection. We now are able to perform minimally invasive endovascular procedures, resulting in a significant reduction in morbimortality.Figure 1.: Gastroduodenal artery pseudoaneurysm (red arrow), 2cm in size, with surrounding complicated necrotizing pancreatitis.Figure 2.: Transcatheter selective embolization via coiling of the gastroduodenal artery pseudoaneurysm.

Recurrent gastrointestinal bleeding arising from a jejunal arteriovenous malformation in a child with capillary malformation-arteriovenous malformation syndrome

Abstract Capillary malformation-arteriovenous malformation (CM-AVM) syndrome is classically a RASA1 mutation with small CMs and either central nervous system or musculoskeletal AVMs. However, CM-AVM2 has recently been discovered, and is characterized by an EPHB4 mutation to the EPHB4-RAS-ERK pathway. The skin findings favor those of hereditary hemorrhagic telangiectasia with Bier spots and telangiectasias, and the presence of central nervous system and musculoskeletal AVMs mirror classic CM-AVM. To our knowledge, this is the first report of a visceral AVM in CM-AVM2 in the literature. The patient presented with recurrent gastrointestinal bleeds, and after an extensive workup culminating in diagnostic visceral angiography, was found to have a CM-AVM2 with a jejunal AVM.

03:27 PM Abstract No. 241 Effects of time to visceral angiography for gastrointestinal bleeding on angiographic success

Gastrointestinal bleeding (GIB) is a complex problem with a multitude of etiologies requiring a multidisciplinary approach to treatment. There is varying data regarding the role of urgent endoscopy (EGD), colonoscopy, CT, nuclear medicine tests, or conventional angiogram in the acute setting. This retrospective review was conducted to evaluate the effect of time to angiogram on angiographic outcomes. The RRSB at University of Rochester approved this retrospective cohort study. Visceral angiograms performed from Jan 2012 to Dec 2015 were evaluated. Index angiograms for GIB were identified. Exclusion criteria included recent abdominal surgery (30 days), empiric embolization, or incomplete arteriograms. Multiple factors were included in the analysis, age, gender, angiogram time, EGD, colonoscopy, anti platelet use, anticoagulant use, INR, CT, and Tc99m RBC scan (RBC Scan), among others. 118 angiograms were included in the final analysis. 44 angiograms resulted in identification and embolization of a bleed. (average age 67.4 yrs, 65% male) 74 angiograms failed to identify a bleed. 74 (average age 70.6yrs, 52% male) In cases with a positive RBC scan in the preceding 24 hours, successful identification and embolization was significantly statistically correlated with a shorter time to angiogram 4.6 hrs compared to 9.6 hrs for unsuccessful angiograms (p=.026). Patients with a bleed identified on EGD or colonoscopy prior to successful angiogram had a shorter time to angiogram 9.1 vs 10 hours for non-diagnostic angiograms, although not significant. CTA examinations were excluded due to low sample size. 92% of active bleeds seen on RBC scan and 93% of directly visualized bleeds corresponded to the embolized location. Visceral arteriography is a key tool in the identification and treatment of acute GI bleeding. Successful angiograms had a, statically significant, shorter time to angiogram from positive RBC scan compared to inconclusive angiograms. Angiography should be performed as soon as possible after a positive RBC scan. Successful embolization after EGD did not have a strong time dependence, likely owing to several factors.

Transcatheter embolization effectively controls acute lower gastrointestinal bleeding without localizing bleeding site prior to angiography

Background and aims: Colonoscopy is preferred for treatment of lower gastrointestinal bleeding (LGIB). However, several conditions such as poor bowel preparation can cause endoscopic failure, leading to surgery or transcatheter therapy as alternative options. We aimed to assess the efficacy and safety of transcatheter arterial embolization (TAE) for LGIB in patients with endoscopic failure.Methods: Between January 2005 and June 2015, 93 consecutive patients with acute LGIB underwent visceral angiography at three academic hospitals. Among them, a total of 52 patients were treated with TAE for LGIB and analyzed. Technical success, complications and 30-day rebleeding and mortality after TAE were investigated retrospectively in patients with and without localization of LGIB.Results: Technical success of TAE was achieved in all patients. After TAE, 30-day rebleeding and mortality rate were 27% (14/52) and 29% (15/52), respectively. TAE was performed without localizing bleeding site in 32 of 52 patients (62%). Between patients with and without localized bleeding site, there were no significant differences in 30-day rebleeding rate (25% vs. 28%) and mortality rate (15% vs. 38%). Causes of death were mostly unrelated to bleeding. Only two cases of bowel infarction occurred after TAE in patients without bleeding site localization. Rebleeding could be predicted if the patient received more than six units of packed red blood cell transfusion before TAE in multivariate analysis.Conclusions: TAE can be an effective treatment for LGIB even without localizing bleeding site.

