Cardiovascular and Interventional congressR Radiological Society of Europe news 30 years of CIRSE CIRSE 2015 – Lisbon INNOVATION | EDUCATION | INTERVENTION Saturday, September 26, 2015

THE EARLY DAYS | THE BIRTH OF CIRSE | FIRST STEPS: 19862005 | MODERN ERA 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 EARLY DAYS 30RSE . EARLY Cyears

Dear colleagues, tradition of tumour boards, feature stimulating (IDEAS). This stand-alone programme features interdisciplinary exchanges on commonly 14 hours of targeted education, and will run Once again, we find ourselves returning to encountered challenges in the oncological and right here in the Centro de Congressos de Lisboa Lisbon to celebrate the biggest IR event of vascular fields. from Sunday morning until midday on Tuesday. the year. This year, however, we have more Delegates who have registered for either event than one event to celebrate: not only is Good practice can only be achieved – and will be able to attend these specialised sessions CIRSE launching the first Interdisciplinary maintained – by ongoing debate and critical and the CIRSE 2015 technical exhibition. Endovascular Aortic Symposia (IDEAS) evaluation. To this end, Hot Topic Symposia to morrow, but it is also celebrating its 30th on both paediatric and aortic interventions Going green Anna-Maria Belli Patrick Haage birthday! are planned, as are a number of Controversies CIRSE President Scientific Programme sessions addressing radiation safety, arterial In keeping with IR’s tradition of dynamism, Committee Chairperson The subspecialty has come a long way in this intervention and venous disease. To ensure and the digital age we find ourselves in, CIRSE time, and the congress will be showcasing vari- that best practice is determined by clinical has decided to become a greener meeting. ous events and services to reflect this. Today’s data, the popular Evidence Fora will examine The Main Programme has been replaced by Opening and Awards Ceremony will see the the use of peripheral and drug- a lighter abstract book, with more detailed Gold Medal awarded to Josef Rösch, one of IR’s eluting devices. information about the programme, faculty most exceptional pioneers (see page 2). and congress centre still available in the handy Other programme highlights for CIRSE 2015 Pocket Guide, as well as via the CIRSE app’s A one-off “X-Session” on Monday will feature include four Venous Forums, tackling diverse Itinerary Planner. This will reduce not only our the personal reminiscences of six CIRSE past- aspects of venous interventions. The high environmental footprint, but also the weight of presidents, who will recall important forma- turnout for 2014’s session on DVT and PE your congress bags! tive moments from their clinical careers, and suggests these will be particularly attractive to reflect on how the field of IR has grown and our delegates. Helping hands Christoph A. Binkert Fabrizio Fanelli progressed since their early involvement. Scientific Programme IDEAS 2015 Programme We also encourage you to attend our more The CIRSE app features many useful tools Committee Deputy Chairperson And in addition to our Members’ Lounge, we community-oriented sessions, such as the to help with your congress planning, including Chairperson have a special 30 Years of CIRSE Lounge, where Opening and Awards Ceremony, the Film an exportable itinerary, abstracts and inter- visitors can pick up memorabilia or browse a Interpretation Quiz, Amazing Interventions, active floor plans. It allows you to evaluate brand-new, specially created webpage that CIRSE meets China, and the one-off X-Session. sessions, search the technical exhibition by charts the history of the society. You never product category, take part in e-voting sessions know whose photo you might stumble across! Of course, special thanks are owed to our and submit questions to the moderator in industry partners, who participate not only selected sessions. Broad scientific programme in our Technical Exhibition, but also organise Satellite Symposia and Learning Centres, and It is available for iPhone, iPad and Android Once again, the congress is structured around support us in our aim to provide a unique (www.cirse.org/app) – those who already have six clinical tracks, allowing delegates to easily forum for innovation, education and research it installed on their device should add the find the sessions that are most relevant to their in IR. CIRSE/IDEAS 2015 event. Élia Coimbra Belarmino Gonçalves own daily practice and research. CIRSE 2015 Local Host CIRSE 2015 Local Focus on aortic interventions If you’ve any questions about the app, the Committee Chairperson Host Committee Interdisciplinary collaboration is an essential pocket guide or the congress itself, please call SPC Representative part of modern medical practice, and we are The widespread adoption of, and new techno - to the dedicated Info Point between Auditoria committed to welcoming practitioners from logi cal developments in, EVAR and TEVAR 1 and 2, where our friendly staff would be other specialties to our Annual Meetings. The in spired the introduction of a feature that is pleased to help. newly formed Multidisciplinary Expert Board making its debut at CIRSE 2015: the Inter- sessions, which draw on the collaborative disciplinary Endovascular Aortic Symposium We hope you’ll enjoy your stay in Lisbon!

Cardiovascular and Interventional Radiological Society of Europe C RSE 2 Opening and Awards Ceremony Saturday, September 26, 2015

Opening and Awards Ceremony – 14:30, Auditorium 1

Welcome to CIRSE 2015: four and a half and piano. He discovered the Glass Harp over Gold Medallist days of first-rate lectures, workshops and twenty years ago, and has been playing it ever debates on the ever-evolving IR subspe- since. cialty. With prominent researchers and clinicians coming together from all over the He covers a broad range of classics with his Josef Rösch globe to present the very best the field has instrument, covering pieces by Franz Liszt as Laudation: Jan Peregrin to offer, there is much to celebrate! well as by Leonard Cohen. The sound needs to be witnessed to be believed – and even Please join us for the Opening and Awards then it remains difficult to comprehend how a Ceremony, which starts today at 14:30 in collection of wine glasses can produce such an Auditorium 1. The event provides an ideal impressively wide range of subtle sounds. opportunity to highlight the achievements of Josef Rösch was born in Pilsen, Czechoslovakia niques, visceral and transjugular select physicians and researchers who have Spatina has performed all over the world, (today the Czech Republic) in 1925. He earned liver procedures to coronary angiography, made exceptional contributions to inter- including in Berlin, London, Moscow and his medical degree at Charles University in fallopian tube recanalisation and expandable ventional radiology. Sydney, and has made several TV appearances. Prague in 1950, before completing his radio- . An innovator in his field, Dr. Rösch logic training at the Central Military Hospital developed the TIPS technique in 1969, and The ceremony will again feature live musical His music was featured in a well-known car in Prague. Dr. Rösch began his angiographic introduced embolisation of gastrointestinal entertainment. This year, this will be provided advert in 2010. The film industry has also career with transparietal splenoportography haemorrhage in 1972. In the 1980s, his research by Petr Spatina, an artist who has developed an shown interest in his unique skill, and he has in 1954, later adding visceral angiography. focused on the use of endoluminal prostheses, intriguing technique involving a truly unique already been involved in producing music for While in Prague, he wrote two monographs: including their use in TIPS. His work helped instrument – the Glass Harp − consisting of 33 two European feature films. Transparietal Splenoportography and Radiology introduce TIPS to clinical practice. wine glasses, filled and tuned with water. of Spleen and Pancreas. The latter became a Be sure to join us for what will surely be a prime teaching book, and was translated into A prolific writer, Prof. Rösch has authored or Spatina was born in the Czech Republic as a memorable event! four languages. He became Doctor of Medical co-authored 493 scientific papers and book farmer’s son, and initially studied the accordion Sciences at Charles University in Prague in chapters, two books, and 23 scientific exhibits; 1965, and Docent in 1966. contributed to 17 teaching films/videos and CDs; and served as co-editor of two books. He In 1967, Dr. Rösch moved to the USA following is a fellow of both CIRSE and SIR, an honorary an invitation from Dr. Charles Dotter. Aside fellow of the ACR, a member of the RSNA from a two-year visiting professorship at UCLA, and the American Heart Association, and CVIR Editor’s Medal Award he has worked at OHSU ever since. At OHSU, an honorary member of many radiological he served as Chief of Cardiovascular Radiology societies worldwide. and, in the late 1980s, was instrumental in Use of Percutaneous Aspiration establishing the Dotter Interventional Institute, His work has been recognised with many CardioVascular and The official journal of the Cardiovascular and Interventional Radiological Society of Europe Thrombectomy vs. Anticoagulation of which he was the Founding Director until awards and honours, not least an OHSU Therapy to Treat Acute Iliofemoral Venous 1993. Prof. Rösch retired from clinical practice research professorship, the Josef Rösch Chair of CV Thrombosis: 1-Year Follow-up Results of a in 1995, and has since focused on research and Interventional Radiology Research, and epony- R Randomised, Clinical Trial education. mous honorary lectures by both CIRSE and the Society of Interventional Radiology of the This year’s Editor’s Medal will be presented V. Cakir, A. Gulcu, E. Akay, A. E. Capar, T. His research has covered diverse aspects of Czech Republic. to a research group from Turkey, for their Gencpinar, B. Kucuk, O. Karabay, A. Y. Goktay. IR, from super-selective catheterisation tech- investi gations into acute iliofemoral venous CVIR 2014 (Aug); vol. 37(iss. 4):969-76 thrombosis.

Award of Excellence and Innovation in IR

The Award of Excellence and Innovation in IR that inhibits tumour vessel growth instead of European Radiology: Vascular and Interventional Sciences. He is named as inventor on seven is sponsored by the R.W. Günther Foundation, relying on standard doxorubicin-eluting beads. and CVIR. Prof. Denys has published over 170 patents. and seeks to reward and encourage excep- papers in peer-reviewed journals. tional research in the field of interventional The group’s investigations have scrutinised Katrin Fuchs is a Ph.D. candidate at the radiology. The award is presented during the different elements of this option, focusing Dr. Pierre Bize is a senior physician in the University of Geneva, focusing her thesis on Opening and Awards Ceremony of the CIRSE on sunitinib malate, which has been identi- Department of at CHUV. He anti-angiogenic strategies for transarterial Annual Meeting, bestowing recognition and a fied as a potent inhibitor. In one study, the trained in general , cardiac surgery and chemoembolisation. She completed her phar- €5,000 prize to the best applicant. group demon strated that sunitinib could be neurosurgery before focusing on radiology macy studies at the University of Regensburg, adequately carried by a widely used, commer- and interventional radiology. He specialises in in Germany, in 2010, and is a licensed pharma- This year, the award will go to the Leman cially available type of embolic microsphere. tumour ablation and embolisation techniques, cist since 2011. Research Group from Lausanne, Switzerland, The researchers have also compared different including chemoembolisation, and has particu- for their research on drug-eluting beads loaded in vitro methods to measure the drug released lar expertise in the management of VX2 animal Dr. Olivier Jordan, a senior lecturer at the with anti-angiogenic agents for chemoembo- from sunitinib-eluting beads, focusing on the model trials. University of Geneva, holds a Ph.D. in physics. lisation. influence of varying hydrodynamic conditions. He works at the university’s Laboratory of Prof. Gerrit Borchard is full professor in biop- Pharmaceutics and Biopharmaceutics, carrying The innovation In addition, the group has successfully tackled harmaceutical sciences at the University of out research projects on injectable biomateri- the challenge of loading drug-eluting beads Geneva. In 2013, Prof. Borchard was elected als, and teaching on biomaterials and technolo- Transarterial chemoembolisation uses with anti-angiogenic agents of low aqueous Vice President of the Executive Committee of gy transfers. His areas of expertise include drug microspheres to both embolise the hepatic solubility, such as sunitinib, developing a novel the European Federation of Pharmaceutical delivery via loco-regional approaches. artery and block the tumour’s blood supply, method for doing so. The new loading method and to serve as targeted anti-cancer or has been patented in Europe. anti-angiogenic drug-carriers. Drug-eluting beads have become an accepted part of The winning team this procedure. However, challenges remain. The suitability of the main drug used for The research was produced by the Leman this therapy – Doxorubicin – has been ques- Research Group, which consists of Prof. Alban tioned. In addition, the ischaemia induced Denys, Dr. Pierre Bize, Prof. Gerrit Borchard, by the embolisation also contributes to the Katrin Fuchs and Dr. Olivier Jordan. development of new vessel sprouts near the tumour. Prof. Alban Denys heads the Digestive and Oncologic Imaging and Interventional The Leman Research Group has paved the way Radiology Unit at the University Hospital of for overcoming these hurdles by exploring Lausanne (CHUV), where he is also a full pro- the possibility of combining embolic beads fessor. Prof. Denys serves as reviewer for mul- with a multi-targeted tyrosine kinase inhibitor tiple journals, and is on the editorial board of (from left to right) A. Denys, K. Fuchs, G. Borchard, O. Jordan, P. Bize

Special Edition / CIRSE 2015 – Lisbon I 3 congress Opening and Awards Ceremony newsR

Distinguished Fellow Distinguished Fellow

Riccardo Lencioni Katerina Malagari Laudation: Andy Adam Laudation: Elias Brountzos

