AORTIC ANEURYSMS Moderator:John Rose / Peter Gaines
Free papers (8 mins presentation / 2 mins discussion)
Abstract 53
VALIDATION OF A NEW 3-DIMENSIONAL HELICAL CT TECHNOLOGY: COMPARISON WITH SIZING CATHETER ANGIOGRAPHY IN ASSESSMENT OF ABDOMINAL AORTIC ANEURYSMS (AAA) FOR ENDOLUMINAL REPAIR
R Singh-Ranger, T McArthur, M Raphael, W Lees, M Adiseshiah. University College London Hospitals NHS Trust, London W1N 8AA
PURPOSE: Spiral CT angiography (SCTA) is the emerging gold standard in imaging AAA for endovascular grafting. Data processing generates multiplanar formats allowing vascular channel measurement for graft-sizing. Volumatic SCTA data can supply information on changes in aneurysm sac morphology post deployment.
In this study, validation of SCTA (Siemens Somatom Plus 4) geometric and volume data was made using phantom aneurysms and a sizing angiography catheter (Cook).
MATERIALS AND METHODS: Six glass aneurysms, filled with a contrast-water mixture of measured density and similar proportions as found in vivo during SCTA, were scanned using standard AAA SCTA protocol. Volumes were calculated at windows of 0 Hounsfield and compared to the values obtained using a pyknometer and measuring calipers. Measurement of AAA neck and distal cuff lengths, diameters and vascular channel length were also performed with sizing pigtail catheter in seven patients having concurrent SCTA.
RESULTS: Median errors were 1.1% (range 0.36-2.72) for scanned versus actual volumes and 0.9% (0.4-1.5%) for distances on scanned phantoms. In vivo catheter measurements also agreed with SCTA producing significant correlation between aneurysm neck, cuff lengths and diameters (P<0.04). However, vascular channel length was repeatedly underestimated compared to SCTA.
CONCLUSION: SCTA is accurate in selection for endoluminal AAA repair. Vascular channel length, a requisite for graft-sizing, is underestimated by rigid catheters which take the shortest route inside this channel. In contrast, SCTA measures points within the true lumen. Volumatic data may provide the important information necessary to define outcome after endoluminal repair.
Abstract 54
WHAT HAPPENS TO ABDOMINAL AORTIC ANEURYSMS (AAA) AFTER ENDOVASCULAR GRAFTING? A VOLUMATIC STUDY USING SPIRAL CT ANGIOGRAPHY (SCTA)
R Singh-Ranger, T.McArthur, M Raphael, W Lees, M Adiseshiah. University College London Hospitals NHS Trust, London W1N 8AA
PURPOSE: Although transfemoral exclusion is feasible in treating selected AAA, the sequelae of grafting on sac morphology are unknown. It is hoped a reduction in intra-aneurysmal pressure causes sac shrinkage.
In this study volume changes of grafted aneurysms were followed to determine the long-term effects of treatment.
MATERIALS AND METHODS: From an experience of 46 cases of endoluminal repair of AAA, 11 patients with PTFE aorto-uni-iliac grafts were available for study from 6-48 months post-intervention. Postoperative SCTA was carried out at day 5, and 6 monthly intervals thereafter. Volumes were measured from the lowest renal artery to the aortic bifurcation at windows set for Hounsfield values of 0 for the aneurysm and 100 for its vascular channel. Volumatic data was validated to an accuracy of 1.1% using glass phantoms. 2 patients developed endoleak and 1 developed graft infection.
RESULTS: All patients had significant increase in sac volume post-grafting (P=0.02)*. In patients without complications, no further change in volume occurred to a mean of 16 months. Vascular channel volume decreased after grafting (P=0.01) * and remained stable. Maximum AP and lateral diameters did not significantly change post-intervention. Patients with complications had continued increase in sac volume but not diameter long- term.
CONCLUSION: Endovascular grafting causes initial increase in aneurysm volume due to formation of new clot in the periprosthetic space. There is no further increase in volume unless endoleakage occurs. In contrast, postoperative AP and transverse diameters do not change. Volumatic assessment of AAA morphology is recommended in long-term follow-up of grafted patients.
