Interventionell Radiologisches Olbert Symposium

POSTER ABSTRACTS AND AUTHOR INDEX BERLIN, 12.– 14.1.2017 Transnational congress of the German, Austrian and Swiss Societies of Interventional Radiology (DeGIR, ÖGIR & SSVIR) Online Publication Number: 10.1007/s00270-016-1520-1

All electronic posters accepted for IROS 2017 will be presented in one of the Poster Safaris or the Scientific Splash session. The respective dates and timings are shown below: THURSDAY, JANUARY 12 PS 702 / Poster-Safari

13:15 – 14:00

FRIDAY, JANUARY 13 PS 1802 / Poster-Safari SS 1901 / Scientific Splash PS 2002 / Poster-Safari

13:15 – 14:00 14:15 – 15:00 15:00 – 15:45

Poster Abstracts

P-702.1 Frequency of normal variants of bronchial arteries in conventional catheter angiography M. Stauder1, M. Montag1, R. Chapot1, M. HeijkampRösler1, R. Puls2; 1Essen/DE, 2Greifswald/DE In conventional catheter angiography of bronchial arteries variants of bronchial arteries have to be considered. We investigated the frequency of normal variants in 281 patients who had received a conventional catheter angiography. 281 angiograms from recent years were examined (26.4% women, 73.6% men, median age was 54 years). We found a large number of normal variants of bronchial arteries. Right bronchial arteries arise most frequently from the intercostobronchialis trunk. The left bronchial arteries arise directly from the aorta. If bilateral bronchial arteries are present, this origin in almost all cases is the aorta. Rare atypical origins are from the internal mammary artery, the right thyrocervical trunk and the left intercostobronchialis trunk. Standard variants of bronchial arteries are found relatively frequently. The catheter angiography provides this information and is the gold standard for the planning and execution of occlussions of the bronchial arteries. P-702.2 Aneurysms and pseudoaneurysms of visceral arteries: experiences of interventional radiological therapy in a tertiary care setting H. Ruhnke, T. Kröncke; Augsburg/DE Purpose: Evaluation of experience in interventional therapy of incidental and symptomatic visceral artery aneurysms. Material and methods: 43 aneurysms were treated in 38 patients (19 female, 19 male, mean age 57 +/- 16 years (18-82)) from 2011 to 2015. Characteristics of the aneurysms (true vs. false aneurysm, size, etiology, localisation, symptoms) were considered. Furthermore, we evaluated pre- and post-interventional diagnostics and the intervention itself concerning technical success, materials used and therapy-associated complications. Results: 24 true aneurysms (maximum diameter 30 +/- 18 mm (11-67 mm)) and 19 false aneurysms (maximum diameter 25 +/- 33 mm (3-150 mm)) were evaluated. Arteria lienalis (n=14) and Arteria renalis dextra and sinistra (n=18) were most frequently affected. The etiology was most commonly degenerative-atherosclerotic (44%) or iatrogenic post-operative (21%). 18/48 interventions were performed due to an active bleeding, false aneurysms were more often associated with active bleeding (63% vs. 25%, p=0,012). Most of the aneurysms