Riccardo Lencioni is one of the world’s foremost Riccardo Lencioni also launched the first Katerina Malagari is an associate professor nationally, and has published 107 articles in interventional oncology specialists, and is programme on RFA of lung tumours in of radiology in the IR division of the peer-reviewed journals. particularly well-known for his influential work Europe. He has been active in investigating Department of Radiology at the University on liver cancer. the potential synergies between molecular- of Athens, in Greece. Dr. Malagari was board Her publications focus on chemoembolisa- targeted agents and interventional techniques, certified in 1990, and obtained her Ph.D. tion of HCC, with recent articles assessing In 1994, while still a radiology resident, Prof. and was the principal investigator for the two from the University of Athens two years later. the response of HCC to transarterial chemo- Lencioni published the first European study largest multicentre randomised controlled She completed a fellowship in Chest at the embolisation with mRECIST criteria and on the combined use of chemoembolisation trials assessing the clinical benefits of inno- University of Alabama at Birmingham, and a contrast-enhanced US, the safety and efficacy and ethanol injection for the treatment of vative regimens – the very first global clinical fellowship in interventional radiology at the of chemoembolisation of HCC, and chemo- hepatocellular carcinoma (HCC), in CVIR. This studies ever conducted in the field of inter- University of Athens, before obtaining EBIR embolisation with doxorubicin-eluting beads was followed one year later by his seminal work ventional oncology. He is also well-known for certification in 2010. for unresectable HCC. on prognostic factors for HCC patients treated being the lead author of the modified RECIST with local ablation. The criteria for identifying criteria (mRECIST) for the evaluation of tumour Her clinical and research interests centre on Dr. Malagari is an active member of various long-term survivors, published in his 1995 response in HCC. embolisation, with a special focus on inter- multidisciplinary committees and of several paper in Cancer, were confirmed as the best ventional oncology. She is currently part international societies, including CIRSE, SIR, outcome predictors for liver transplantation, He has received considerable international of Prof. Dimitrios Kelekis’s research team, the Αmerican Roentgen Ray Society, and the and are currently accepted worldwide for recognition, including awards for the most- working with Dr. Mary Pomoni at Evgenidion European Society of Thoracic Imaging, serv- defining early-stage HCC. cited publications from the editors-in-chief of Hospital and Attikon University Hospital. ing as President of the latter’s Annual Meeting European Radiology and CVIR. Prof. Lencioni She also actively contributes to efforts to in 2007. She contributed to CIRSE’s quality Prof. Lencioni has always been on the cutting is actively involved with numerous scientific develop scientific protocols for research in assurance guidelines for the endovascular edge of research in interventional oncology. societies and organisations, including CIRSE, inter ventional oncology, and is part of the treatment of occlusive lesions of the sub- He conducted the first randomised controlled SIR, EAR, ECR, RSNA, WCIO, ESGAR, ILCA and National Referral Centre for Liver Diseases and clavian and innominate arteries, served on the trial on the use of radiofrequency ablation for SIRM. Hepatocellular Carcinoma of Greece. Scientific Programme Committee for ECIO 2013, HCC in 2003, and the first intention-to-treat and has given numerous presentations at CIRSE analysis of long-term survival of treated In addition, Riccardo Lencioni has authored 182 An editorial board member of CVIR, Annual Meetings and ECIO and GEST confer- pa tients in 2005. The results of these studies articles in peer-reviewed, international journals Dr. Malagari is also an active reviewer for ences. led to the recognition of image-guided abla- indexed in PubMed. According to the SCOPUS various other scientific journals, including tion as the standard of care for non-surgical database, his publications have been cited in Hepatology, Hepatogastroenterology, European Her work was recognised with the Best patients with early-stage HCC in international international scientific literature over 13,000 Radiology, Chest and European Respiratory Scientific Paper award at ESTI 2005. She was guidelines. times, amounting to an h-index of 53. Journal. She has also contributed to sixteen also part of the team awarded the CVIR Editor’s books, distributed both in Greece and inter- Medal in 2012.

Distinguished Fellow Distinguished Fellow

Hannu Ilmari Manninen Gao-Jun Teng Laudation: Poul-Erik Andersen Laudation: Dierk Vorwerk

Hannu Manninen completed his M.Sc. degree femoropopliteal ASO. Recently he has also Dr. Gao-Jun Teng is a professor and the Chair spiral automated lumbar nucleotome that in medical physics and his M.D. degree at the focused on aortic interventions and novel of Radiology and at Zhongda has been used to treat thousands of patients University of Kuopio in 1980. He finalised his techniques for treatment of intracranial Hospital, Southeast University in Nanjing, in China. As a research fellow in Dartmouth- thesis in diagnostic radiology in 1985 and aneurysms and acute stroke. He has been an China. Hitchcock Medical Centre (1995-1998), Dr. Teng completed his residency in Kuopio University editorial board member of European Radiology, was involved in the mechanism study of TIPS Hospital in 1987. He was appointed head of Acta Radiologica and CVIR. At the time of Dr. Teng’s radiology residency, restenosis, helping to verify the role of bile leak the 1st Department of Radiology at Kuopio IR had only just been introduced to China. in TIPS restenosis and use of covered stents. University Hospital in 1989. In 2004, he was Prof. Manninen has served the Radiological After a mini-fellowship with Dr. Zhijiang Liu, both promoted to chairman of the entire Society of Finland as board member, Vice- Dr. Teng decided to pursue a career as an Dr. Teng is an active researcher. He has radiology clinic, and became Professor of President and President. He has also been an interventional radiologist in 1987. As the first authored or co-authored more than 300 Interventional Radiology at the University of adminstrative member of the Finnish Medical IR at Zhongda Hospital, he began his IR career publications featured in Lancet Oncology, PNAS, Eastern Finland. Society Duodecim and the Finnish Society of with interventional oncology. He also per- Radiology, Journal of Hepatology, Diabetes, CVIR Angiology. He was a member of the Council of formed many "first interventional procedures" and JVIR as well as 10 Chinese book chapters. Prof. Manninen is the author or co-author of Medical Faculty of Kuopio University from 2001- at Zhongda Hospital, including transcatheter He has delivered hundreds of lectures and more than 150 peer-reviewed original publi- 2003 and a president of the Finnish Society of embolisation for gastroenteral bleeding and scientific presentations nationally and inter- cations and he has written 20 reviews or book Interventional Radiology from 1997-1998. haemoptysis, PTA/stenting for renal arterial nationally. He has also hosted many Chinese chapters, mainly focused on cardiovascular Prof. Manninen is also EBIR-certified and a stenosis, treatment of Budd-Chiari syndrome, scientific conferences. Over the last decade, imaging and interventional radiology. For CIRSE Fellow. He was the local chairman of the TIPS, percutaneous discectomy, percutaneous Dr. Teng has served as editor and associate more than 25 years, his main areas of scientific first advanced ESIR course on vascular inter- vertebroplasty, grafting for AAA and editor for many journals, including CVIR and interest have been endovascular therapies ventions, held in Kuopio in 2008, and since , IVC filter placement, and RF, Chinese JVIR. for peripheral ASO, including pioneering 1996, has organised ten national meetings in cryo- and microwave ablation of tumours. pros pective studies of infrapopliteal PTA Kuopio University Hospital focusing on vascular Dr. Teng was President of the Chinese Society and gene therapy. He has been the principal imaging and interventions, including lectures During his career, Dr. Teng has developed of Interventional Radiology (CSIR) during the investigator in two prospective randomised and live cases transmitted from angio-suites several new techniques and devices, includ- term 2009-2011, and is currently the vice- trials, com paring hysterectomy with endo- and operating theatres. He has also held ing a unique radioactive stent system for president of the Chinese Society of Radiology, vascular embolisation of uterine leiomyomas numerous hands-on training sessions using oesophageal carcinoma and biliary tract and president-elect of the Asia-Pacific Society and evaluating the placement of drug-eluting pig models for small groups of young inter- malignancies, respectively, with a Phase 3 of Cardiovascular and Interventional Radiology stents with bypass surgery for treatment of ventional radiologists. trial published in Lancet Oncology, and a new (APSCVIR) for the term 2014-2016.

Cardiovascular and Interventional Radiological Society of Europe C RSE 4 Vascular Interventions Saturday, September 26, 2015

Don’t miss it ! Controversies in venous disease treatment Special Session Surgery for Paget Schroetter syndrome is mandatory: pro Saturday, September 26, 11:30-12:30 Stephen Black Auditorium 6

e-voting

Stephen Black Paget Schroetter syndrome is a phenomenon on restoring normal venous outflow from the A recent review of the literature has indicated Guys and St Thomas’ of upper limb deep thrombosis stimulated upper limb and, if performed early enough, a clear benefit from a strategy of rib removal. Hospital / King’s College, by repetitive endothelial damage to the sub- maintaining the integrity of the vein and Somewhat surprisingly, the addition of veno- University of London clavian and axillary , resulting in throm- minimising endothelial damage. plasty to lysis plus rib resection did not appear London, UK bosis. to confer any additional benefit [11]. However, Therefore, there are two options for treatment: this is undoubtedly a reflection of the num- It is well recognised that anatomical factors bers involved in the study, as it continues to which allow for repetitive trauma during the 1) Venous lysis without surgery (lysis, veno- seem that venoplasty after first rib resection course of exercise (or effort) facilitate and plasty +/– stent) for a persistent significant stenosis would be perpetuate this trauma [1, 2]. The anatomical 2) Venous lysis plus surgery (+/- venoplasty advantageous. Dr. Black is a consultant vascular surgeon at abnormalities that allow the thoracic outlet to +/– stent) Guys and St Thomas’ Hospital, where he is the be restricted are formed by the first rib, clavicle This paper suggests symptom relief at last clinical lead for venous and lymphoedema and scalenus anterior muscle in the main, with The first non-surgical strategy ignores the follow- up was significantly more likely in the surgery. He is also Honorary Senior Lecturer at contribution from other abnormalities such as contribution made by the anatomical factors, first rib resection (with or without venoplasty, King’s College London. Together with colleagues the presence of a cervical rib, congenital bands, and therefore the original underlying risk factor 95%) than in the rib not removed (54%) group he has established a multi-disciplinary team for hypertrophy of scalenus tendons, and abnor- for re-thrombosis remains (Fig. 1). (p <0.0001), as was patency (98% vs. 48%, the management of complex venous disease. mal insertion of the costoclavicular ligament. p <0.0001 vs. rib not removed). In the papers His clinical interests are primarily treatment of These anatomical factors contribute to the Published results of the first strategy suggest reviewed, 40% of patients who did not have deep venous disease and DVT. Dr. Black is an repetitive endothelial injury to the vein, which good results may be achieved in up to 75% the rib removed required this at a later stage examiner for the Fellowship of the European ultimately results in thrombus formation. The of patients (although many studies publish due to persistent symptoms. Board of Vascular Surgery and is on the role of other factors such as haematological worse results), with the remainder requiring Programme Committee for Charing Cross and the abnormalities, while undoubtedly part of the surgery at a delayed interval due to residual This review did highlight the paucity of robust European Venous Forum Hands-on Workshops. process, are less well established [3]. symptoms, principally recurrent thrombosis evidence and the absence of proper trial data and development of post-thrombotic to influence current treatment strategies. A Established practice had, as with lower limb syndrome. randomised trial of lyisis plus venoplasty vs. DVT, viewed anti-coagulation alone as the gold lysis, plus first rib resection and venoplasty, standard treatment for DVT of both upper and A strategy of selective surgical intervention would be beneficial. The experience of trials

References: lower limb. With advancements of, in particular, after lysis, while in principal sensible to avoid for ileo-femoral DVT has suggested it would be 1. Zell L, Kindermann W, Marschall F, et al. Paget- S chroetter catheter-directed lysis techniques, it is now the risks of surgical intervention, is only pos- difficult to randomise patients to conventional syndrome in sports activities- case study and literature review. Angiology. 2001;52:337–42. [PubMed] increasingly apparent that the long-term sible with a robust pathway for identifying treatment vs. any lysis strategy. 2. Urschel HC, Jr, Patel AN. Surgery remains the most effective consequences of conservative management in which patients would require surgery. No such treatment for Paget-Schroetter syndrome: 50 years‘ experience. Ann Thorac Surg. 2008;86:254–60. [PubMed] a young patient population are unacceptable, pathway exists, with current evidence too It therefore remains, with current evidence, 3. Heron E, Lozinguez O, Alhenc- G elas M, Emmerich J, Fiessinger with the rate of post-thrombotic syndrome heterogeneous to allow for meaningful that the best results for the treatment of Paget- JN. Hypercoagulable states in primary upper extremity . Arch Intern Med. 2000;160:382–6. [PubMed] higher in the upper limb than the lower limb analysis [8]. Schroetter syndrome are achieved by a policy 4. Donayre CE, White GH, Mehringer SM, et al. Pathogenesis [2, 4-6, 7]. of catheter-directed lysis and correction of the determines late morbidity of axillosubclavian vein thrombosis. Am J Surg. 1986;152:179–84. [PubMed] In addition, venoplasty and stenting without anatomical abnormality (first rib resection) in 5. AbuRahma AF, Robinson PA. Effort subclavian vein thrombosis: The premise is accepted that, ultimately, inter- rib resection has extremely poor outcomes due all patients who are suitable for intervention. evolution of management. J Endovasc Ther. 2000;7:302–8. [PubMed] vention confers better results; this is predicated to stent fracture and re-occlusion [2, 8-10]. 6. U rschel HC, Razzuk MA. Paget- S chroetter syndrome: What is the best management? Ann Thorac Surg. 2000;69:1663–9. [PubMed] 7. Grunwald MR, Hofmann LV. Comparison of urokinase, alteplase, and reteplase for catheter- directed thrombolysis of deep venous thrombosis. J Vasc Interv Radiol. 2004;15:347–52. [PubMed] 8. Lee JT, Karwowski JK, Harris EJ, et al. Long-term thrombotic recurrence after nonoperative management of Paget- Schroetter syndrome. J Vasc Surg. 2006;43:1236–43. [PubMed] 9. Molina JE, Hunter DW, Dietz CA. Protocols for Paget- S chroetter syndrome and late treatment of chronic subclavian vein obstruction. Ann Thorac Surg. 2009;87:416–22. [PubMed] 10. Urschel HC, Jr, Patel AN. Paget-Schroetter syndrome therapy: failure of intravenous stents. Ann Thorac Surg. 2003;75:1693–6. 11. L ugo J, Tanious A, Armstrong P, Back M, Johnson B, Shames M, Moudgill N, Nelson P, Illig KA. Acute Paget- S chroetter Syndrome: Does the First Rib Routinely Need to Be Removed after Thrombolysis? Subclavian vein post-plasty (top picture) and the same patient at 6 weeks without rib resection. First rib resection: exposure showing artery, scalenus anterior muscle and vein.