*Wilcoxon paired test
Abstract 55
MORPHOLOGICAL CHANGES IN THE ABDOMINAL AORTA AFTER AAA STENT GRAFTING
R D Jones, IA Zeally, A Brown*, MG Wyatt* & JDG Rose. Departments of Radiology & Vascular Surgery*, Freeman Hospital Newcastle
PURPOSE: To assess the effect of exclusion of the aneurysm sac on the size and shape of the proximal neck and the aneurysm sac. Also to correlate any significant morphological changes with the performance of the stent-graft.
MATERIALS AND METHODS: Up to July 1998 a total of 60 patients, mean age 71.4 years, were treated with bifurcated endovascular stent-grafts. Follow up CT scans and plain films have been analysed for changes in proximal neck dimensions, aneurysm sac diameter and abnormal angulation or disruption of the stent-graft skeleton.
RESULTS: All devices were successfully deployed (50 Vanguard, 4 AneuRx, 3 EVT & 3 Talent). There were 3 peri-operative deaths due to co-morbid conditions and 3 late deaths (1 graft related rupture). 48 patients were followed for more than 3 months, median 12 months (3-31). There has been a decrease in size of the aneurysm sac in 70% of cases, with a mean diameter reduction of 5.9mm (1-25mm). Size increase seen in 20.5%, mean 3mm (1- 10mm). Proximal neck diameter increased slightly (in the order of 10%) in 64% of cases, and most obvious after 12 months. Slight buckling in the body or limbs of the stent-grafts (<30o) in 40% of cases but severe kinking (>30o) in less than 10%. No disconnection of the modular contra-lateral limbs were detected. 4 endoleaks (1 proximal) and 4 limb occlusions seemed related to causes other than kinking.
CONCLUSION: Further study is required to confirm progression of the aneurysmal process in a significant proportion of cases. This may be related to failure to identify small but important endoleaks and to current endograft technology.
Abstract 56
LEVOVIST ENHANCED ULTRASOUND AS THE PRIMARY FOLLOW UP INVESTIGATION AFTER EVAR?
R McWilliams1,J Martin2, D Gould1, P Harris2, J Brennan2, G Gilling-Smith2, A Bakran2, P Rowlands1. Departments of Radiology1 and Vascular Surgery2, Royal Liverpool University Hospital.
PURPOSE: To report the value of Levovist enhanced ultrasound in the follow up of patients after endovascular repair of abdominal aortic aneurysm.
MATERIALS & METHODS: 12 patients were followed up on 13 occasions after EVAR by contrast enhanced spiral CT according to the Eurostar protocol. All patients had unenhanced colour doppler ultrasound and Levovist (Schering) enhanced ultrasound on the same day. The presence or absence of endoleak was noted and diagnostic confidence recorded on a visual analogue scale. The ultrasound examinations were reported blind to the CT results. CT scans were performed with 5mm collimation, pitch of 2 and reconstructions every 2.5 mm. Single pass CT was used after 100ml pump injected contrast medium. Levovist was injected intravenously using a single dose of 300mg/ml concentration. CT was the gold standard for the purposes of the study.
RESULTS: There were 3 endoleaks shown by CT, two were confirmed at angiography and repaired, one lumbar sac perfusion remains untreated. Unenhanced ultrasound detected only one endoleak (sensitivity 33%). Levovist enhanced ultrasound detected all 3 leaks (sensitivity 100%). Levovist enhanced ultrasound indicated 3 endoleaks which were not confirmed by CT (specificity 70%). One of these patients has a sac which has increased in size, the other 2 had distal implantation leaks at completion angiography.
CONCLUSION: Unenhanced ultrasound is not an adequately sensitive test to screen for endoleak after EVAR. In this small group of patients contrast enhanced ultrasound appears to be a reliable screening test for endoleak. The results raise some concerns about single pass CT as a gold standard for endoleak screening.
Abstract 57
TREATMENT OF SECONDARY MID-GRAFT ENDOLEAKS ASSOCIATED WITH THE VANGUARD ENDOPROSTHESIS
RD Edwards 1, DA Gould 2, JG Moss1 ,D Kessell 3, IR Robertson 3. Departments of Radiology, Gartnavel General hospital, Glasgow1 , Royal Liverpool University Hospital 2, St James University Hospital, Leeds 3.