COMBINED TREATMENT FOR KLATSKIN NON-RESECTABLE TUMOR USING INTRA-FLOW PHOTODYNAMIC THERAPY AND REGIONAL CHEMOTHERAPY

The experience of treatment of 28 patients with Klatskin tumor is summarized. Bile ducts tumor of stages III-IV was diagnosed in 25 patients. A total of 97 sessions of intra-flow photodynamic therapy and 74 courses of regional chemotherapy were conducted. One patient due to a full response to treatment there was performed orthotopic liver transplantation from a cadaver donor. In all observations the diagnosis was confirmed morphologically by means of intraflow biopsy or after investigation of the removed specimen. All patients at the time of the beginning of treatment underwent percutaneous cholangiodrainage. Intra-flow photodynamic therapy was performed in the dose-fractionation mode by the “LAKHTA-MILON” diode laser device using quartz optic fiber systems and a catheter with a cylindrical diffuser at a radiation power at the fiber output of one watt. The density of the supplied energy was 200 J/cm2. Radachlorin or Photon preparations were used as photosensitizers. Subsequently, in 2-4 days, visceral angiography of the hepatopancreatoduodenal zone with the arterial catheter inserted into the celiac trunk or the common hepatic artery to carry out regional chemotherapy by GemOx mode was performed. 21 (71,4%) patients died at the time from 8 to 42 months. 7 (28.6%) patients who undergo repeated courses of combined treatment at intervals of 1,5 to 3 months are alive and under observation from 10 to 26 months. The median survival is 21 months, the average life span is 15,4 + 0,8 months. A one-year survival rate is 78%, a two-year survival rate - 18%, a three-year survival rate - 4%. Survival of patients (according to Kaplan-Meier) is 18 months.

3:09 PM Abstract No. 24 Predictive value of computed tomography angiography vs 99mtechnetium-labeled red blood cell scintigraphy for lower gastrointestinal bleeding prior to transcatheter visceral angiography

3:09 PM Abstract No. 24 Predictive value of computed tomography angiography vs 99mtechnetium-labeled red blood cell scintigraphy for lower gastrointestinal bleeding prior to transcatheter visceral angiography

Management of Acute Lower Gastrointestinal Bleeding

Acute lower gastrointestinal bleeding (LGIB), defined as hemorrhage into the gastrointestinal tract distal to the ligament of Treitz, is a major cause of morbidity and mortality among adults. Overall, mortality rates are estimated between 2.4% and 3.9%. The most common etiology for LGIB is diverticulosis, implicated in approximately 30% of cases, with other causes including hemorrhoids, ischemic colitis, and postpolypectomy bleeding. Transcatheter visceral angiography has begun to play an increasingly important role in both the diagnosis and treatment of LGIB. Historically, transcatheter visceral angiography has been used to direct vasopressin infusion with embolization reserved for treatment of upper gastrointestinal bleeding. However, advances in microcatheter technology and embolotherapy have enabled super-selective embolization to emerge as the treatment of choice for many cases of LGIB.

Rupture of Cystic Artery Pseudoaneurysm: a Rare Complication of Acute Cholecystitis.

Pseudoaneurysm (PA) of the cystic artery is rare. Most of the reported cases are iatrogenic and develop secondary to liver biopsy, laparoscopic cholecystectomy, ERCP, and liver transplant. Other reported causes include trauma, malignancy, arteriovenous malformations, and inflammation in the hepatobiliary and pancreatic system. Cystic artery psuedoaneurysm is usually asymptomatic but may also present as vague abdominal pain, intra-abdominal mass, and hemobilia. In the event of rupture, it may present as a catastrophic intra-peritoneal bleeding with hemorrhagic shock. Doppler ultrasound and contrast-enhanced CT scan are useful tools for the diagnosis of this condition. However, selective visceral angiography is confirmatory and offers the opportunity for therapeutic embolization. We report a case which presented with upper right quadrant abdominal pain, vomiting, and hypotension. Abdominal ultrasonography revealed subhepatic hematoma and pericholecystic fluid collection along with acute calculus cholecystitis and sludge in the bile duct. Subsequent contrast-enhanced CT and CT angiography confirmed the presence of ruptured cystic artery psuedoaneurysm with subhepatic hematoma. The patient after resuscitation underwent selective visceral angiography and successful coil embolization of the cystic artery pseudoaneurysm. During the same admission, ERCP and biliary stenting were also performed followed by laparoscopic cholecystectomy. This case reports a rare entity which was successfully treated using a multimodality strategy.