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were diagnosed by CT (77%). 41/48 treatments were technically successful, there was a complication rate of 10%, whereby only one major complication was seen. Aneurysms were primarily treated using coils and if necessary with additional embolisates (fluid embolisates or vascular plugs) (75%). Conclusion: Interventional therapy for visceral artery aneurysms is safe and effective. Especially multi-morbid patients benefit from minimally invasive therapy options with comparable morbidity and mortality to surgery. P-702.3 Percutaneous treatment of head and neck venous malformations – Long-term quality of life results D. Grieb1, D. Meila1, B.A. Greling1, M. Hechtner2, C. Jacobs2, K. Melber1, M. Schlunz-Hendann1, F. Brassel1; 1Duisburg/DE, 2Mainz/DE Purpose: We present the long-term results of patients with head and neck venous malformations (HNVM) after percutaneous treatment based on a quality of life questionnaire. Material and methods: From our database of 70 patients with vascular malformations of the head and neck, we analysed the medical files of 32 patients with low-flow HNVM (treated 2000 – 2014). Percutaneous sclerotherapy with Polidocanol was the treatment of choice. Additional embolotherapy with fibrin glue was performed. The patients were asked to answer a quality of life questionnaire about the following symptoms before and after treatment: pain, functional impairment, cosmetic deformity and impairment in daily life. Results: 20 patients answered the questionnaire. In 49 therapeutic sessions one minor complication directly related to sclerotherapy was encountered (2%). 8 out of 20 patients (40%) complained of pain before treatment. 3 patients were completely cured after sclerotherapy and 4 reported an improvement. 8 patients (40%) reported functional impairment before treatment. A complete relief after treatment was noted in 5 of them. All 20 patients presented initially with cosmetic concerns. 3 reported complete relief after treatment. Major improvement was observed in 12 patients. 15 out of 19 patients (78.9%) complained about impairment in daily life. After treatment 7 of them reported a complete relief, while 5 noticed an improvement. 18 (90%) patients were very satisfied with their treatment in general. Conclusion: Percutaneous sclerotherapy is a well-tolerated treatment for HNVM with a low complication rate. Positive subjective results and improvement in different aspects of quality of life can be achieved.

Berlin, January 12 – 14, 2017

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Poster Abstracts

P-702.4 An economic way of recanalising arterial occlusions of lower extremity arteries M. Cunier, E. Schoch, P. Aubert, C.A. Binkert; Winterthur/CH Lower extremity peripheral artery disease (PAD) is very common with a worldwide prevalence between 7 to 10 percent, increasing to 15 to 20 percent in people over 70 years of age. The majority of patients with PAD have atherosclerotic disease of the lower extremity leading to peripheral artery obstruction. Considering the increasing health care costs and the decreasing resources, it is important to use efficient and economic recanalisation techniques. The aim of our study was to determine the success rate of a simple recanalisation technique of arterial occlusions between the aortic bifurcation and the popliteal artery. Furthermore, we wanted to identify the factors associated with technical failure. The technique is based on a curved angiographic catheter (KMP; Kumpe catheter, 5F) as the only leading point. If recanalisation failed, we used a step-up approach progressing to more complex and expensive techniques. More than half of the arterial occlusions could be recanalised by only using a KMP. With the increasing grade of calcification and in more chronic occlusions, the technical success rate decreased. P-702.5 Real-time 3D-guidance in transjugular intrahepatic stent-shunt (TIPSS) placement using C-arm Cone-Beam CT (CBCT) – clinical experience G. Böning, W.M. Lüdemann, J. Chapiro, M. Jonczyk, G. Wieners, D. Schnapauff, D. Geisel, B. Gebauer, R.W. Günther, F. Streitparth; Berlin/DE Purpose: Placement of a transjugular intrahahepatic stent shunt (TIPSS) is a technically challenging standard procedure in interventional radiology and applied to patients who suffer from symptoms of portal hypertension, frequently caused by liver cirrhosis. The aim of this study was to evaluate the feasibility of Cone-Beam CT (CBCT)-based real-time 3D-guidance in TIPSS placement and relative dose of CBCT. Material and methods: 13 patients with indications for TIPSS placement were prospectively included. 12 patients suffered from therapy-refractory ascites and