PURPOSE: Mid-graft endoleaks (MGE) at the connection site are a recognised complication of endovascular repair of abdominal aortic aneurysms (EVAR) using modular endoprostheses. These may be clinically silent but repair is mandatory as the risk of aneurysm rupture remains. We report our experience of 4 patients who developed MGE with the Vanguard device.
MATERIALS AND METHODS: Mid-graft connection site endoleaks were detected in 4 patients who had undergone EVAR with the Vanguard device 6-12 months previously. In all cases the degree of connection site overlap was within the manufacturers recommendations at the time of placement. 3 patients were asymptomatic and were picked up at routine follow-up by enhanced computed tomography. 1 patient gave a 6 week history of short distance claudication and had an associated thrombosis of the contralateral (c/l) iliac limb. This patient, unlike the others showed no evidence of partial lysis within the aneurysm sac. In all cases treatment consisted of placing a Passager stent-graft across the defect. Preliminary thrombolysis was performed in the patient with the c/l limb thrombosis.
RESULTS: All MGE's were successfully treated. Complications included thrombosis of the c/l limb due to prolonged post-procedural femoral compression (150 mins), requiring a femoro-femoral crossover. A large femoral pseudoaneurysm in the patient receiving lysis resolved on conservative treatment.
CONCLUSION MGE's may be treated with a bridging stent-graft but additional intervention contributes to the overall procedural cost and morbidity. Possible causes include inadequate connection site overlap, excessive neck angulation and the effect of sac shrinkage. Plain radiographs are important to exclude a connection site dislocation.
Abstract 58
FOLLOW UP OF ABDOMINAL AORTIC ANEURYSM STENT-GRAFT: THE AETIOLOGY AND SIGNIFICANCE OF KINKED GRAFTS.
DA Gould, RD Edwards, R McWilliams, PC Rowlands, J Martin, D White, TR Helliwell, J Brennan, GL Gilling-Smith, A Bakran, PL Harris. Departments of Radiology, Histopathology and Vascular Surgery, Royal Liverpool University Hospital, UK.
SUMMARY: 32 patients have been followed for 14.3 months (mean) following endovascular repair (EVR) for abdominal aortic aneurysm (AAA). 22 had graft distortion (GD) which was associated with reduced sac dimensions and an increased incidence of limb endoleak.
MATERIALS AND METHODS: All patients had been investigated by preoperative computed tomography (CT) and angiography and were followed up by these investigations according to the Eurostar protocol. Complications were recorded, including any postoperative GD.
RESULTS: 40 patients (32 male, 8 female, mean age 71) were managed by EVR with 33 Vanguard, 7 AneuRx devices. 39 were technically successful with 32 followed for over 3 months (mean 14.3). There were 6 secondary limb endoleaks, 22 distorted grafts, 2 limb occlusions and 7 late deaths of which 3 were graft-related with 2 infected grafts and 1 rupture. Post mortem studies in one of these showed sac wall and lumen fibrosis. Possible factors in GD were graft lengthening, sac shortening and graft movement. Review of CTs and angiography showed no graft lengthening and <2mm graft movement. There was a mean sac diameter change of +5.5mms in non-distorted grafts and -6.3mms in GD (p = 0.0062). Sac length reduced by 3.6mms in non- distorted grafts and 15.8mms in GD (p = 0.0001). All 6 secondary limb leaks were associated with GD.
CONCLUSION: Procedural success with sac exclusion and subsequent sac diameter reduction correlated with sac length reduction and GD. GD appears to be an important cause of late limb leak and indicates a need for review of stent-graft design.
Abstract 59
EARLY RESULTS OF ENDOVASCULAR ANEURYSM REPAIR WITH THE ANEURX STENT GRAFT SYSTEM: THE UNITED KINGDOM ANEURX STUDY GROUP EXPERIENCE
David Kessel on behalf of the UK AneuRx Study Group. St James's University Hospital, Beckett St, Leeds LS9 7TF
PURPOSE: To report the collective experience of the UK AneuRx Study Group. The group comprises representatives from the principal UK centres using the AneuRx stent graft.
MATERIALS AND METHODS: A longitudinal study of all patients treated with a modular stent graft (AneuRx) in the UK. Procedural and follow up data were collected by questionnaire.