Endovascular Treatment of Visceral Artery Pseudoaneurysms in Patients with Chronic Pancreatitis: Our Single-Center Experience

To analyze our experience in endovascular treatment as first-line approach for severe and acute hemorrhage in patients with chronic pancreatitis. From 2010 to 2016 at our institution, 12 males (mean age 66years) with bleeding pseudoaneurysms (PSAs) underwent urgent visceral angiography and endovascular treatment. All patients had chronic pancreatitis. True visceral artery aneurysms and PSAs arising after surgery were excluded from the study. Pancreatitis was caused by alcohol abuse in 9 (9/12, 75%) patients and biliary lithiasis in 3 (3/12, 25%). Involved arteries were gastroduodenal (5/12, 50%), splenic (2/12, 16%), common hepatic (2/12, 16%), middle colic (1/12, 9%), and celiac trunk (1/12, 9%). All patients underwent computed tomography angiography (CTA) scan and visceral angiography followed by endovascular treatment using different devices. Technical success rate was 100%. Bleeding was stopped in all patients, and no one required reembolization. No major complications occurred. There were 2 complications associated with the endovascular procedure: in one case, a coil migration and in another case, in-stent restenosis at 6months. Follow-up included CTA performed during hospitalization and at 6 months after the procedure. Our experience confirms the role of CTA and visceral angiography as diagnostic and therapeutic tool, respectively.

Preventive transarterial embolization in upper nonvariceal gastrointestinal bleeding

BackgroundTransarterial embolization (TAE) is a therapeutic option for patients with a high risk of recurrent bleeding after endoscopic haemostasis. The aim of our prospective study was a preliminary assessment of the safety, efficacy, and clinical outcomes following preventive TAE in patients with non-variceal acute upper gastrointestinal bleeding (NVUGIB) with a high risk of recurrent bleeding after endoscopic haemostasis.MethodsPreventive visceral angiography and TAE were performed after endoscopic haemostasis on patients with NVUGIB who were at a high risk of recurrent bleeding (PE+ group). The comparison group consisted of similar patients who only underwent endoscopic haemostasis, without preventive TAE (PE− group). The technical success of preventive TAE, the completeness of haemostasis, the incidence of rebleeding and the need for surgical intervention and the main outcomes were compared between the groups.ResultsThe PE+ group consisted of 25 patients, and the PE− group of 50 patients, similar in age (median age 66 vs. 63 years), gender and comorbid conditions. The ulcer size at endoscopy was not significantly different (median of 152 mm vs. 127 mm). The most frequent were Forest II type ulcers, 44% in both groups. The distribution of the Forest grade was even. The median haemoglobin on admission was 8, 2 g/dl vs. 8,7 g/dl, p = 0,482, erythrocyte count was 2,7 × 1012/L vs. 2,9 × 1012/L, p = 0,727. The shock index and Rockall scores were similar, as well as and transfusion – on average, four units of packed red blood cells for the majority of patients in both groups, however, significantly more fresh frozen plasma was transfused in the PE− group, p = 0,013. The rebleeding rate was similar, while surgical treatment was needed notably more often in the PE- group, 8% vs. 35% accordingly, p = 0,012. The median ICU stay was 3 days, hospital stay – 6 days vs. 9 days, p = 0.079. The overall mortality reached 20%; in the PE+ group it was 4%, not reaching a statistically significant difference.ConclusionPreventive TAE is a feasible, safe and effective minimally invasive type of haemostasis decreasing the risk of repeated bleeding and preparing the patient for the definitive surgical intervention when indicated.