one from acute bleeding. We used real-time, 3D-guidance based on a C-arm acquired CBCT (Allura Xper FD20 and XperCT, Philips Healthcare, Andover, MA, USA). Evaluated were technical success of TIPS-placement, puncture-time to assess portal-venous system, number of punctures needed, and applied radiation dose of the intervention as well as relative dose of CBCT. Results: In 12 of 13 patients (92 %), TIPSS could be successfully implanted. CBCT-based guidance for portal vein puncture could be applied to all patients. Further US-guidance was not necessary in these cases. In one patient, the TIPSS could not be implanted, neither after using additional US-guidance, due to difficult anatomical situation. In the 12 of 13 patients with technical success, the puncture time was 12±14 minutes, with 3±3 punctures needed. Total applied dose (dose area product, DAP) was 479±222Gy/cm2 during intervention. Relative dose of CBCT was 5±3%. Conclusion: CBCT-based real-time 3D-guidiance for portal vein puncture in TIPSS-placement is feasible and the relative dose of CBCT is low compared to total dose of intervention. P-702.6 Interventional treatment of peripheral vascular malformations – Long-term results with special emphasis on Quality of Life aspects B.A. Greling; Düsseldorf/DE Purpose: We present our long-term results of patients with peripheral venous malformations (PVM) and peripheral arteriovenous malformations (PAVM) after interventional treatment. Material and methods: We retrospectively analysed the medical files of 100 patients with PVM (41) and PAVM (59) that were treated between 2002 and 2014 at our department. The interventional procedure of choice for PAVM was primarily a transarterial superselective embolisation using liquid embolic agents, and percutaneous sclerotherapy with Polidocanol for PVM. Patients answered a symptoms based Quality of Life (QoL) questionnaire before and after treatment. Results: 30 patients with PVM and 44 patients with PAVM answered the questionnaire. In 407 therapeutic sessions (PVM: 112, PAVM: 295) 16 minor complications directly related to the treatment were encountered. 70% in PVM-group reported an improvement in motion pain, 54% in PAVM-group. 70% in PVM-group reported an improvement in rest pain, 50% in PAVM-group. 50% in PVM-group reported an improvement in functional

Poster Abstracts

impairment, 52% in PAVM-group. 40% in PVM-group reported an improvement in skin deformity, 27% in PAVM-group. 56% in PVM-group reported an improvement in swelling, 50% in PAVM-group. 34% in PVM-group reported an improvement in sensibility disorders, 13% in PAVM-group. 53% in PVM-group reported an improvement in impairment in daily life, 50% in PAVM-group. More than 95% of patients with PAVM and PVM were very satisfied with their treatment in general. Conclusion: Interventional treatment is a well-tolerated therapy for PAVM an PVM with a low complication rate. Positive subjective results and improvement in different aspects of QoL can be achieved. P-702.7 First experience using transradial approach with liver interventions

later (peri-interventional mortality 4.2%). Another patient developed a large intrahepatic haematoma and three patients perihepatic haematomas with a significant drop in haemoglobin count which could be managed without invasive procedures or blood transfusion (minor complications). No haemorrhagic events where found in the MWA group. Two complications occured in the MWA group, both were classified as major (6.2%). One patient developed a gall bladder necrosis and received emergent cholecystectomy. The patient died shortly after surgery (peri-interventional mortality (3.1%). A duodenal fistula with liver absess was found in a second patient, who received endoscopic clipping and percutaneous absess drainage. Conclusion: IRE of the liver resulted in a higher rate of haemorrhagic complications and a lower rate of non-haemorrhagic complications compared to thermal ablation (MWA).

S. Schotten, R. Klöckner, C. Düber, M.B. Pitton; Mainz/DE

P-1802.2

13 patients who received transarterial therapy of the liver (TACE, SIRT mapping, embolisation) were treated by a transradial approach. All procedures were performed from the left side with 4F and 5F catheter systems. One patient received two treatment sessions via the transradial route. Technical success was 100%. There were no access-related complications. Procedure time and radiation dose for the interventionalist were comparable to transfemoral procedures. Patients, who received prior interventions via a femoral approach, preferred the radial access.

Dissected MCA aneurysm in a 12-month-old infant: feasibility of interventional therapy?

P-1802.1 Comparison of the safety profile of IRE and MWA in the treatment of liver malignancies: increased risk of bleeding after IRE? S. Schotten, R. Klöckner, C. Düber, M.B. Pitton; Mainz/DE We conducted a retrospective analysis comparing the complication rates of thermal (MWA) and non-thermal (IRE) ablations for primary and secondary hepatic malignancies over a period of two years. During this period, 24 patients had been treated with IRE (27 tumours in 26 sessions) and 32 patients with MWA (42 tumours in 35 sessions). Complications occured after 5 of 26 IRE treatments (total complication rate 19%). All complications were related to haemorrhage. One complication was rated as major (3.8%). This patient developed a large intrahepatic haematoma with liver laceration and subsequently underwent laparotomy and liver packing due to haemodynamic instability and died three weeks