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Cardiovascular and Interventional Radiological Society of Europe

Special Edition / CIRSE 2015 – Lisbon I 5 congress Vascular Interventions newsR

Don’t miss it ! Controversies in venous disease treatment Surgery for Paget Schroetter syndrome is mandatory: con Special Session Saturday, September 26, 11:30-12:30 Gerard O’Sullivan (EBIR) Auditorium 6

e-voting

The title of this debate is "Surgery for Paget quired. If, however, symptom relief is not great, To interventional radiologists, "surgery" would Gerard O’Sullivan Schroetter syndrome is mandatory". Not only is or the patient’s livelihood depends on having clearly represent some form of open opera- (EBIR) it not mandatory, it is in fact rarely indicated, as an arm that can function at a high level (athlete, tion, whereas "surgery" to the general public University College the literature amply demonstrates. musician) then thrombolysis will directly attack would be taken to include any form of inter- Hospital Galway the thrombus, followed by continued anti- vention including , wire passage, Galway, Ireland The problem with coagulation for several months. Some authors thrombolysis and venoplasty. I am not sure (TOS) is that it is a catch-all term for a wide stop at thrombolysis, while others feel surgery which meaning we should take. In fact, again it variety of conditions whose causes are attri- is needed to decompress the area between doesn’t matter because neither "surgery" nor buted to compression of neurovascular struc- the back of the first rib and the front of the any form of “intervention” are indicated in the tures as they exit the thorax. clavicle. The timing of this is debated. If the vast majority of patients. vein is damaged, it needs to be gently dilated Dr. Gerry O’Sullivan is a consultant interventional Paget Schroetter syndrome is the venous or perhaps replaced following surgical decom- The results from surgery vary considerably de- radiologist at the University College Hospital, subset of thoracic outlet syndrome (VTOS): pression. pending on operator experience. Complications Galway. He completed his basic training in radiology it comprises between 3-10% of all cases of are inevitably under-reported, as low volume in Plymouth and St. George’s, London, before TOS. It is rare; you will see about 45-50 cases of Even if they are "acute" by history (<14 days), centres are unable to present their data. completing an IR fellowship in Stanford under Mike lower-limb DVT for one case of acute VTOS/PSS. often venography reveals multiple collaterals Potential complications from surgery can Dake. He worked as a consultant in Chicago before That said, acute PSS/VTOS is relatively easy for – suggesting that it is acute on chronic – and include pneumothorax, injury to the subclavian moving to Galway in 2002. He specialises in vascular the trained clinician to recognise, comprising the collaterals themselves make the game more artery or vein, injury to the brachial plexus and procedures, and is particularly well known for his upper limb swelling, pain and colour change complicated still. To quote Thomson et al. 2011: long thoracic nerve, apical haematoma, inter- expertise in the venous field, especially DVT. In this most commonly after significant upper limb costobrachial nerve injury, and injury to the respect, Dr. O’Sullivan has been a regular faculty exertion (throwing a javelin, playing baseball, "The presence of good collateral veins on the thoracic duct. member at CIRSE meetings, actively participating in etc.). It is more common in the dominant arm, preoperative venogram suggests that outflow debates, lectures, panel discussions and workshops and more common in young males. obstruction is longstanding and presents a There is no level 1 evidence to back up this each year since 2006. dilemma. Removal of the first rib may not treatment plan. A Cochrane review (2014) Apart from truly acute presentations, the improve the functional obstruction because concluded that there is a need for an agreed References: diagnosis can be clinically difficult: there is no it has relied on the collaterals for some time. definition for the diagnosis of TOS, agreed out- 1. H. Machleder, "A brief history of the thoracic outlet agreement on what tests to perform. Some Conversely, if the rib is resected, preferential come measures, and high quality randomised compression syndromes," in Thoracic Outlet Syndrome, K. A. Illig, R. W. Thompson, J. A. Freischlag, D. M. Donahue, rely on colour Doppler US, some insist on veno- flow through the well-established collaterals trials that compare the outcome of interven- S. E. Jordan, and P. I. Edgelow, Eds., pp. 3-9, Springer, New York, graphy, some CT/MR – most use provocative may steal blood from a stenosed subclavian tions with no treatment and with each other. NY, USA, 2013 2. Venous Thoracic Outlet Compression and the Paget-Schroetter arm manipulation. Some use electro-diagnostic vein and lead to immediate thrombosis during Syndrome: A Review and Recommendations for Management. stimulation. To me, the best test seems to be an the postoperative period." In summary, if we lived in an ideal world where J. F. Thompson, R. J. Winterborn, S. Bays, H. White, D. C. Kinsella, A. F. Watkinson. Cardiovasc Intervent Radiol (2011) 34:903-910 experienced clinician taking a good history, and all patients presented acutely, were all gifted 3. R. L. Feinberg, "Clinical presentation and patient evaluation in performing a thorough physical examination But the reality is that not all patients are gifted musicians who wished to continue on in their VTOS," in Thoracic Outlet Syndrome, K. A. Illig, R. W. Thompson, J. A. Freischlag, D. M. Donahue, S. E. Jordan, and P. I. Edgelow, on a reasonably intelligent patient within two athletes/musicians, and they are rarely referred chosen career, and you worked in a centre Eds., pp. 345-353, Springer, London, UK, 2013 weeks of the initial onset of symptoms. in time: the diagnosis is often delayed or in- where an experienced vascular surgeon could 4. A. J. Doyle and D. L. Gillespie, "VTOS for the primary care team: when to consider the diagnosis," in Thoracic Outlet Syndrome, correct, and by the time the correct diagnosis is undertake thoracic outlet surgery within 24 K. A. Illig, R. W. Thompson, J. A. Freischlag, D. M. Donahue, For acute axillo-subclavian venous thrombosis, made, the window for thrombolysis has passed hours of finishing catheter-directed thromboly- S. E. Jordan, and P. I. Edgelow, Eds., Springer, 2013 5. W. Brandon and J. A. Freischlag, "Thoracic outlet syndromes," treatment needs to address three problems: and we enter the chronic phase. Here the sis, (and assuming that a good quality RCT is ac- in Current Surgical Therapy, J. L. Cameron and A. M. Cameron, the thrombus, the extrinsic compression, and waters become much more muddied. Accurate tually done somewhere in the world), then you Eds., Elsevier, New York, NY, USA, 11th edition, 2013 6. B. S. Brooke and J. A. Freischlag, "Contemporary management the intrinsic damage to the vein. Initial anti- distinction between chronic VTOS and neuro- should consider voting "yes". In the real world, of thoracic outlet syndrome". Current Opinion in Cardiology, vol. 25, no. 6, pp. 535–540, 2010 coagulation often results in rapid symptom logical TOS is more difficult, as there is signi- unfortunately, "NO" is the only sensible option. 7. A comprehensive review of Paget-Schroetter syndrome. relief and no further intervention may be re- ficant symptom overlap. K.A. Illig, A.J. Doyle. J Vasc Surg 2010;51:1538-47

INNOVATION | EDUCATION | INTERVENTION

CIRSE 2015 LIVE AND ON DEMAND

Live-Channels Room 1 Room 2 Room 3 Room 4 On-demand

Once again, the hugely popular CIRSE live-stream will be hosted on ESIRonline, providing you with an ideal opportunity to share some of the congress highlights with colleagues who could not attend in person.

New this year: on-demand service. Tune in whenever suits your schedule! COMING LIVE FROM THE 4 LARGEST AUDITORIA AT CIRSE 2015!

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Cardiovascular and Interventional Radiological Society of Europe C RSE Have fun and do good! Take part in the CHILDREN’S CANCER CHARITY EVENING Saturday, September 26 at 19:00 Lisbon University Stadium

Join us tonight for sports and socialising – all are welcome!

Shuttle buses leave from outside the congress centre at 18:15 and will drop you off at various central locations after the event.

A delicious buffet will be provided from 19:45 until the end of the Football and Tennis Cup.

Where: Lisbon University Stadium Av. Prof. Egas Moniz 1600-190 Lisbon

If you miss the shuttle bus, the stadium can also be reached by public transport:

Yellow Metro line to Cidade Universitária Buses 701, 731, 735, 738, 755 or 768 to Hospital Sta. Maria

The event supports the Portuguese Association "Acreditar", which helps patients and families confronted with childhood cancer. For further information on Acreditar, please visit www.acreditar.org.pt.

CIRSE supports compliance with ethical standards. Therefore, CIRSE emphasises that the present invitation is directed to participants of CIRSE 2015, and recommends that participants who want to take part in the Children’s Cancer Charity Evening bear any and all costs in this context (including donations) themselves.

Kindly note that participation in the Children’s Cancer Charity Evening is NOT included in the CIRSE 2015 registration fee! C RSE I 7 congress Transcatheter Embolisation newsR

Don’t miss it ! Bariatric embolisation Early clinical results of bariatric embolisation Special Session Saturday, September 26, 08:30-09:30 Clifford Weiss, Olaguoke Akinwande, Dara Kraitchman and Aravind Arepally Auditorium 2