RESULTS: 77 patients (69 males) mean age 73 years (54-85) with aneurysms (AAA 73, iliac 4) have been treated. Bifurcated devices were used in 71 (92%) with straight tube grafts deployed in 6. Additional extensions were deployed in 26 (34%). Adjunctive angioplasty was necessary in 51(65%) patients to achieve a seal. Immediate complications were seen in 8 (10%) only 2 (3%) of these required surgery, there were no surgical conversions. There was 1(1.3%) death at 2 days. At discharge 8 (10%) patients had endoleaks, 6 (75%) sealed spontaneously. At 30 days one iliac graft had thrombosed and there were 3 groin infections. There were 3 endoleaks at 6 months, all were due to patent lumbar arteries (2 of the leaks were persistent, 1 developed between 3-6 months). Contemporary results will be presented.
CONCLUSION: Aneurysms can be safely and successfully treated with the AneuRx system. Technical success rates of aneurysm exclusion are high. Graft extension cuffs are often helpful and increase the likelihood of success.
Abstract 60
RETA - THE REGISTRY OF ENDOVASCULAR TREATMENT OF ABDOMINAL AORTIC ANEURYSMS.
S.M. Thomas, P.A. Gaines, J.D. Beard, on behalf of the British Society of Interventional Radiologists and the Vascular Surgical Society of Great Britain. Sheffield Vascular Institute, Northern General Hospital, Sheffield
PURPOSE: The RETA Registry is a voluntary registry within the United Kingdom established as a joint venture between Radiologists and Surgeons. The aim is to carefully evaluate the endovascular treatment of abdominal aortic aneurysms during introduction into clinical practice prior to widespread adoption.
MATERIALS AND METHODS: 367 patients have been submitted to the registry from 23 centres since its inception on 1st January 1996. In the majority (81.5%) an elective repair was performed for an asymptomatic aneurysm. The mean age of patient was 71.9 years and 28% were deemed unsuitable for conventional repair. 199 (54.5%) bifurcated, 18 (5%) tube and 148 (40.5%) aorto-uniiliac with crossover stent graft types were placed.
RESULTS: At the end of the procedure 77.4% of aneurysms were excluded with no complications. 21 (5.7%) of patients required conversion to open repair. 44 (12%) required additional endovascular procedures. At 30 days 87.3% of aneurysms were excluded or repaired. The 30 day mortality was 6.8% (n=24) with a significant improvement between 1996 and 1997, from 10.8% to 3.8% respectively. There were 25 (7.1%) persistent leaks. The death rate was related to the fitness of patient, device used and requirement for conversion.
1 year follow up data is available on 140 patients. There have been 13 deaths (9.4%), 3 ruptures (2.1%), and some form of complication in 24% of cases overall.
CONCLUSION: Improving results have been demonstrated for the primary procedure. At present there is a relatively high complication rate at follow up and ruptures have occurred. Rigorous continued follow up is required.
HEPATOBILIARY and MISC INTERVENTION
Moderator: David Nichols / Ruth England
Free papers (8 mins presentation / 2 mins discussion)
Abstract 61
MR GUIDED INFRA-RED LASER THERMAL ABLATION OF LIVER TUMOURS IN AN INTERVENTIONAL MR SCANNER. A FEASIBILITY STUDY.
De Jode MG*, Gedroyc W*, Lamb G*, Taylor-Robinson S. Interventional Magnetic Resonance Unit* and Department of Gastroenterology, St Mary's Hospital Paddington London.
PURPOSE: To establish the safety and technical feasibility of MR-guided thermoablation of primary and secondary liver tumours performed as a one- step integrated procedure in an open configuration 0.5T interventional MR scanner (IMR).
MATERIALS AND METHODS: Procedures were done under local or general anaesthesia. Lesions were targeted with a Flashpoint tracking device under real-time MR guidance, and punctured using an MR compatible kit with a Titanium needle followed by a 9F sheath. A Nd -YAG laser with an interstitial water-cooled fibre was used at powers up to 25W for 20minutes. Monitoring was performed during the laser therapy with an MR thermal mapping technique using a colourisation display.
