Educational Exhibit Posters Chosen by the Annual Scientific Meeting Committee In advance of the upcoming annual meeting of the Society of Interventional Radiology in Washington, DC, the program committee wishes to highlight the educational exhibit e-posters that will be presented. The posters were chosen using blinded review. Authors are congratulated for their contributions. Daniel Sze, MD, FSIR Chair, 2017 Annual Meeting Scientific Program Educational Exhibit e-Posters Abstract No. 581 Etiology Technique Used Hepatic artery pseudoaneurysms: a pictorial review of Trauma Falling injury Gelfoam with intraprocedural different scenarios and managements cone-beam 3D CT imaging R. Galuppo Monticelli1, Q. Han1, G. Gabriel1, S. Krohmer1, D. Raissi1 Gunshot injury Coiling Iatrogenic Post cholecystectomy Onyx embolization 1University of Kentucky, Lexington, KY Post biliary drain Coiling PURPOSE: The focus of this educational exhibit is to present a pictorial placement review of the anatomical considerations and management in varied Post ERCP Gelfoam cases of hepatic artery pseudoaneurysms (HAPs) secondary to differ- Tumor Hemorrhage Embozene ent etiologies. Special attention is given to troubleshooting HAPs with Tumor related Post TACE N-Butyl cyanoacrylate varied anatomical presentations. Transplant related Portal hypertension iCAST covered Stent MATERIALS: Hepatic artery pseudoaneurysm (HAP) is an unusual but Idiopathic Otherwise healthy male Coiling with sandwich technique serious complication of acute or chronic injury to the hepatic artery that can potentially be fatal. HAPs are classified as intrahepatic or extrahe- patic. There are many etiologies of HAP formation, including trauma, iat- Abstract No. 582 rogenic, tumor, pancreatitis, inflammatory and idiopathic. Early detection Stenting as a first-line therapy for symptomatic and treatment is critical to decrease morbidity and mortality. Endovas- acute phase ICA dissection: review and institutional cular therapy is the preferred initial management. Different endovascular experience techniques can be utilized depending on anatomical considerations. P. Davidson1, J. Singh2 RESULTS: We present a pictorial review of singular cases of hepatic 1 pseudoaneurysm with remarkable anatomical considerations and their Wake Forest University Baptist Medical Center, Winston Salem, 2 management with different endovascular techniques (see table). NC, N/A, Winston Salem, NC CONCLUSIONS: Clinical presentation and radiographic characteristics PURPOSE: Review the evolving role of stent placement as a primary of HAPs. Explore endovascular techniques for the management of therapy for acute phase ICA dissection. Provide a pictorial review of HAPs. Special considerations and troubleshooting for variant hepatic cases performed at our institution and briefly outline techniques. Iden- vascular anatomy. tify patients who are candidates for intervention SIR assumes no legal liability or responsibility for the completeness, accuracy, and correctness of the information presented in the abstracts. Abstracts will be published in the Annual Meeting Supplement to the Journal of Vascular and Interventional Radiology as submitted by the authors, except for minor stylistic adjustments to ensure consistency of format and adherence to Supplement style. Dosages, indications, and methods of use for products that are referred to in the Supplement by the authors may reflect their clinical experience or may be derived from the professional literature or other clinical sources. Because of the differences between in vitro and in vivo systems and between laboratory animal models and clinical data in humans, in vitro and animal data may not necessarily correlate with clinical results. *An underline under an author’s name designates the abstract presenter. †N/A in the author affiliation area indicates that no affiliation was available at press time. © SIR, 2017 SIR 2017 Annual Scientific Meeting | 1 2 | Educational Exhibit e-Posters SIR 2017 Annual Scientific Meeting MATERIALS: Internal carotid artery (ICA) dissection may be sponta- access, as well as various recanalization techniques, with case exam- neous, traumatic, or iatrogenic. While often asymptomatic, symptoms ples. C. Overview of relevant inventory for arterial recanalization via related to flow limitation and distal emboli may be present. Arterial dis- these access sites. D. Visual overview of outcomes and complications. sections account for a significant portion of the strokes seen in young CONCLUSIONS: Ultrasound-guided arterial access via radial, brachial, patients. Anticoagulation has been the mainstay of therapy in the past popliteal, or pedal arteries provide alternatives or adjuncts to tradi- as the pathogenesis has been thought to relate primarily