Obesity is a chronic illness that is currently endpoint was 30-day adverse events and and solid gastric emptying showed no change Clifford R. Weiss regarded a public health crisis [1]. Moreover, weight loss. Secondary endpoints were blood from baseline. Johns Hopkins Hospital the World Health Organization recognises pressure, lipid profile, ghrelin levels, serum Baltimore, MD/USA global obesity as an epidemic [2], therefore, obesity hormones (leptin, GLP-1, PYY), eating Discussion there is a need to establish effective and safe and hunger/satiety assessments, quality-of- treatments for this disorder. There are multiple life parameters, food intake and endoscopic Our preliminary findings showed that bariatric established conditions linked to obesity includ- assessment. embolisation was safe for the treatment of ing diabetes, heart disease, stroke and cancer, morbid obesity as demonstrated by the lack to name but a few. Conversely, weight loss de- Patient pre-procedure assessment included of high-grade adverse events. As expected, creases the risk of some of these conditions. pre-procedural CTA, upper endoscopy, gastric mild gastrointestinal adverse events were seen, emptying study, gastric hormone panels, which can easily be managed but likely require Dr. Weiss is an Associate Professor of Radiology, The initial management of obesity is lifestyle quality-of-life questionnaire (QOL) and obe- a short post-procedure inpatient observational Surgery and Biomedical Engineering in the intervention, which includes diet modification sity-related psychological assessment. Post- period. Given the small sample size in this early Division of Vascular and Interventional Radiology and exercise – the goal being to create a net procedural assessment included upper endos- stage of analysis, it is difficult to compare mor- at the Johns Hopkins Hospital. He received his energy deficit. Unfortunately, most obese copy (at week 2 and month 3), gastric emptying bidity rates with bariatric surgery at this time. medical, diagnostic and interventional radiology patients fail lifestyle modification techniques studies (1 month and 6 months), full laboratory Quality of life was preserved throughout the training at Johns Hopkins and is now also their and resort to surgery. Bariatric surgery (Roux- and gastric hormone panels, QOL and 30-day evaluation period, which implies that Director of Interventional Radiology Research and en-Y gastric bypass, sleeve gastrectomy, gastric obesity-related psychological assessments. The the procedure does not interrupt normal daily the Medical Director of the Johns Hopkins Center banding) in a well-selected population has procedure involved a celiac angiogram with functioning and may outperform surgery in for Bioengineering, Innovation and Design. His good efficacy compared to lifestyle modifica- cone-beam CT (Siemens Healthcare) to assess this regard. Although a conclusion about the clinical practice is currently focused on the treat- tion, but carries a significant risk of minor and the anatomy. Then, subselective left gastric and efficacy of BE is premature as only five patients ment of vascular malformations. He serves on major morbidity (10% and 13 %, respectively) gastroepiploic angiograms were performed were sampled, we can make some preliminary numerous policy and review boards within the [3]. Current pharmacological therapies, while to better assess fundal perfusion. After careful observations. radiological sciences, and has published over 40 theoretically safer, have not shown results planning, embolisation of one or more fundal peer-reviewed articles. His research on bariatric approaching those seen with bariatric surgery. arteries was performed with 300-500 μm mi- There was modest but statistically significant embolisation has been done in collaboration with crospheres. Preliminary results were obtained mean weight loss at 30 days. Of note: our in- colleagues Dr. Olaguoke Akinwande, Dr. Dara Bariatric embolisation (BE) is an investigational in our five enrolled patients at the 30-day time house weight management programme was L. Kraitchman and Dr. Aravind Arepally. minimally invasive technique that could point. A paired two-sample t-test was used to not mandated after our procedure and, as a potentially result in weight loss by way of evaluate the differences in weight. result, most patients were not compliant. This ghrelin hormone modulation [4]. Ghrelin is implies that the weight loss experienced by our of particular interest because of its potent Results patients was mostly related to the procedure orexigenic (appetite-stimulating) effects alone, making the observed modest weight References: 1. Wang Y, Beydoun MA. The obesity epidemic in the United and its abundance in the fundus of the Median BMI at study enrollment was 43.9 lost more impressive. Further, the weight loss States – gender, age, socioeconomic, racial/ethnic, and stomach, permitting endovascular targeting. (range: 40.2 to 47.8) and median age was 36 curve did not plateau during the 30-day time geographic characteristics: a systematic review and meta- regression analysis. Epidemiologic reviews. 2007;29:6-28. Specifically, embolisation to the arteries years old (range: 31 to 49). After completion of interval, so we expect more weight loss in the doi: 10.1093/epirev/mxm007. PubMed PMID: 17510091 2. James WP. WHO recognition of the global obesity epidemic. supplying the fundus of the stomach inhibits bariatric embolisation in five subjects, there ensuing weeks. Preliminary findings showed International journal of obesity. 2008;32 Suppl 7:S120-6. ghrelin- producing cells and consequently were no major adverse events. Three subjects no significant change in mean serum hormone doi: 10.1038/ijo.2008.247. PubMed PMID: 19136980 3. O’Rourke RW, Andrus J, Diggs BS, Scholz M, McConnell DB, decreases the release of ghrelin to the (60%) were admitted (<48 hour admission) levels in our initial dataset. Most likely this is Deveney CW. Perioperative morbidity associated with bariatric circulation [5-7]. Given the promising findings for nausea, vomiting and epigastric pain. A due to the small sample size in this initial phase surgery: an academic center experience. Archives of surgery. 2006;141(3):262-8. doi: 10.1001/archsurg.141.3.262. seen in our animal studies, we are performing small superficial ulcer was seen in the fundus/ of our study. Unexpectedly, gastric emptying PubMed PMID: 16549691 an FDA-approved physician-initiated IDE lesser curvature in one patient (20%). After 12 was unaffected by BAE. This is quite intriguing 4. Weiss CR, Gunn AJ, Kim CY, Paxton BE, Kraitchman DL, Arepally A. Bariatric embolization of the gastric arteries (investigational device exemption) study to endoscopies in 5 patients, no other ulcers were given the potential ischaemic insult on the for the treatment of obesity. Journal of vascular and inter- determine the safety and early efficacy of this seen. There was a 4% (SD: 1.7%; p=0.0091) and gastric fundus and the resulting modulation of ventional radiology : JVIR. 2015;26(5):613-24. doi: 10.1016/j. jvir.2015.01.017. PubMed PMID: 25777177; PubMed Central novel technique on human subjects. 5.28% (SD: 3.5%) reduction in excessive weight ghrelin that is known to interfere with gastric PMCID: PMC4414740 loss at the 4 and 12-week time points. Mean emptying [8]. We will continue to assess trends 5. Paxton BE, Kim CY, Alley CL, Crow JH, Balmadrid B, Keith CG, et al. Bariatric embolization for suppression of the hunger hor- Methods serum ghrelin decreased by approximately in hunger hormone levels and gastric emptying mone ghrelin in a porcine model. Radiology. 2013;266(2):471-9. 9% (SD: 35%) at the 4 week time point. Mean in a larger data set as we continue to the phase doi: 10.1148/radiol.12120242. PubMed PMID: 23204538 6. Arepally A, Barnett BP, Montgomery E, Patel TH. Catheter- Our single arm prospective phase I study serum GLP-1 (a hormone that promotes satiety) II stage of our study. directed gastric artery chemical embolization for modula- enrolled morbidly obese adult subjects (BMI increased by 107% at the 30-day time point. tion of systemic ghrelin levels in a porcine model: initial experience. Radiology. 2007;244(1):138-43. doi: 10.1148/ of 40-60; weigh <400 lbs/180 kg) without Mean serum leptin adjusted for weight also Conclusion radiol.2441060790. PubMed PMID: 17581899 significant co-morbidities. Our protocol was increased by 11% (SD: 41%) at the 30-day time 7. Arepally A, Barnett BP, Patel TH, Howland V, Boston RC, Kraitchman DL, et al. Catheter-directed gastric artery approved by the Institutional Review Board point. Hunger appetite scores dropped sharply Our pilot clinical trial shows that BE is safe, chemical embolization suppresses systemic ghrelin levels in and Federal Drug Administration. Patients were in the first 2 weeks following the procedure feasible and shows early efficacy in regard porcine model. Radiology. 2008;249(1):127-33. doi: 10.1148/ radiol.2491071232. PubMed PMID: 18796671; PubMed Central excluded if there was a history of malignancy, and showed a steady rise thereafter. At the to weight loss. As the study continues to the PMCID: PMC2657856 8. Perboni S, Inui A. Appetite and gastrointestinal motility: role of vascular disease, diabetes, prior abdominal 30-day time point, subjective hunger did not planned 20 patients, more insight into the early ghrelin-family peptides. Clinical nutrition. 2010;29(2):227-34. surgery, variant or prohibitive gastric arterial reach the baseline level. Quality of life was and longer-term efficacy will be obtained. doi: 10.1016/j.clnu.2008.10.016. PubMed PMID: 19945199 anatomy, or peptic ulcer disease. The primary unchanged throughout the study. Lastly, liquid

Immerse yourself in IR learning – visit the

Speakeer Centre Eyye-Check Eye-Check

CIRSE 2015 Simulator Gallery RoomRoom I Room II ` `

RPP1RPP1RPP22 RPP3RPP3 RPP4RPP4 RPPRPP5 RPP6 RPP7 Located next to the Technical Exhibition and Radiation RadiationRadiation ProteProtection Pavilion Room 3.B `

y Photo-

63 RPP12 er 5858 5959 ` Protection Pavilion, this year’s Simulator Gallery will host ll graphy 60 RPP11 WC RPP8 64 Studio 57 RPP9 a number of structured hands-on workshops, as well as 65 RPP10 Room ator Ga l 56 6262 61 0.01 Room 3.A 68a

open-door sessions where you can try out the simulators 66a ` Simulator Gallery Simu 66 5555 67 in your own time. 68 53 54 Cloakroom 52

5151 69 799 50 For more information about the scheduled events, please 49 70 71 S18

72 73 S19 Exhibition Hall 1 to First FÄ looor S16 S17 visit the CIRSE Info Point on the first floor. Ä S20 48 74 75 76 77 78 S21 80 46 47 Exhibition Hall 1, Entrance Level Hotels, Tours & 45 WC Social Events 44

Cardiovascular and Interventional Radiological Society of Europe C RSE 8 Advertisement Saturday, September 26, 2015

Advertorial

Transradial Access for Interventional Radiology Procedures

Transradial access has become increasingly more satisfied with radial access procedures with peers. The way that Merit ran the Think- popular for coronary interventions; the most than with femoral. Most often, patients cited Radial™ course is that they cover several types advantageous aspect being very low access- the shorter post-procedure recovery time and of procedures and give real-world tips and tricks site bleeding complications, which may help earlier times to ambulation; however, less on how to be successful for the different kinds contribute to reductions in the risk of adverse discomfort and pain have also been reported. of procedures. I left the course feeling like I was events. Patient preference for transradial access could ready to do radial access." be a motivating factor in the adoption of a Recently, interventional radiologists have begun radial-first approach for interventionalists. "I got a lot out of the course, particularly in the hands-on portion. The practical training to utilize transradial access for procedures – According to Kiemeneij et al., a survey of that Merit Medical provides saves time and from uterine fibroid embolization, interven- patients found that 75 percent of the patients allows attendees to have hands-on practice tional oncology, and trauma. who underwent transradial PTCA after trans- using cutting-edge technology. Having femoral diagnostic catheterization preferred experienced operators on hand to answer "Aside from the benefits of earlier ambulation the radial approach because of post-procedural questions was a great benefit." and fewer complications, transradial access pro- ambulation. In 1999, a randomized comparison cedures are less expensive," says Darren Klass, of transradial access on quality of life and cost "I am very honored to work with Merit on the MD, PhD, Interventional Radiologist, Vancouver effectiveness conducted by Cooper et al., dis- ThinkRadial™ course specifically designed for Coastal Health, who has performed more than covered that radial was preferred by 80 percent interventional radiologists," says Dr. Klass. "The 200 procedures using the radial approach. of the patients surveyed. A study of patient obvious benefits of transradial access have been experience during PCI using both radial and proven in other disciplines and will continue to "I have received thank-you notes from the femoral access by Geijer et al. in 2004 included a be adopted by radiologists." nursing staff because the radial approach re- patient questionnaire that asked patients to rate quires fewer post-procedure nursing hours." the discomfort and pain they felt during and The ThinkRadial™ course is also unique be- after the procedure. Patients graded discomfort cause the senior leadership of Merit Medical "Not going to a radial approach is to do yourself and pain much lower when using radial access. participates. "It was very nice to see firsthand a disservice," says Michael Neuwirth, MD, Inter- how Merit works, what drives them, seeing the ventional Radiologist, Carle Heart and Vascular The 2011 RIVAL trial reported that 90 percent of actual CEO, CFO and CMO, speak with them Institute, Urbana, Ill. "Sticking with the femoral the patients who had transradial approach said and hear their visions. At one meal during approach for interventional radiology proce- they would prefer it if an additional procedure the conference, the senior management of dures is to keep your head in the sand. I tell my were needed. In a patient satisfaction survey Merit spent time asking participants what our colleagues that the radial approach will change conducted from October 2010 to April 2011 by priorities and needs are. It was eye opening," their practices, affect their bottom lines, and the Jesse Brown VA Medical Center in Chicago, says Dr. Neuwirth. SOURCE MATERIALS is significantly better for patients. I have had 97 percent of the 32 patients surveyed said they Kiemeneij F, Laarman GJ, Odekerken D, et al. A Randomized a number of patients thank me because their preferred the radial procedure; 91 percent rated To learn more about Merit Medical’s ThinkRadial™ comparison of percutaneous transluminal coronary angioplasty by procedures were simpler and less complicated the radial procedure an 8 on a scale of 1 to 10; program, including upcoming training opportuni- the radial, brachial and femoral approaches: The ACCESS study. J Am Coll Cardiol 1997. JACC Journal Online. 29:1269–1275. for them. We have seen a great deal of success and 94 percent would recommend the radial ties, go to www.ThinkRadial.com/CIRSE. http://content.onlinejacc.org/article.aspx?articleid=1121715. in a number of procedures that fall outside of approach over the femoral. Accessed June 25, 2015 cardiac interventions, including AV fistulagrams, "While there’s not much in the peer-reviewed MATRIX: Radial Access Reduces Net Adverse Events; Bivalirudin fibroid embolizations, mesenteric and renal Learning Transradial Access literature on transradial access for Interventional Shows Mixed Results in ACS Patients | ACC News Story. American College of Cardiology Website. http://www.acc.org/latest-in- angiograms and stenting, liver Interventional Radiology, I feel that will soon change," says cardiology/articles/2015/03/15/20/00/1045am-pt-316-matrix- radial-access-reduces-net-adverse-events-bivalirudin-shows- Oncology, and for standard lower extremity Merit Medical will be conducting a ThinkRadial™ Dr. Klass. "Until the literature catches up, the mixed-results-in-acs-patients. Published March 16, 2015. angiograms. You can even use it for subclavian course for Interventional Radiology, October course in October will be practical and hands- Accessed June 4, 2015 stenting." 22–24, 2015, at their South Jordan, Utah, head- on, not a literature review." Knapik, ML. Transradial arterial access for Cath and PCI, and the quarters. Dr. Klass will be leading the IR track impact on hospital bottom lines. Cath Lab Digest. 2012; 9(20). Using transradial access for many interventional of the course, while Sandeep Nathan, MD, will "I am very selective about attending any event http://www.cathlabdigest.com/articles/Transradial-Arterial- radiology procedures requires longer catheters conduct the interventional cardiology track. that takes me away from my family," shares Access-Cath-PCI-Impact-Hospital-Bottom-Lines than the standard lengths used for cardiac inter- Dr. Neuwirth. Bochenek-Cobb L, Durham K. Patient satisfaction and ventions. Merit Medical carries catheters in the Islam A. Shahin, MD, Interventional Radiology, complications of transradial catheterization. Diag Interv Cardiol. July 15 2011. lengths and shapes needed for IR procedures. Methodist Dallas Medical Center, recently "The Merit ThinkRadial™ course was worth Furthermore, the company offers practitioners attended the ThinkRadial™ course. "I got a lot the time investment." http://www.dicardiology.com/article/patient-satisfaction- andcomplications-transradial-catheterization the option of customizing catheters to meet out of the course, particularly in the hands-on their specific shape and length requirements. portion. The practical training that Merit Medical "I got a great deal from the course that I am Jolly S.S., Amlani S., Hamon M., Yusuf S., Mehta S.R.; Radial versus femoral access for coronary angiography or intervention and "Using Merit’s catheters, I catheterize to almost provides saves time and allows attendees to implementing into my practice," says Dr. Shahin. the impact on major bleeding and ischemic events: a systematic any point in the body above the knee," shares have hands-on practice using cutting-edge "The people at Merit were gracious and helpful, review and metanalysis of randomized trials. Am Heart J. 157 2009:132-140. Klass. technology. Having experienced operators on and I really enjoyed the course." hand to answer questions was a great benefit." Schäufele T, et al., “Radial access versus conventional femoral puncture: outcome and resource effectiveness in a daily routine: Patient Experience with Transradial the Raptor trial” AHA 2009; Abstract 41. Procedures "Merit’s training was a class act," says Dr. Neu- Cooper CJ, El-Shiekh RA, Cohen DJ, Blaesin L, Burket MW, Basu A, wirth. "The course gave me the opportunity to Moore JA. Effect of transradial access on quality of life and cost of cardiac catheterization: A randomized comparison. Am Heart Since 1997, surveys of patients who have had practice the radial approach and understand J 1999;138:430-436. transradial intervention indicate that they are the nuances of the procedure while interacting