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G. Wirth, Y. Tanyildizi, C. Kampmann, W. Wagner, S. Boor, M.A. Brockmann; Mainz/DE Paediatric intracranial aneurysms are rare and challenging to treat. We report the case of a 12-month-old infant who presented with a five months history of worsening right-sided haemiparesis. MRI demonstrated a large symptomatic saccular left medial cerebral artery aneurysm, without evidence of subarachnoid haemorrhage or any infarction. Angiography showed a stenosis of the angled dissected M1-segment and an 9x12mm measuring apical directed aneurysm. After interdisciplinary discussion interventional percutaneous treatment by stent-assisted aneurysm coiling was initiated. A retractable stent was placed from the distal M1-segment over the aneurysm down to the distal internal carotid artery. Subsequently, the dissecting aneurysm of the left medial cerebral artery was coiled in jailing technique without complications. Retraction of the stent retriever resulted in a restenosis of the parent vessel. The stent was reimplanted to stabilise the dissected parent vessel and to eliminate the stenosis. The symptoms presented at admission resolved completely in the post interventional course. The time-of-flight MRI-angiography showed no residual perfusion of the aneurysm. Regardless of the patient‘s young age, dual platelet aggregation inhibition is administered for at least six months. This case and another single case show that endovascular treatment of aneurysms in infants is feasible; studies are required to confirm these findings.

Berlin, January 12 – 14, 2017

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Poster Abstracts

P-1802.3 The randomized Freeway Stent Study completed the 6-month follow-up and favours the use of drug-eluting balloons over plain balloons for the postdilatation of nitinol stents in the SFA and PI segment to lower restenosis rate J. Tacke1, K.A. Hausegger2, H. Schröder3, S. MüllerHülsbeck4, S. Stahnke5, J. Dambach5; 1Passau/DE, 2Klagenfurt/AT, 3Berlin/DE, 4Flensburg/DE, 5Bonn/DE Purpose: Stents are needed in up to 50 % of all peripheral interventions where PTA with plain or drug-eluting balloons alone will not reopen the vessel sufficiently. Nevertheless, the restenosis rate of stents is still a major limitation of peripheral arterial interventions. Drug-eluting balloons potentially overcome the problem of in-stent restenosis when used for post-dilatation after primary nitinol stenting in the SFA and PI segment. Material and methods: The Freeway Stent Study is a prospective, randomised, international trial conducted in 13 centers in Germany and Austria. 204 patients were enrolled and randomised to primary stenting followed by either DEB (FREEWAY ™) or POBA post-dilatation. Primary endpoint is clinically driven target lesion revascularisation (TLR) at 6 months, secondary endpoints include patency rate, shift in Rutherford classification, ABI and MAE at 6 months. Results: The 6-months follow-up has been completed. The results highly favor the use of FREEWAY ™ DEB over POBA based on clinically driven TLR rate and a significant better outcome in primary patency rate at 6 months. This is supported by statistically significant better clinical outcomes for patients in the DEB group. Conclusion: The use of DEB as post-dilatation device is investigated in a new approach to decrease the restenosis rate after nitinol stenting in the SFA and PI segment. The Freeway Stent Study shows that the usage of DEB as a restenosis prophylaxis seems to be safe and feasible. The 6-months follow-up results give significant and positive trends in all parameters in favour of DEB. P-1802.4 Percutaneous hepatic perfusion with Melphalan (Chemosaturation) in patients with hepatic metastasis of ocular melanoma: experience in 11 patients S. Marquardt, M. Kirstein, A. Vogel, F. Wacker; Hannover/DE Purpose: To assess safety, side affects and efficacy of percutaneous hepatic perfusion (PHP) in patients with hepatic metastasis of ocular melanoma.