RESULTS: 20 procedures on 11 patients are described, seven with hepatomas and four with secondary deposits. All but two have been performed under local anaesthetic and sedation. All lesions were visible with Manganese contrast. Burns have been produced in all patients up to 4cms in diameter, and thermal mapping has allowed good visualisation of the thermal lesions as they appear in all cases. Up to three separate burns have been produced via a single track by withdrawing the fibre and repeating the therapy. No complications have occurred during the treatment and all but two of the patients have been discharge the next day. Repeat procedures have been possible in seven patients.
CONCLUSION: An integrated MR guided and monitored laser thermoablation technique is described for use as a one-step procedure in an interventional magnet. The technique is feasible, safe , tolerated under local anaesthetic and produces thermal lesions up to 4cm without significant side effects. Given the prevalence of surgically incurable liver cancer the technique has a wide potential
Abstract 62
A MULTI-MODALITY APPROACH TO THE TREATMENT OF NONRESECTABLE HEPATOCELLULAR CARCINOMA.
A.G.Cowie*, A.N.Khan*, D.J.Sherlock+. Departments of Diagnostic Radiology* and Hepatic Surgery+, North Manchester General Hospital, Manchester, UK.
PURPOSE: To evaluate the efficacy of a multi-modality approach (MMA) to the treatment of nonresectable hepatocellular carcinoma (HCC) in terms of survival time.
MATERIALS AND METHODS: Thirty six patients with nonresectable HCC were treated over a three year period. A modified segmental trans-arterial chemo- embolisation (TACE) technique was used as first line treatment in all 36 patients. The technique involved an initial superselective intra-arterial injection of 2-4 mls of 1% lignocaine followed by embolisation using an emulsion of 50 milligrams of doxorubicin and 10 mls of iodized oil. The embolisation was subsequently sealed with 500-700 micron PVA particles. A total of 53 TACE's were performed with each patient undergoing between 1 and 5 chemoembolisations. The largest tumour embolised was 11cm and the largest number of tumours embolised in a single therapeutic episode was 18. Seven patients received second line percutaneous ethanol injection treatment because of a poor response to TACE. Four patients underwent hepatic resection and/or cryotherapy after TACE.
RESULTS: The over all cumulative survival rates at 1, 2 and 3 years are 82%, 56%, and 28% respectively. All eleven patients treated with a combination of modalities are alive 18 to 36 months after their initial treatment.
CONCLUSION: The life expectancy of nonresectable HCC is usually 6 weeks to 3 months. This is considerably increased using a MMA which should be tailored on an individual patient basis. A MMA appears to offer a promising therapeutic option in the management of this increasingly common malignancy.
Abstract 63
BUDD-CHIARI SYNDROME: TREATMENT BY ENDOVASCULAR TECHNIQUES
Kessel D, Davies M & Robertson I. St James's University Hospital Beckett Street, Leeds LS9 7TF
PURPOSE: To assess the value of interventional radiological techniques in the treatment of Budd-Chiari syndrome.
MATERIALS AND METHODS: A retrospective review identified nine patients with Budd-Chiari syndrome who were treated by interventional radiological techniques. All patients had hepatic dysfunction and ascites, patients with involvement of the IVC also had peripheral and truncal oedema. A variety of pathologies were identified;
Congenital hepatic vein webs 2
Thrombosed hepatic veins no peripheral flow 1
Thrombosed main hepatic veins with stenosis of accessory hepatic veins 2
Thrombosed middle and right hepatic veins, short occlusion LHV 1
Post hepatic surgery IVC stenosis +/- hepatic vein stenosis 3
Treatments included angioplasty and stenting from jugular, femoral and transhepatic approaches.
RESULTS: Venous patency was restored in 8 patients. Angioplasty was the sole therapy in 6 patients, 3 patients were stented. Two of the three stents remain patent (one patient died of unrelated causes 2 years after treatment), the single failure occurred in a patient with complete thrombosis of the peripheral hepatic veins. Hepatic function improved in all patients in whom patency was restored.
CONCLUSION: Patients with Budd-Chiari syndrome can be treated with conventional endovascular techniques. A patent peripheral hepatic vein segment is essential if recanalisation is to succeed.
Abstract 64
EVOLUTION OF RADIOLOGICAL TREATMENT FOR BUDD CHIARI SYNDROME.