CIRSE SYMPOSIUM To learn more about the radial approach, including Transradial Approach in our upcoming training opportunities, please visit: Interventional Radiology ThinkRadial.com/CIRSE Sunday, Sept. 27, 2015 Auditorium 6, 13:00 – 14:00 Moderator: Prof. Dr. Christoph A. Binkert Speakers: Dr. Aaron M. Fischman and Dr. Darren Klass

Special Edition / CIRSE 2015 – Lisbon I 9 congress Vascular Interventions newsR

Don’t miss it ! Evidence Forum: Peripheral angioplasty Should balloon angioplasty be the first-line treatment Special Session Saturday, September 26, 10:00-11:00 for infrapopliteal disease? Auditorium 1 Thomas Rand (EBIR)

It is now more than a decade since we began Daily practice antegrade-retrograde access can be created, Thomas Rand discussing the endovascular treatment of This brings us to the next point, which is our resulting in pedal-plantar loop techniques, or (EBIR) infrapopliteal disease. daily work and general approach to infra- subintimal flossing, which was first described General Hospital Hietzing popliteal vessel disease. as the SAFARI technique. Pedal-plantar loop Vienna, Austria Back then, research was investigating plain techniques can create a guidewire loop from balloon angioplasty (POBA) vs. stents vs. As a general rule, efficient treatment is based the anterior tibial artery to the posterior tibial surgery vs. conservative treatment. Later, on the biological behaviour of the underlying artery through the pedal arch. Such techniques covered and coated stents entered the fray, disease and on the appropriateness of methods facilitate the recanalisation of long segments of which made things more complex still, and and techniques. infrapopliteal pedal and plantar arteries. recently a whole new generation of balloons has become available; particularly drug-coated Particularly for infrapopliteal lesions, the So, if we put all this together, and combine Prof. Thomas Rand is an interventional balloons, which have created even more biological background is crucial. Patients study results with the biological background radiologist and Head of Radiology at Hietzing fascinating possibilities to match one against with diabetes mellitus, which is frequently of BTK lesions and a clinical approach to daily General Hospital, Vienna. He graduated from the other. It’s a thrilling time to be involved in associated with small vessel disease below the practice, PTA is most effective and makes it the University of Vienna, specialising first in this field. As always, when a new technique knee, present with long diffuse arteriosclerotic easy and quick to treat long lesions. osteoradiology, and later in interventional comes along, our early conclusions were most- disease. Highly calcified and rigid stenoses, radiology. He completed his professorial thesis ly: "further studies are needed..." as well as long occlusions exist, and more than These considerations are reflected by an in 2000 on the diagnosis of rheumatological 80% of lesions are more than 10 cm in length. obvious change in paradigms for the treat- illnesses. Prof. Rand completed fellowships at New And now, several years and many studies later, ment of long infrapopliteal lesions: the revised York University and the University of California, do we have any answers? Due to the background and nature of BTK TASC-II guidelines note "increasing evidence San Diego. He has been author or co-author on lesions, it is essential to treat this special group to support a recommendation for angioplasty over 100 peer-reviewed articles and 10 books. He Well, I would say: yes, we do. of lesions with dedicated tools and concepts, in patients with CLI and infrapopliteal artery is a member of numerous scientific societies, and and as simply and effectively as possible: occlusion" and lesion length is no longer used is much involved with research and education, as The evidence to determine a recommendation for treatment. well as being an active faculty member at CIRSE Let us start with the studies, before coming to Low-profile balloons up to 20 cm in length meetings. the interpretations. contribute substantially to the successful treat- Regarding stents, however, such treatment ment of such long BTK lesions. Although a true options are still very efficient regarding more Recent publications presented the results from lumen approach will generally be considered focal and short segments, or bail-out pro- meta-analyses of drug-eluting balloon (DEBs) as a first-line technique for longer lesions, it is cedures. and drug-eluting stent (DES) placement, were acceptable if not beneficial to carry out angio- DEB and DES demonstrated superior outcomes plasty for longer segments from a subintimal In conclusion, angioplasty of infrapopliteal compared to PTA and bare-metal stents (BMS). tract by using a hydrophilic guidewire. lesions can achieve excellent clinical results At the same time, several current investigations with the proper use of dedicated techniques have changed their study questions and end- Fantastic techniques have been successfully and devices. With the current developments, points from evaluation of numeric results, such used and described by several interventio- and proper consideration of the biological as restenosis, and freedom of re-intervention, nalists. By using micropunctures of pedal background of lesions, PTA shows itself to be to clinical aspects, such as improvement of arteries, infrapopliteal arteries can be accessed a fast and effective tool, which should be con- clinical results or freedom from amputation. with a retrograde technique, and/or an sidered as a first-line therapy.

As a further and very effective development in the PTA section, drug-coated balloons have References: recently come into use and are a strong new 1. Baerlocher MO et al. Meta-analysis of drug-eluting tool for the treatment of long segmental le- balloon angioplasty and drug-eluting stent placement for infrainguinal peripheral arterial disease. J Vasc Interv sions, and have shown absolutely promising Radiol. 2015 2. Laird JR et al. Drug-coated balloons for infrapopliteal disease: results. digging deep to understand the impact of a negative trial. J Am Coll Cardiol. 2014 3. Zeller T et al. IN.PACT DEEP J Am Coll Cardiol. 2014 In the DEBATE study, drug-eluting balloons 4. Siablis D et al: The IDEAS randomized controlled trial. strikingly reduced one-year restenosis, target JACC Cardiovasc Interv. 2014 5. Canaud L et al. Infrainguinal angioplasty with drug-eluting lesion revascularisation and target vessel stents and balloons. J Vasc Surg. 2014 occlusion in the treatment of below-the-knee 6. Fanelli F. Endovascular treatment of infrapopliteal arteries: angioplasty vs stent in the drug-eluting era. Eur Radiol. 2014 lesions in diabetic patients with critical limb 7. Liistro F et al. Drug-eluting balloon in peripheral intervention ischaemia, compared with PTA. for below the knee angioplasty evaluation (DEBATE-BTK): Circulation, 2013 8. Manzi M et al. Treating calf and pedal vessel disease: When comparing Placlitaxel-coated balloons the extremes of intervention. Semin Intervent Radiol. 2014 (PCB) vs. DES in long infrapopliteal lesions, another recently published prospective randomised controlled trial demonstrated that DES are associated with significantly lower re- sidual immediate post-procedure stenosis and have shown significantly reduced vessel reste- nosis at six months. PCB, however, might pro- duce positive vessel remodeling. Generally au- thors considered DEB as the leading approach Even long occlusions in the lower leg (Fig.1) can in below-the-knee disease. be treated effectively with long balloons (Fig. 2) and the vessels functionally and morphologically In sum, I would say we can conclude that recreated (Fig. 3). All figures courtesy of Dr. Gerard "coating" is better than "no coating"; however, Mertikian, who performed this investigation the optimal matching of stents and balloons recently in our department. requires some fine-tuning.

www.cirse.org/esir2015

ESIR 2015 Expert Course Critical Limb Ischaemia – Diagnosis, Treatment and Parameters for Success Amsterdam (NL), October 16-17 European School of Interventional Radiology

Cardiovascular and Interventional Radiological Society of Europe C RSE 10 Obituary / Poster Awards 2015 Saturday, September 26, 2015

Remembering François Pinet A tribute to Jean Claude Gaux

François Pinet left us on July 22, 2015. We France) and in 1986 he became president of the Professor Jean Claude Gaux passed away on All his students and fellows are forever in debt would like to honour him and remember the SFR (French Society of Radiology). July 9, 2015. to his extraordinary enthusiasm, teaching and important role that he played in the founda- research capabilities. The French cardiovascular tion of CIRSE. Trained in cardiology by Roger Since 1976 he organised the International His demise is a severe loss for the field of community has benefitted greatly from his Froment, he was one of the pioneers of this Society of Cardiac and Vascular Radiology cardiovascular, diagnostic and interventional wisdom and dedication, and his loss is keenly kind of radiology in France and Europe; he took Congress in Lyon. He was instrumental in radiology in France and Europe. felt by us all. part in the world’s first-in-man coronarography the merger of the two existing societies using the Arnulf method. (the European College of Angiography and He was one of the major contributors to the Marc Sapoval the European Society of Cardiovascular development of important interventional In France, Prof. Pinet motivated young students and Interventional Radiology), convincing techniques such as peripheral and renal artery to pursue this clinical specialty. With his wife, Lunderquist and Boijsen in northern Europe stenting, aortic endografting, , Annick, he created a school and sent his stu- and Lamarque and Rossi in southern Europe. development of IR techniques in haemodialysis dents abroad. He led the two volumes of this Together with Prof. Olbert, he organised the grafts, and many, many more. discipline concerning the "Radiodiagnostic inaugural CIRSE congress in 1985! He acted as Treaty". With the help of Ecoiffer, he founded general secretary, and then became a Gold He was also one of the founding members of the Vascular Radiology French Society. Medallist in 1991. the French Society of Cardiovascular Imaging Between 1977 and 1980 he was the president (SFICV), and in recognition of his contribution of CERF (college for radiology teachers in Michel Amiel to French and European IR, was awarded Distinguished Fellowship of CIRSE in 2000.