to thrombo- tional access techniques for successfully treating lower extremity embolism. Although anticoagulation has a clear role in ICA dissection chronic total occlusions. Interventionalists treating peripheral arterial treatment, patients presenting with large vascular territory ischemia disease should be familiar with these techniques. are candidates for stenting to restore flow and prevent infarct com- pletion. A large randomized controlled trial has not been performed; however, systematic review of the literature and our own experience Abstract No. 584 shows efficacy and safety. Midaortic syndrome: a rare cause of hypertension in RESULTS: Procedure details will include techniques for microca- children theterization of the true lumen and subsequent stent choice and deployment. Our algorithm for patient selection is reviewed. Patients J. Koo1, J. Hazelton2, M. Pasyk3, G. Elias3, J. Tisnado3 presenting with ischemic symptoms, but demonstrating penumbra on 1Wayne State University School of Medicine, Detroit Medical Center, CT perfusion imaging are candidates for emergent endovascular inter- Detroit, MI, 2Wayne State University School of Medicine, Detroit, vention. Dual antiplatelet therapy is initiated following a bridge with a MI, 3Virginia Commonwealth University, Richmond, VA fast-acting agent such as Integrilin (eptifibatide). Excellent outcomes with reversal of symptoms such as hemiparesis have been achieved in PURPOSE: To review the pathophysiology, clinical presentation, radio- some cases. logic diagnosis and therapeutic management of mid aortic syndrome in children. CONCLUSIONS: Patients with ICA dissection and ischemic symptoms who are found to have evidence of penumbra are candidates for MATERIALS: Midaortic syndrome (MAS) is a rare cause of hypertension emergent endovascular stenting. Although larger studies are needed, in children. It is characterized by significant stenosis of the mid abdom- review of the literature and our own experience shows promising inal aorta and is frequently associated with concomitant involvement results with satisfactory safety and efficacy. of visceral (celiac and superior mesenteric) and renal arteries. The eti- ology of MAS is unclear and controversial. RESULTS: Depending upon the site of vascular stenosis, the child may Abstract No. 583 be asymptomatic or may present with uncontrollable hypertension Off the beaten path: alternative access sites for with or without renal failure. Other clinical manifestations include endovascular recanalization lower limb claudication, headache, epistaxis, chest pain, cardiac failure and abdominal pain. If left untreated, MAS is associated with signifi- 1 2 3 4 4 5 M. Liao , W. Phyu , H. Lee , M. Walsworth , A. Chen , J. Park cant morbidity and mortality. Diagnostic images of MAS with Doppler 1N/A, San Gabriel, CA, 2N/A, N/A, 3N/A, Manhattan Beach, CA, 4N/A, ultrasonography, contrast-enhanced CT, and MRI are presented. Each Santa Monica, CA, 5West Los Angeles VA Medical Center, Los imaging modality is correlated with the patient’s clinical presentation Angeles, CA and diagnosis. The indications for treatment, timing, and rationale for various management strategies are discussed. The traditional thera- PURPOSE: 1. To review the indications and rationale for performing peutic intervention is open surgical reconstruction with bypass graft- alternative forms of access to perform or guide arterial recanalization. ing, however, depending upon the nature of the vascular involvement, 2. Techniques include radial, brachial, popliteal, and pedal access. 3. percutaneous angioplasty with or without stenting may be performed. To guide the reader through the anatomy, patient selection, interven- Finally, the specific procedural details and the goals of therapeutic tional methods, benefits, and potential complications of these differ- options are reviewed. ent access techniques. 4. Case examples will be presented to highlight the techniques. CONCLUSIONS: Radiologic evaluation is critical for the diagnosis and development of patient-specific treatment strategy. Both, traditional MATERIALS: The conventional access point for performing lower open surgical bypass and newer endovascular techniques may be extremity and pelvic arterial intervention is the common femoral employed during the management of mid aortic syndrome. Open artery. However, the failure rate in recanalizing chronic total occlusions surgery is the primary treatment of choice; however, endovascular (CTOs) approximates 20% from this approach for lower extremity intervention may provide a safe and less invasive treatment option for intervention. In these cases (and even for primary intervention), alter- patients with mid aortic syndrome. native arterial access sites can be utilized to