S Olliff, Queen Elizabeth Hospital, University Hospital Birmingham, NHS Trust.
PURPOSE: To review recent experience of interventional radiology for the management of Budd Chiari syndrome.
MATERIALS AND METHODS: The radiological records and clinical notes of interventional radiology in Budd Chiari syndrome from 1996 to 1998 were examined. Radiological procedures include: hepatic vein dilatation, hepatic vein stent insertion, trans-hepatic approach to the hepatic veins, TIPS, thrombolysis, mesocaval shunt dilatation and stenting.
RESULTS: There were 10 men average age 41 and 11 women average age 39. Follow up was performed on 4 patients treated before 1996. Hepatic vein dilatation was successful in 4 and unsuccessful in 4. Percutaneous trans- hepatic and combined dilatation procedures were performed in 6. Hepatic vein stents were inserted in 5. There were 10 TIPS procedures including one failure. One had dilatation of a mesocaval shunt stenosis which also required stenting. For those treated before 1996 one combined trans- hepatic trans-jugular recanalisation was required. Two hepatic vein stents were placed. There were a number of follow up hepatic vein balloon dilatations. Three patients have required further intervention in follow up TIPS procedures. Two with failure of hepatic vein dilatation and TIPS had surgical mesocaval shunts. No other patients required surgery. All of the patients are alive and well apart from one who has died with recurrent renal carcinoma.
CONCLUSION: Interventional radiology has been effective in the management of Budd Chiari syndrome. The rationale of procedure selection will be discussed.
Abstract 65
RADIATION DOSIMETRY IN VARICOCELE EMBOLISATION
N Chalmers, A Hufton. Department of Radiology, Manchester Royal Infirmary and North Western Medical Physics
Oxford Road, Manchester M13 9WL
PURPOSE: Varicocele embolisation is undertaken in healthy young men. The procedure is of limited clinical benefit and there is a safe surgical alternative. Therefore it is important that we know the level of radiation risk posed to the patient and any offspring.
MATERIALS AND METHODS: Lithium fluoride (LiF) thermoluminescence dosemeters were positioned on the upper inner thighs of ten consecutive patients treated between 28/11/97 and 9/4/98 in order to estimate the dose to the testes. The dose-area product (DAP) readings, average kV and screening times were recorded for each patient. In addition, the DAP and screening times were analysed retrospectively for all patients treated between 1/10/94 and 28/11/97. Effective dose was calculated and fatal cancer risk was estimated.
Results: See table. Values are medians (1st quartile-3rd quartile)
Philips MD3 Philips MD3 Philips Integris V3000 Prospective Retrospective Retrospective
No of patients 10 23 19
DAP Gy.cm2 5.6 (4.9-12.5) 39.6 (19.6-58.1) 65 (14.4- 133.5)
Screening time (min) 5.2 (4.9-6.9) 14.6 (8.7-22) 5.7 (4.2- 13.7)
Gonad dose (mGy) 0.045 (0.035-0.065) - -
Effective dose (mSv) 0.66 (0.58-1.46) 4.6 (2.3-6.8) 7.6 (1.7-15.6)
Fatal cancer risk 40 per million 270 per million 450 per million
CONCLUSION: The gonad dose is only just above the threshold of measurement and is not considered significant. Significant differences in screening time and DAP exist between the prospective and retrospective data and between the two X-ray machines. Meticulous attention to technique is required to maintain effective dose at the lowest possible level.
Abstract 66
NASOLACRIMAL STENTING FOR EPIPHORA.
H R Seymour, TM Buckenham. Department of Radiology, St. George's Hospital, London.
PURPOSE: Flouroscopically guided nasolacrimal stent placement has been described as a safe and easy method of treating lacrimal sac and nasolacrimal duct obstruction. Previous treatments have centred on the use of surgical techniques, for which patency rates are well documented. Few studies have reported the patency rates following nasolacrimal stent (NLS) placement. We carried out a prospective study into the efficacy of NLS insertion.
MATERIALS AND METHODS: Patients with epiphora and nasolacrimal duct or sac obstruction or stenosis were invited to participate. All patients had dacrocystography to document the level of obstruction or stenosis. We inserted NLS under regional anaesthesia and recorded radiation doses. All patients were followed-up at regular intervals by telephone and where appropriate radiological investigation and intervention.