Poster Awards 2015

SCIENTIFIC POSTERS EDUCATIONAL POSTERS

Magna Cum Laude Magna Cum Laude Foot perfusion CT: an experimental validation Pharmacokinetics and safety of transarterial Embolization of hemorrhoidal arteries: the Superior hypogastric nerve block for acute pain and an initial clinical experience sorafenib chemoembolization in VX2 tumor emborrhoid technique control in uterine fibroid embolization S. Hur, H.J. Jae, J.E. Kim, C.S. Kim, S.H. Lee, S. Cho; model of rabbit liver N. Moussa1, F. Tradi2, C. Del Giudice1, O. Pellerin1, B. Almazedi1, J. Yoon2, D.A. Valenti2, L.-M.N.J. Seoul National University, Radiology, Seoul/KR G.M. Kim, M.D. Kim, J.Y. Won, S.I. Park, D.Y. Lee, V. Vidal3, M.R. Sapoval1; 1Hôpital Européen Boucher2, T. Cabrera2, C. Torres2; 1York Teaching W. Shin, M. Shin; Severance Hospital, Yonsei Uni- Georges Pompidou, Vascular and oncological Hospital NHS Foundation Trust, Radiology, York/ Cum Laude versity College of Medicine, Radiology, Seoul/KR Interventional Radiology, Paris/FR, 2Hôpital de la UK, 2McGill University Health Centre, Radiology, Comparison of pharmacokinetics and drug Timone, Radiology, Marseille/FR, 3Hôpital Timone Montreal, QC/CA delivery properties of doxorubicin/Lipiodol® Balloon pulmonary angioplasty for chronic Adultes, Service de Radiologie, Marseille/FR formulations in a hepatocellular carcinoma thromboembolic pulmonary hypertension The role of interventional radiology in (HCC) rabbit VX2 model (CTEPH) Cum Laude managing invasive placenta F. Deschamps1, G. Farouil1, C. Hollenbeck2, M. Toborek1, A. Torbicki2, M. Kurzyna2, S. Darocha2, The role of IR in the treatment of benign bone R. Zener, D. Wiseman, A. Mujoomdar; London J.-F. Mayer2, L. Tselikas1, S. Catoen2, C. Robic2, R. Pietura1; 1Medical University of Lublin, and soft tissue tumours: current status Health Sciences Centre, Department of Medical W. Gonzalez2, T. de Baère1; 1IGR, Interventional Department of Radiography, Lublin/PL, 2Medical G. Tsoumakidou, V. Petsatodis, M.-A. Thénint, Imaging, London, ON/CA Radiology, Villejuif/FR, 2Guerbet, Guerbet France, Centre of Postgraduate Education, European J. Garnon, G. Koch, J. Caudrelier, A. Gangi; Villepinte/FR Health Centre Otwock, Department of Pulmonary University Hospital of Strasbourg, Interventional Pelvic venous anatomy: all that we need to Circulation and Thromboembolic Diseases, Radiology, Strasbourg/FR avoid complications during venous pelvic or Clinical results of PADI trial: percutaneous Otwock/PL gonadal embolization transluminal angioplasty versus drug-eluting Balloon-occluded retrograde transvenous J.M. Lozano1, G.F. Mejia2, H.A. Jaimes3; 1Clínica stents for infrapopliteal lesions in critical limb Long-term (>5 years) clinical and histological obliteration for gastric varices with foam Universitaria Colombia, Interventional Radiology, ischaemia follow-up of successful radiological sclerosant: how foam sclerosant changed our Bogota/CO, 2Clinica Universitaria Colombia, M. Spreen1, J. Martens1, W.P.T.M. Mali2, H. van percutaneous treatment of biliary strictures in procedure Vascular Surgery, Bogota/CO, 3Clinica de Marly, Overhagen3; 1HagaZiekenhuis, Radiology, The pediatric liver transplant recipients K. Yamada1, M. Yamamoto1, M. Horikawa2, Interventional Radiology, Bogota/CO Hague/NL, 2University Hospital Utrecht, Dept. of R. Miraglia, L. Maruzzelli, M. D’Amico, A. Luca; H. Shinmoto1, T. Kaji1; 1National Defense Medical Radiology, Utrecht/NL, 3Haga Teaching Hospital, Mediterranean Institute for Transplantation College, Radiology, Tokorozawa/JP, 2Oregon Interventional radiology in pregnant and Leyenburg, Radiology, The Hague/NL and Advanced Specialized Therapies (ISMETT), Health & Science University, Dotter Interventional lactating patients: fetal and neonatal risks Diagnostic and Interventional Radiology, Institute, Portland, OR/US R. Ramnarine1, G.T. Yusuf1, P. Kane1, M. Daneshi1, Certificate of Merit Palermo/IT A. Pascoal2, T. Bangay1, C.J. Wilkins1, D.R. Evans1, The influence of metallic implants on Certificate of Merit D. Huang1, T. Ammar1; 1King’s College Hospital the dissipation of thermal energy during Effect of body composition on liver Percutaneous cryoablation of the celiac plexus NHS Foundation Trust, Radiology, London/UK, irreversible electroporation hypertrophy after portal vein embolization in cancer patients 2King’s College Hospital NHS Foundation Trust, H.J. Scheffer1, J.A. Vogel2, W. van den Bos3, K.P. van prior to major liver resection measured by CT E. de Kerviler, C. de Margerie-Mellon, A. Coffin, Physics, London/UK Lienden4, J.H. Klaessens5, R.M. Verdaasdonk5, volumetry C. de Bazelaire; Saint-Louis Hospital, Department M.R. Meijerink1; 1VUMC, Radiology and Nuclear I. Dudás1, Z. Straky1, É. Török2, P. Péter2, A. Zsirka- of Radiology, Paris/FR Medicine, Amsterdam/NL, 2AMC, Surgery, Klein2, O. Hahn2; 1Semmelweis University, Amsterdam/NL, 3Academic Medical Center, Department of Diagnostic Radiology and Urology, Amsterdam/NL, 4AMC, Radiology, Oncotherapy, Budapest/HU, 2Semmelweis Uni- Amsterdam/NL, 5VU University Medical Center, versity, 1st Department of Surgery, Budapest/HU Physics and Medical Technology, Amsterdam/NL

Special Edition / CIRSE 2015 – Lisbon I 11 congress Radiation Protection newsR

Don’t miss it ! Controversies in radiation safety Raising awareness of radiation protection – Special Session Saturday, September 26, 11:30-12:30 the CIRSE 2015 activities Room 5.A

e-voting

Awareness of radiation-related health risks The Pavilion also makes available recently dose is within an acceptable range, especially There are also some cases in which the presence is on the rise, but pushing practitioners and published guidelines on radiation protection when many or particularly complex cases are of a real-time dose monitor on-site might be institutions to adopt meaningful measures to in interventional procedures, as well as new involved. ignored by the staff. For example, if this kind of reduce that risk can be challenging. CIRSE’s occupational exposure limits and reporting system has been installed in a department for Radiation Protection Pavilion, which made obligations introduced by the updated By contrast, a real-time dosimetry system gives a long time, one might stop looking at it. Also, its debut last year, again aims to encourage European Basic Safety Standards Directive. every individual operator easy access to per- for sophisticated procedures that usually entail medical professionals to actively protect sonal exposure data for each procedure per- higher radiation doses compared to "standard" themselves by providing practical infor mation, For those interested in the most recent formed, with time-stamped dose data helping ones, staff may neglect to check the monitor. o utlining available solutions and offering scientific findings on health risks related to to identify the procedure or specific step taken In any case, it is difficult to remember what relevant services. occupational radiation exposure, the Radiation during a procedure that is res ponsible for the happened during a procedure if data are not Protection Subcommittee has compiled an highest exposure during a work day, week or analysed afterwards by a physicist or someone New Features abstract book covering occupational health month. As Prof. Jaschke notes: else with good knowledge of radiation protection. hazards in interventional radiology; eye-lens This year’s Pavilion places great emphasis on dose and radiation-induced cataracts; efficacy By providing easily accessible information about Prof. Efstathopoulos therefore believes that, interactivity, and includes several new features of radiation protection equipment; radiation radiation exposure, real-time dosimetry systems while real-time monitoring systems can indeed that make it a particularly unique educational protection of patients; and recommended ICRP allow medical staff to immediately change their be useful tools to raise awareness amongst the experience. For example, congress delegates publications. Copies of this publication can be behaviour in order to minimise their radiation staff, they do not diminish the importance of are invited to practice on a radiation safety picked up at the Pavilion. dose. Also, operators obtain immediate infor- the TLD or other legal dosimeters. simulator, interact with a special Kinect tool mation clarifying to what extent their indi- that visualises scatter radiation, and test their Eye Check-Ups for Members vidual dose is increased when they change their Be Part of the Solution knowledge in a radiation protection quiz. position to the patient, change the settings of the To address the risk of radiation-induced angiographic equipment or, for example, take a We hope many of you will stop by the Pavilion Delegates are also encouraged to participate cataracts faced by IRs, sub-capsular opacity magnified view or an angled or lateral view of a to inform yourself, interact with experts, test in a raffle designed to both raise awareness screening is again being offered in two rooms region of interest. your knowledge, and help us spread the word and put them in the running for some great of the Pavilion, from today through Tuesday. about the importance of effective radiation prizes that will help improve their departments’ Two qualified ophthalmologists are performing He also notes that the use of new software in protection! radiation safety. Each copy of Congress News the screening, which is free of charge and angiographic equipment may be giving staff comes with a sticker displaying a radiologist available to all CIRSE members. While all members a false sense of security, dis couraging who is failing to take proper precautions. m embers received invitations to pre-register them from strictly adhering to previously Delegates can obtain the proper protective kit for these check-ups in advance, onsite registra- employed optimisation strategies. With by visiting any of the exhibitors in the Pavilion, tion may still be possible. If you are interested real-time dosimetry, any malfunctions become who will provide them with the missing parts, in making use of this great service but have not immediately obvious, and appropriate steps which can be peeled off and added to the pre-registered, please feel free to stop by the can be taken to re-optimise the angiographic stickers. The backing card will then serve as a Pavilion to see about availabilities. equipment. For all these reasons, Prof. Jaschke raffle ticket; delegates should fill in their name, is strongly in favour of using real-time moni- Today’s RPP Mini Talks ID number and email address, and hand it in. Scrutinising Solutions: Real-Time Dose toring, noting that "it can only bring gains We also encourage everyone who has par- Monitoring − lower doses, more confidence and a higher Saturday, September 26 ticipated to place the completed sticker onto awareness of good practice". their jacket or congress bag to further raise While most practitioners acknowledge that 12:30 – 13:00 awareness. radiation safety is an important issue, opinions Prof. Efstathopoulos acknowledges that real- RPP Opening Ceremony 2015 diverge when it comes to deciding on how time feedback on radiation dose may decrease W. Jaschke (Innsbruck/AT) Practical Information in Diverse Formats to best reduce exposure. A special session on exposure, and notes that the gold standard "Controversies in radiation safety" will delve for radiation monitoring currently consists of 14:00 – 14:15 This year’s event also includes short presen- further into one possible solution, scrutinising personal dosimetry with the use of passive Why radiation protection matters tations by experts, hosted by the Radiation the value of real-time dose monitoring of staff. personal dosimeters. However, he points out E. Brountzos (Athens/GR) Protection Subcommittee and select industry The session will feature presentations by Prof. that such monitoring does also entail some partners – an excellent opportunity to engage Werner Jaschke (Innsbruck/AT), Chairperson of drawbacks: 14:15 – 14:30 in live exchanges on hot topics in radiation the Radiation Protection Subcommittee, and Industry presentation – TOSHIBA safety and receive practical tips for your Prof. Efstathios Efstathopoulos (Athens/GR), a The utilisation of extra sensors in addition to the DoseRite, better protection for patients day-to-day work. The presentations will take member of the committee. personal dosimeters already in use may cause and clinicians place directly in the Pavilion during breaks in some inconvenience to the staff, given that they A. Patz (Zoetermeer/NL) the official scientific programme. The full list of According to Prof. Jaschke, current practice will have additional parameters to think about today’s "RPP Mini Talks" is printed below. generally involves operators wearing badges during the preparation for a procedure. Moreover, 16:00 – 16:15 and rings to measure their personal dose, in some cases, such as in departments where Industry presentation – RADPAD In addition, a selection of tailored infor mational with operators receiving monthly reports on radiation protection culture is not well-developed, Radiation related illness to operators/ material, scientific publications and info post- their dose, usually at the end of the following or for staff members who are not very familiar interventionalists ers on radiation safety and dose management month. Given that time range, it can be very with ionising radiation, the indication of the E. Radtke (Kansas City, KS/US) is on display and available to take home. difficult for practitioners to gauge whether the active dosimeter may be misinterpreted.