Ileal angiodysplasia causing chronic, occult gastrointestinal bleeding in a 14-year-old boy

Abstract A 14-year old boy with anemia due to chronic gastrointestinal bleeding required recurrent transfusion. An extensive non-invasive evaluation that included detection of fresh blood in the small bowel followed by laparotomy with on-table pan-endoscopy (including enteroscopy) was unsuccessful in identifying a bleeding source. After repeat capsule endoscopy at our center confirmed bleeding in the distal small bowel, CT angiography identified a 6-mm focal area of enhancement in the ileum communicating with a distal branch of the superior mesenteric artery. Direct visceral angiography with super-selective arteriography identified a fast-flow vascular malformation supplied by terminal branches of the ileal artery. Diagnostic laparoscopy revealed intra-abdominal adhesions and no clear vascular malformation. Initial careful visual and manual examination of the bowel after conversion to laparotomy failed to identify the lesion. On-table retrograde enteroscopy demonstrated a small, pulsatile lesion without ulceration or adherent clot in the mucosa of the proximal ileum. With endoscopic transillumination, a cluster of serpiginous vessels could be seen within the wall of the small bowel. The lesion was resected and pathology was consistent with angiodysplasia. Angiodysplasia is a rare cause of occult, chronic gastrointestinal bleeding in children. A multidisciplinary approach optimizes the likelihood of therapeutic success.

4:03 PMAbstract No. 353 - Complications of prolonged arterial sheath placement after visceral angiography

4:03 PMAbstract No. 353 - Complications of prolonged arterial sheath placement after visceral angiography

A Rare Hepatic Arterial Variation Established in Preoperative MDCT Angiography

Preoperative evaluation and exact description of origins and courses of hepatic vasculature is essential to avoid iatrogenic complications and to have effective results in surgical and radiologic procedures of hepatobiliary pancreatic region. Therefore, preoperative visceral angiography is critical. Digital substraction angiography is gold standart for the evaluation of vascular structures but its invasive nature limits its use. In recent years with the introduction of Multidetector CT (MDCT) Angiography, the use of conventional angiography has been reduced. We present a case of hepatic arterial variation in which Common Hepatic Artery (CHA) originates from not Celiac Trunk but from Superior Mesenteric Artery (SMA) which is established in preoperative MDCT Angiography of a patient scheduled for Whipple operation for cancer of pancreatic head.

Abstract 20179: Correlation Between Visceral Fat and Coronary Artery Calcium in Metabolic Syndrome Patients

Introduction: To assess the relationship between visceral fat (VF) and coronary artery calcium (CAC), we performed visceral fat scan and coronary CT angiography (CCTA) in metabolic syndrome (MetS) cohort. Hypothesis: There is correlation between VF and CAC. Methods: From January to September 2014, among 1000 MetS patients who were referred from 24 public health centers in Seoul, 740 patients who performed visceral fat scan (HDS-2000, Omron) were enrolled in this analysis. MetS was defined as any three of the following traits in one individual: abdominal obesity (waist circumference of men>90cm, women>85cm), high triglyceride (TG) (>150mg/dL), low high-density lipoprotein cholesterol (HDLc) (men100mg/dL). Severity of fatty liver were graded from 0 to 3 by ultrasound. Brachial ankle pulse wave velocity (PWV), carotid intima-media thickness (IMT), Left ventricular mass index (LVMI), CAC and Augmentation index (AIx) were also measured. Results: The cut-off value of high VF area was calculated 88cm2 by Youden index. Incidence of MetS patients who had high VF area (≥88cm2) was 36% (267/740) and the prevalence of men was higher than women (53.4% vs 18.7%, p<0.001). High VF group showed higher CAC than normal VF (11.2±43 vs 25.6±95, p=0.025). VF showed positive correlation with PWV and IMT (p=0.028 and 0.019). LVMI, CAC, abdominal subcutaneous fat, fatty liver grade, serum glucose, TG, HDLc, TG/HDLc ratio, systolic and diastolic blood pressure were also positively correlated with VF (all of the p< 0.01). Conclusions: High VF group showed high CAC. Moreover, VF area showed positive correlation with PWV, IMT, LVMI, CAC, TG/HDLc ratio, abdominal obesity, fatty liver grade and abdominal subcutaneous fat in MetS cohort. It may be considered that VF can predict severity of CAC, arterial stiffness, atherosclerosis, insulin resistance and fatty liver in MetS.