RESULTS: A total of 21 stents were inserted. 62% were due to obstruction. Procedural success (immediate patency) was achieved in 17 (81%). The early (<2months) primary assisted patency rate was 82% (14/17). Follow-up of patients was over an average of 9 months (range 4 - 14months). 78% (11/14) patients were symptomatically improved at late follow-up. Late patency was demonstrated in 8/9 patients by dacrocystography. 3 patients had stents removed one of which was symptomatically improved. 2 patients refused radiological follow-up but clinically improved. The mean radiation dose was 198.7 cGy.
CONCLUSION: Nasolacrimal stenting is a simple and effective way of treating epiphora, with a low procedural failure rate and few complications.
Abstract 67
THE USE OF SPIRAL CT IN THE ASSESSMENT OF LACRIMAL STENTS - INITIAL FINDINGS
Dr.E.A.North St.Helier Hospital, Carshalton
PURPOSE: To assess the use of spiral CT after nasolacrimal duct stenting.
MATERIALS & METHOD: 21 lacrimal stents were inserted in 17 patients. 13 of the patients were followed up by spiral CT 4 weeks after insertion. Patients were clinically assessed for epiphora and this was correlated with the CT findings. Radiation dose to the eyes was reduced by a protective shield during the topogram and by scanning from the top of the duct rather than the sac. A slice thickness of 1mm with a 1.5 mm feed (pitch 1.5) with a review of 0.5mm was chosen. Multiplanar reconstructions in the coronal, sagittal and occasionally oblique planes were used.
RESULTS: Excellent images of the stents were produced. In those patients whose symptoms were improved, the stents were shown to be surrounded by an air gap and/or the lower end was free from the inferior turbinate. In those patients whose symptoms had not improved the stent was shown to be embedded in soft tissue. No patients were clinically worse after stent insertion.
CONCLUSION: Spiral CT may be more helpful than conventional dacrocystography in the assessment of stent effectiveness because there is a better appreciation of the anatomy and the reason for stent failure can be appreciated at an early stage. Further follow up and comparison with dacrocystography is being undertaken.
Abstract 68
ANAESTHESIA, NURSING CARE AND CLINICAL TRENDS IN INTERVENTIONAL RADIOLOGY: A EUROPEAN SURVEY.P. Haslam, B. Yap, PR. Mueller, MJ Lee. Academic Department of Radiology, Beaumont Hospital & Royal College of Surgeons in Ireland, Dublin .
PURPOSE: To determine current European practice in interventional radiology regarding nursing care, anaesthesia and clinical care trends.
METHODS: A survey was sent to 977 European interventional radiologists to assess the use of sedoanalgesia, nursing are, monitoring equipment, pre and post-procedure care and clinical trends in interventional radiology. Patterns of sedoanalgesia were recorded for both vascular and visceral interventional procedures. Respondents rated their preferred level of sedoanalgesia for each procedure graded as follows: (a) awake/alert, (b) drowsy/arousable, (c) asleep/arousable, (d) deep sedation and (e) general anaesthesia. Sedoanalgesic drugs and patient care trends were also recorded.
RESULTS: 241 out of 977 radiologists responded (25%). The total number of procedures analysed was 208,679. The majority (56%) of diagnostic and therapeutic vascular procedures were performed at the awake/alert level of sedation, 32% were performed at the drowsy/arousable level and 12% at deeper levels of sedation. The majority of visceral interventional procedures were performed at the drowsy/arousable level of sedation (41%), 29% were performed at deeper levels of sedation, and 30% at the awake/alert level. 83% reported the use of a full time radiology nurse, 67% used routine blood pressure/pulse oximetry monitoring and 46% reported the presence of a dedicated recovery area. 87% reported daily patient rounds, 30% had inpatient hospital beds and 51% had day case beds.
CONCLUSION: This survey show clear differences in the use of sedation for vascular and visceral interventional procedures. Many, often complex, procedures are performed at the awake/alert level of sedation. Trends towards making interventional radiology a clinical speciality are evident with 51% of respondents having day case beds and 30% having inpatient beds.
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Last Update: 21st October 1998
Author: Dr Andrew Downie
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