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INNOVATION | EDUCATION | INTERVENTION

Special Edition / CIRSE 2015 – Lisbon I 13 congress Neurointerventions newsR

Don’t miss it ! In-depth diagnostic and treatment concepts Where do we stand on "one-stop-shop" flat-panel in acute stroke Special Session angio-stroke imaging? Saturday, September 26, 10:00-11:00 Christian Stroszczynski Room 5.A

Flat-panel angiography is a new technique ed. Due to the fact that in acute stroke cases tional angiography implicates a higher rate of Christian Stroszczynski which enables high-resolution images of even a reduction of a few minutes between relevant motion artifacts when compared to University Clinic Regensburg neurovascular structures as well as cross- clinical symptoms and intervention has a MS-CT. Regensburg, Germany sectional imaging of the brain when 3D angio- proven impact on the outcome (“time is brain; graphy is performed (DynaCT, cone-beam CT). every minute counts”), new strategies such as Various algorithms may reduce motion arti- To obtain 3D images in the angiosuite, the one-stop flat-panel angiography seems to be facts, but the radiation dose needed for diag- flat panel rotates quickly around the neuro- possible. nostic images is high and induces a higher risk cranium, usually after intra-arterial injection for damage to the brain and especially of the of contrast media. Backprojection of acquired On the other hand, there is still a lack of evi- lens. data enables three-dimensional reconstruc- dence concerning the accuracy of cross-sec- tion of intra cranial arteries based on data sets tional images based on flat-panel angiography. Especially in cases where the angiosuite is Prof. Stroszczynski is an interventional radio- which covers the whole head in one rotation In addition, low prevalence in patients who are integrated into a multidisciplinary setting, logist and Director of the Institute of Diagnostic because of the large field of view of the flat suitable for thrombectomy is the biggest bar- ventricular drainages, biopsies and various Radiology in University Clinic Regensburg. He panel. In contrast to conventional computed rier for switching from actual management of image-guided therapies might be more easily was previously employed as deputy director tomo graphy with multi-slice detectors, the stroke from multi-slice computed tomography performed because of the combination of real- and clinical lead at the Institute of Diagnostic spatial resolution and the conspicuity of the as the standard modality to the angiosuite. time fluoroscopy and the three-dimensional Radiology in the Carl-Gustav-Carus University in vessels are superior. Using high-resolution visualisation of targets and devices. Dresden. His clinical expertise spans hepatology, mode, the spatial reso lution of rotational While the clinical benefits of diagnostic oncology and vascular interventions, and angiography is 200 μm, which is one third rotational angiography are still limited, peri- Image overlay of intracranial stents to 3D he is one of the region’s leading experts on when compared to resolution obtained with and post-procedural cross-sectional images angiograms is another valuable tool which interventional radiology. In his role as vice-chair standard MS-CT. On the other hand, contrast are of additional value. The use of rotational facilitates neurointerventional procedures. of the German Society of Interventional Radiology resolution of soft tissue structures such as brain angiography ranges from the visualisation of Dissections involving intracranial arteries are (DeGIR), his aim is to improve the integration of parenchyma is still reduced when compared ventricular systems, brain tumours and other sometimes difficult to assess using conven- interventional treatment of stroke into patient to MS-CT. Because direct visualisation of acute soft tissue pathologies as well as bone struc- tional digital subtraction angiography (DSA) care pathways. He has published almost 350 brain infarction with typical minimal altera- tures, which allows the evaluation of difficult and can be easily visualized by rotational angi- scientific articles, spanning a wide range of tions of tissue density remains challenging for anatomies, the detection of bleeding or other ography. clinical topics. rotational angiography, the vast majority of complications, which might be easily missed radiologists will relinquish the use for diagnosis in a 2D view and only detected hours later in a In conclusion, flat-panel angiography using of acute stroke. post-procedural CT. modern dose-sparing detectors are valuable tools for the peri- and post-procedural image However, early data suggest that the vast Both pre-operative and peri-interventional CT/ guidance of intracranial procedures. Until now, majority of intracranial bleeding in cases of MRI data may be fused with rotational angi- clinical use of one-stop-shop angiography in stroke should be detected or excluded by the ography. When pre-operative cross-sectional stroke patients is still in its infancy due to flat-panel CT technique. In addition, perfusion data sets are used, image-fusion software both limited contrast resolution and logistical analysis for the detection of penumbra areas is must correct the different positions of the reasons. However, a massive reduction of door- introduced for routine clinical use. head on diagnostic images and during hybrid to-needle time in stroke patients suitable for surgery. Usually, the use of fusion software is thrombectomy can be obtained, especially in Very recently, the enormous impact of early still somewhat time-consuming and somewhat hospitals where MS-CT is the bottleneck in thrombectomy in acute stroke was demonstrat- imprecise. The longer acquisition time of rota- diagnostic pathways.

References: 1. Patel AP, Gandhi D, Taylor RJ, Woodworth G. Use of Dyna CT in evaluation and treatment of pseudoaneurysm secondary to craniofacial tumor resection: Case report and diagnostic implications. Surg Neurol Int. 2014 2. Ganguly A1, Fieselmann A, Boese J et al.: In vitro evaluation of the imaging accuracy of C-arm conebeam CT in cerebral perfusion imaging. Med Phys. 2012 Nov;39(11):6652-9 3. van den Berg LA, Koelman DL, Berkhemer OA et al: Type of Anesthesia and Differences in Clinical Outcome After Intra-Arterial Treatment for Ischemic Stroke. Stroke. 2015 Apr 7 4. Borst J, Marquering HA, Beenen LFM et al. Effect of Extended CT Perfusion Acquisition Time on Ischemic Core and Penumbra Volume Estimation in Patients with Acute Ischemic Stroke due to a Large Vessel Occlusion. PLoS ONE 2015; 10(3) e0119409 5. Jovin TG, Chamorro A, Cobo E et al.: Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke. N Engl J Med. 2015 Apr 17 6. Berkhemer OA, Fransen PS, Beumer D et al.: A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015 Jan 1;372(1):11-20

Fig. 1a: multi-slice CT Fig. 1b: flat-panel angiography Fig. 1c: digital subtraction angiography

Figure 1: (a) multi-slice CT and (b) flat panel angiography in one patient with (c) subarachnoid bleeding based on ruptured anterior communicating artery

aneurysm. Despite the fact that image quality is reduced on flat-panel angiography, image quality is sufficient for diagnosis of SAB. RoomRo 55.CC `

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Cardiovascular and Interventional Radiological Society of Europe C RSE ECIO 2015  THE REVIEW

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Special Edition / CIRSE 2015 – Lisbon I 15 congress Interventional Oncology newsR

Don’t miss it ! Management of colorectal liver metastases Transarterial management of colorectal liver metastases Special Session Saturday, September 26, 11:30-12:30 remains a challenge Auditorium 8 Peter Huppert

Patients with liver metastases from colorectal response rates of 2-63%, PFS of 3-8 months and sequential sessions with time intervals of 3-8 Peter Huppert cancer have a poor prognosis. Fewer than OS of 8.6-14.3 months [16-20] demonstrated weeks. Taking into account the disseminated Community Hospital 25% are candidates for curative resection or that outcomes after TACE appear to be highly nature of metastatic disease, lobar treatment Darmstadt percutaneous ablation, and of those who do, variable and only limited data are available to during TACE seems to be mandatory. However, Darmstadt, Germany 70% will suffer from relapse within 3 years [1]. determine which subgroups of patients will if pre-treatment imaging shows dominant Systemic first-line 5-fluorouracil (5-FU) based benefit from this treatment. Patients who had large tumour involvement of a limited number treatments in combination with irinotecan or one or two lines of systemic treatment prior to of liver segments, transcatheter treatment oxaliplatin and monoclonal antibodies offer TACE seem to have better outcome (median offers the potential to enhance the treatment response rates of 31-62%, median progression- survival 11-12 months) compared to patients intensity by selective segmental injections free survival (PFS) of 6.9-10.6 months and after 3-5 lines (median survival 6 months; prior to lobar injections. This technique of median overall survival (OS) of 14-21.5 months p=0.03) [20]. The presence of extrahepatic regional "boosting" TACE was performed in Dr. Huppert is an interventional radiologist [2-5]. However, in patients refractory to these metastases had no clear impact on survival. 30 of 74 treatment sessions in our study and who works at the Department of Radiology, treatments second- or third-line systemic treat- Studies with larger numbers of patients re- was well tolerated without increase of side Neuroradiology and Nuclear Medicine in the ments are far less effective with RR of 4-21% ported objective response rates below 15% effects [25]. Community Hospital Darmstadt. and median PFS of 2.5-4.8 months [6-8]. [19, 20] and studies including patients with advanced tumour involvement of the liver TARE was evaluated in seven trials comprising A specialist in radiology and neuroradiology, Despite several advantages of catheter-based showed overall survival below 10 months after 1,174 patients, with data of 606 patients from his clinical and scientific work is focused on treatments of liver tumours becoming ap- first TACE [16, 18, 20]. a multicentre trial [28-34]. Most patients had oncology, peripheral vascular disease and portal parent during the last decade, there is still no ST prior to TARE. Local tumour control ranged hypertension. Prof. Huppert is a member of the clear evidence that hepatic arterial infusion Drug-eluting microspheres provide controlled between 29 and 73% depending on time board of the German Society of Interventional chemotherapy (HAIC), via ports or isolated drug release to tumours, reduce systemic drug interval and tumour volume. Overall survival Radiology (DeGIR), and was recently elected hepatic perfusion (IHP), transarterial chemo- side effects and improve reproducibility of was again limited to 6.2-11.6 months. as the President of the German Congress of embolisation (TACE) and transarterial radio- TACE. Irinotecan is a potent drug for treatment Radiology 2018. The German Radiological Society embolisation (TARE) can improve OS and PFS, of colorectal cancer liver metastases with high HAIC, IHP, TACE, DE-TACE and TARE are treat- (DRG) awarded him the Felix Wachsmann prize, respectively, in patients with colorectal liver total body clearance and high liver extraction ment options for patients with failure of one which recognises outstanding contributions to metastases when compared to systemic treat- rate favourable for transarterial liver treat- or more lines of standard palliative ST. The continuing education efforts, in 2012. ment (ST) or best supportive care. However, ments. Today, various types of microparticles clinical results of these treatments are still local response and conversion to resectability are available for clinical use which are capable limited and offer the chance of prolongation due to these treatments has been shown and of being loaded with irinotecan. TACE using of PFS between 4 and 8 months depending this will probably be of benefit in salvage drug-eluting microparticles (DE-TACE) with on tumour load, performance status and patients. irinotecan loaded into several types of micro- extrahepatic tumour spread. The advantages of particles had been evaluated in six retrospec- DE-TACE are a high level of standardisation and Hepatic arterial infusion chemotherapy tive studies and in one RCT comprising 215 a low grade of complexity. In 2007 a systematic review including 10 RCTs patients [21-27]. If patients had pre-treatment concluded that HAIC does not provide a sur- by ST, local tumour control (no progression) vival benefit in comparison to ST [9]. However was 40-86%; however PFS and OS was limited a b subsequent trials showed that HAIC combined to 4-8.1 months and 5.4-13.3 months, respec- with ST after failure of first-line therapy may tively, after first DE-TACE. Using irinotecan- improve PFS to 4-7 months [10-12]. Conversion loaded micro particles during TACE, near to resectability was achieved in 35-47% [11, 13]. complete devascularisation of colorectal liver metastases can be obtained in a substantial Isolated hepatic perfusion proportion of cases. In our study [25] using IHP may improve local response in very select irinotecan-loaded HepaSphere™ microspheres, patients progressive after ST. Response rates complete absence of tumour enhancement up to 60-68% with PFS up to 12 months may be during CT was seen at three months in 7 of possible [14, 15]. 29 patients and necrosis comprising ≥50% of tumour volume in 14 of 29 patients (Fig. 1). TACE In patients with liver metas tases, there is no Since 1998 several trials evaluated conventional standard in terms of selective versus non- TACE in patients with metastases refractory selective application of drugs, embolics and to ST. In the majority of these studies, combi- microspheres. c d e nations of cisplatin, doxorubicin and mitomycin with particles of polyvinyl alcohol (PVA) or For treatments of colorectal cancer metastases collagen for embolisation had been used, but using irinotecan-loaded DC Beads, lobar in- with varying protocols. Reported objective jections were reported involving both lobes by

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References: 1. Pwint et al. Semin Oncol 2010;37:149-59 18. Hong et al. J Vasc Interv Radiol 2009;20:360-7 2. Saltz et al. N Engl J Med 2000;343:905-14 19. Vogl et al. Radiology 2009; 250:281-9 3. Goldberg et al. J Clin Oncol 2004;22:23-30 20. Albert et al. Cancer 2011; 117:343-52 4. Colucci et al. J Clin Oncol 2005;23:4866-75 21. Fiorentini et al. In vivo 2007;21:1085-92 5. Chen et al. J Clin Oncol 2006;24:3354-60 22. Martin et al. Ann Surg Oncol 2011; 18:192-8 6. Hurwitz et al. N Engl J Med 2004;350:2335-42 23. Fiorentini et al. Anticancer Res 2012; 32:3-11 7. Rothenberg et al. J Clin Oncol 2003;21:2059-69 24. Narayanan et al. Anticancer Res 2013;33:2077-83 8. Park et al. Jpn J Clin Oncol 205;35:531-5 25. Huppert et al. Cardiovasc Intervent Radiol 2014;37:154-64 9. Mocellin et al. J Clin Oncol 2007;25:5649-54 26. Stutz et al. Gastroenterol Res Pract 2015;715102 10. Boige et al. Ann Surg Oncol 2008;15:219-26 27. Iezzi et al. Cardiovasc Intervent Radiol 2015;Mar 24 epub 11. Samaras et al. Ann Surg Oncol 2011;18:1924-31 28. Cosimelli et al. Br J Cancer 2010;103:324-31 12. Tsimberidou et al. Hepatogastroenterol 2013;60:1611-23 29. Kalva et al. Am J Clin Oncol 2014 epub 13. D'Angelica et al. Ann Surg 2015;261:353-60 30. Golfieri et al. Radiol Med 2015 epub Figure 1: Bilobar metastatic disease occupying >50% of liver volume (a, b). Tumours show moderate 14. Reddy et al. Ther Adv Med Oncol 2014;6:180-94 31. Kennedy et al. J Gastrointest Oncol 2015;6:134-42 hypervascularisation during arterial phase of DSA (c, d). After TACE, complete arterial filling ("casting") 15. Magge et al. Ann Surg 2014;259:953-9 32. Abbott et al. Clin Colorectal Cancer 2015; Feb 16 epub 16. Tellez et al. Cancer 1998;82:1250-9 33. Sabet et al. Eur J Nucl Med Mol Imaging 2015;42:370-6 is seen (e); after two rounds of TACE, complete tumour necrosis (f, g). Patients survived 12 months after 17. Leichman et al. Cancer 1999;86:775-81 34. Saxena et al. Ann Surg Oncol 2015;22:794-802 first TACE with progession-free interval of 6 months.

Cardiovascular and Interventional Radiological Society of Europe C RSE 30RSE Travel back in time – Cyears revisit 30 years of CIRSE!

This new website is available to view in a special "30 years of CIRSE" booth in Exhibition Hall 2. The booth features a special On April 24, 1985, CIRSE came into existence, viewing screen, as well as offering scientific following the merger of the two previously delegates some CIRSE-branded merchandise: existing IR societies: the European College each delegate can choose one t-shirt and of Angiography and the European Society of one of a number of "goodies" (laptop sleeves, Cardiovascular and Interventional Radiology. USB sticks, mouse pads).

Here in Lisbon we celebrate our 30th annual So call by: take a tour of CIRSE’s thirty year meeting, and we’d like you to travel back in history, and pick up your complimentary time with us and explore the eventful years CIRSE merchandise! that have led to the success of today’s CIRSE.SE.

A specially created "30 years" website will guide you through the various chapters of CIRSE’s history, outlining major milestones in its development.

Special Edition / CIRSE 2015 – Lisbon I 17 congress Vascular Interventions newsR

Don’t miss it ! Venous Forum I: Thermal Ablation of Varicose Veins Special Session Saturday, September 26, 08:30-09:30 Levent Oguzkurt (EBIR) Auditorium 6

Lower extremity varicose veins represent one management of varicose veins. The same differences, all thermal ablation methods with Levent Oguzkurt of the most common vascular conditions in the operator examined the leg with Doppler any parameter seem to have similar excellent (EBIR) adult population. The predominant causative ultrasonography, treated the patient under anatomical and clinical outcomes. Medical Park Hospital Group factor of this condition is either retrograde ultrasonogr aphy and usually did the follow-up Istanbul, Turkey reflux, in which reflux starts in the saphenous Doppler ultrasonography. This improved our Outcomes veins and extends to the tributaries, or understanding of the normal venous anatomy, antegrade reflux in which venous insufficiency its variations and sometimes causes of failure. Most data on thermal ablation methods are starts in the small tributaries of the saphenous With better understanding of the anatomy almost exclusively single-centre data. These system and extends to the truncal vein. and then physiology of the varicose veins, studies demonstrate a very high initial success Patients with varicose veins may be asymp- the non-surgical treatment could hopefully rate with thermal ablation methods, in the tomatic, or may have symptoms such as pain, excel in the successful management of varicose 95-100% range, with patients demonstrating Following 15 years working at Baskent University, heaviness, tiredness, heat sensation, night veins. approximately 90% persistent occlusion of the Prof. Oguzkurt transferred to the division of inter- cramps, itching over the varicose veins and saphenous vein after 24 months. The patterns ventional radiology at Medical Park Hospital paresthesias. Chronic venous insufficiency with Endovenous thermal ablation methods use of recurrence following thermal ablation of Group, Istanbul in 2014. He specialises in vascular skin changes, ankle swelling, pain and even target temperature for successful ablation. saphenous veins are different than those seen interventions, including peripheral artery ulceration of the leg can ensue in long-stand- Temperature increase during laser ablation after surgery. Specifically, new reflux in other revascularisation, endovenous treatment of ing cases. These clinical complaints usually is fast with a high-peak temperature for a saphenous veins (especially anterior accessory venous thrombosis and treatment of varicose cause a decrease in the quality of life. short time, where steam ablation and radio- vein) is responsible for most recurrent varicose veins, as well as varicocele and pelvic congestion. frequency ablation have longer plateau phases veins and neovascularity seems to be very His other areas of expertise include oncologic The traditional treatment was surgical high and lower maximum temperatures. Tumescent rare following endovenous thermal ablation. interventions, hepaticoportal venous inter- ligation and stripping of the incompetent anaesthesia with or without anaesthetic Clinical evaluation and overall quality-of-life ventions and uterine fibroid embolisation. He is saphenous vein. High ligation with stripping solution is always applied before any thermal scores improved in all patients compared with a strong advocate of scientific publishing: not had a 25-60% failure rate, ranging from 5 to ablation and is a very important step to protect baseline. Symptomatic relief remains extremely only has he authored over 110 peer-reviewed 34 years in the available literature. The failures the tissues surrounding the ablated vein, and high through the 5-year interval, with fewer inter national and over 30 peer-reviewed national associated with high ligation usually arise from to reduce complications during and after the than 5% of patients demonstrating return of publications, he also teaches at nationwide neovascularisation in the saphenofemoral ablation procedure. the pain and fatigue symptoms with which meetings dedicated to the topic. surgical bed. Incomplete removal of the they had presented. saphenous vein has been reported to occur Available devices in as high as 62% of patients, as the stripper is Surgical techniques for controlling saphenous passed blindly during the surgical procedure. Laser devices for use in the treatment of reflux, including ligation and even stripping of saphenous reflux are currently available from the saphenous vein, are morbid procedures. least as effective as surgery in the successful Thermal ablation several manufacturers. The laser-emitting Endovenous techniques, by comparison, obliteration of saphenous vein insufficiency machines differ primarily in their power and have low rates of complication. The use of and management of patients’ symptoms. Endovenous thermal ablation methods in the wavelengths. The fibres differ on their tip ultrasound-guided tumescent anaesthesia They also offer improved complication rates form of laser, radiofrequency or steam ablation shape and configuration (bare tip vs. jacketed has dramatically improved complication rates for pain, paresthesia, infection and venous have gained wide acceptance owing to their tip and straight tip vs. radial tip). Although associated with the procedures. Thermal thromboembolism when compared with

Figures: Fig. 1a and b show anterior and lateral projection photos of a 46-year-old woman with varicose veins due to left great saphenous vein insufficiency. Photos taken six months after endovenous thermal ablation (Fig. 1c and d) of the left great saphenous vein shows absence of varicose veins.

high effectiveness in causing obliteration the initial success rate and durability of laser ablation methods can cause pain, bruising, surgical treatment. The effectiveness of of the incompetent saphenous veins. t reatment for saphenous reflux are very tenderness and phlebitis over the treated vein. laser, radiofrequency and steam ablation are Ultrasonography is used in every important promising, we still do not know the best Neural damage to the saphenous nerve is similar. Although some meta-analyses showed step of these procedures. The advantages of settings for power or energy delivered. Power rare but possible when one ablates the great lower recurrence rates for laser ablation and thermal ablation therapies, including short of between 5 and 30 watts and energy delivery saphenous vein distally. Deep vein throm- improved post-operative pain with radiofre- hospital stays, less pain, less bruising and less of between 40 and 120 J/cm are used with bosis, pulmonary embolism are extremely rare quency ablation among all thermal ablation post-operative recovery, placed these methods s uccess. However, there is still no evidence with but can be seen. Over the past five years, the methods, others showed similar effectiveness as the primary treatment option for varicose which to make any credible distinction among incidence of adverse events reported for laser and complication rates. veins in the American and European guidelines. the various power, wavelengths and tip types and radiofrequency ablations were 1 and 2 per The minimally invasive nature of the treatment or shapes in terms of efficacy. The differences 10,000 procedures, respectively. The compli- Many operators now believe that endovenous has obviated the need for surgery and led to with new long radiofrequency catheters cation ratio over the years was <1:2,500 for thermal ablation methods meet the primary greater acceptance by patients, which in turn are minor, as many setting are fixed by the deep vein thrombosis, <1:10,000 for pulmonary aim of high efficacy and low morbidity and has considerably increased the demand for manufacturer. Only ablation cycles can be embolism, <1:50,000 for death. will be defined as the new reference standard endovenous thermal ablation procedures. increased at each segment, which was shown for the management of saphenous vein to be unnecessary in one study. For steam Conclusion insufficiency. Endovenous laser ablation, when first in- ablation, the device does not have mechanical troduced into clinical practice, brought to- differences and the only parameter that can Currently available clinical trial evidence gether an additional improvement for the be changed is pullback duration. With these suggests that thermal ablation methods are at

Cardiovascular and Interventional Radiological Society of Europe C RSE 18 CIRSE 2015 Student Programme Saturday, September 26, 2015

CIRSE 2015 Student Programme – be inspIRed!

The tremendously popular student programme The student programme also contains a range Today’s picks: is now in its sixth year and we heartily welcome of courses and sessions which have been all students to the congress! As a hub of re- especially chosen as being well-suited for search and innovation, CIRSE 2015 is the ideal medical students and doctors at the begin- Basic principles of haemodialysis access Introdução à Radiologia Intervencionista place to find out more about the specialty and ning of their careers, and contains a variety of maintenance (Português) to address any queries about IR that students session types, including Foundation Courses, Auditorium 6 Room 3.B may have. Special Sessions and Workshops. In addition 10:00-11:00 17:30-18:30 to courses named in the student programme, The CIRSE 2015 student programme is designed medical students are welcome to attend all Current evidence and indications for failing Radiologia de Intervenção na perspectiva to showcase the unique aspects of IR as a sessions at CIRSE 2015, apart from the Hands- dialysis access management de um jovem especialista: a formação e specialty and a career path whilst also facilitat- on Workshops. M.R. Sapoval (Paris/FR) futuro desta subespecialidade ing the answering of any questions students Thrombosed dialysis access P.Lopes (Santarém/PT) may have. The aim of the student programme Students are also invited to come to the Student F.G. Irani (Singapore/SG) Técnicas em Radiologia de Intervenção: is to provide a thorough introduction to IR and Lounge, where they can pick up their info- Treatment of central vein occlusions Aplicações clínicas e casos práticos through this spark the interest of bright young packs, write up their notes, meet like-minded A.M. Madureira (Porto/PT) T. Pereira (Vila Nova de Gaia/PT) minds who would otherwise be unaware of peers, and get a complimentary lunch (12:00- Non-maturated dialysis access Os dispositivos médicos da Radiologia what the discipline has to offer. 14:00, vegetarian options available). S.O. Trerotola (Philadelphia, PA/US) de Intervenção: visita guiada à exposição técnica The student programme gives students the We wish the students a wonderful congress! F. Gomes (Faro/PT) opportunity to: CIRSE Opening and Awards Ceremony • get to know the world of interventional Auditorium 1 radiology 14:30-16:00 Introducing IR (English) • learn from the most renowned doctors of the Room 3.A specialty 17:30-18:30 • experience the dynamic atmosphere of a professional medical congress • explore new options for your professional Welcome from the President & general future introduction to IR • interact with like-minded students and A.-M. Belli (London/UK) doctors Summary of conditions / IR treatments E. Brountzos (Athens/GR) The Introducing IR sessions consist of lectures Education, training, IR as a career and an interactive question-and-answer K.A. Hausegger (Klagenfurt/AT) session with top interventional radiologists and Introduction to the congress are in both English and Portuguese, to make IR C.A. Binkert (Winterthur/CH) as accessible as possible. A number of hands- on simulator sessions have been arranged – due to limited numbers, only pre-registration Children’s Cancer Charity Evening is required. Lisbon University Stadium 19:00

Special Edition / CIRSE 2015 – Lisbon I 19 congress CVIR / Featured Paper newsR

CardioVascular and Interventional Radiology CVThe official journal of the CardiovascularR and Interventional Radiological Society of Europe Calling all CVIR Reviewers, Authors and Editorial Board Members!

In recognition of your valuable contribution to the journal, CVIR’s Editor-in-Chief, Dierk Vorwerk would like to invite you to attend this year‘s

CVIR Reception and Award Ceremony Date: Saturday, 26th September, 2015 Time: 12:30 – 13:45 Location: Room "La Fenice", Vila Gale Opera Hotel

NEW – CVIR Lounge and Terminals Unable to make it to the ceremony? Why not stop by for a coffee at the CVIR Lounge or browse the journal at the special CVIR terminals? Both have been set up for your convenience!

Today’s Featured Paper will be presented in the Free Paper session below, taking place from 16:15-17:15

FP 607 MRgFUS and IRE Room 3.A Magnetic resonance-guided focus ultrasound surgery (MRgFUS) compared to uterine artery embolization (UAE): main differences, advantages, therapeutic response, and definition of selection criteria F. Ferrari, A.V. Giordano, F. Arrigoni, S. Carducci, A. Miccoli, S. Mascaretti, G. Mascaretti, C. Masciocchi; L’Aquila/IT

IR Congress News is published as an additional source of information for all CIRSE 2015 Editors-in-Chief: P. Haage, C. Binkert participants. The articles and advertorials in this newspaper reflect the authors‘ opinion. Managing Editor: Ciara Madden, CIRSE Office CIRSE does not accept any responsibility regarding their content. Graphics/Artwork: LOOP. ENTERPRISES media / www.loop-enterprises.com If you have any questions about this publication, please contact us at [email protected].

Cardiovascular and Interventional Radiological Society of Europe C RSE