Material and methods: There is no standard therapy for irresectable hepatic metastasis of ocular melanoma. PHP with Melphalan is a repeatable, percutaneous local therapy, using a double-balloon catheter for isolation of the hepatic inferior caval vein segment. During arterial chemoperfusion of the liver with melphalan, venous blood of the liver is extracted through the double-balloon catheter and filtrated via an extracorporeal hemofiltration circuit before it is given back through a sheath in the internal jugular vein. We retrospectively reviewed data from 11 patients with hepatic metastasis from ocular melanoma that received 1-4 treatments of PHP under general anesthesia in one tertiary care center. Technical success, adverse effects and tumour response (RECIST) were evaluated. Results: Technical success was achieved in all procedures. A reversible drop of blood pressure could be seen in all patients when flushing the filters. Complications from bone marrow suppression were common but controllable. 2 patients with a tumour load exceeding 70% of liver volume died shortly after 1st and 2nd PHP respectively due to acute liver failure. After an average follow-up period of 2 months local response (stable disease or partial response) was observed in 10 patients. One patient died before first follow-up. Conclusion: PHP is a promising therapy in patients with hepatic metastasis of ocular melanoma. Technical execution is problem-free. Complications are mainly due to bone marrow suppression and are manageable. Patients with a high tumour load do not seem to profit. P-1802.5 Coil embolisation of a superior mesenteric arteriovenous fistula under temporary balloon occlusion M. Schlunz-Hendann, D. Meila, H. Matzdorf, K. Melber, B.A. Greling, F. Brassel, D. Grieb; Duisburg/DE A 58-year-old woman presented with abdominal pain and nausea. She underwent a small bowel partial resection a few years earlier. Color duplex sonography (CDS) and abdominal CT revealed a large arteriovenous fistula between the distal superior mesenteric artery (SMA) and an aneurysmatic enlarged superior mesenteric vein (SMV). DSA showed a fistula diameter of 5-6 mm. Endovascular treatment was performed with coils under distinct flow reduction by temporary balloon occlusion of the SMA. DSA and CDS directly following treatment and after three months demonstrated complete closure of the superior mesenteric arteriovenous fistula (SMAVF) with thrombosis of the venous aneurysm. The patient had no more symptoms.

Poster Abstracts

Discussion: SMAVF is a rare abdominal vascular disease, mostly with history of previous abdominal trauma or surgery. Clinical presentation ranges from asymptomatic pulsatile mass, through unspecific abdominal symptoms to portal hypertension with life-threatening gastrointestinal bleeding. Surgical treatment has a high risk of procedural bleeding, thus, endovascular approaches for treatment of SMAVF with coils or stents/stentgrafts have been increasingly performed, but with only a few published cases until now. Organ ischemia due to embolism in the portal venous system and coil migration are the main complications. A critical step is the positioning of the first coils at the fistula point without migration. Temporary balloon occlusion of the feeding artery leads to flow reduction enabling thus an exact placement of the coils. This technically feasible endovascular approach might reduce the risk of coil migration during embolisation of high-flow mesenteric fistula even with large fistula diameters. P-1802.6 Temporary endoleak after EVAR – 3 years later D. Olbrich, G. Turk, P. Schneider, T.K. Helmberger; Munich/DE In our case report we describe the appearance of different types of endoleaks after the implantation of a stentgraft to treat a Stanford B dissection of the aorta. The different types of endoleaks appeared at different points within 3.5 years and required different treatment. On the basis of the presented case we point out the challenges in diagnosing different types of endoleaks and the thereby resulting difficulties in choosing the adequate therapy. P-1901.1 Experimental renal denervation by means of CTsupported periarterial injection of various neurolytic substances in animal models P. Freyhardt, R. Donners, A. Riemert, J. Schnorr, N. Stolzenburg, J.L. Rinnenthal, R.W. Günther, B. Hamm, F. Streitparth; Berlin/DE Purpose: Evaluation of feasibility, safety and efficacy of renal sympathetic denervation with CT-guided periarterial injection of four different potentially neurolytic agents in pigs. Methods and results: Unilateral injection of formulations containing either 5 M hyperosmolar saline, vincristine, paclitaxel or guanethidine around the renal artery was performed in 24 normotensive pigs with 6 animals per group. Needle placement and injections were performed

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under CT-fluoroscopy guidance. CT scans and blood pressure measurements were performed immediately before and after the intervention and 4 weeks after treatment. After euthanasia, norepinephrine (NE) concentrations of both kidneys were determined. The renal arteries and surrounding tissue were examined histologically to evaluate nerve fibre degeneration. Procedures were technically successful with good periarterial injectant distribution in all but one pig. Major adverse events or postinterventional complications did not occur. In the vincristine group, NE concentrations of the renal parenchyma were lower on the treated side in all pigs with a mean decrease of 53% (38% - 62%, p < 0.01) compared to the contralateral control. Respectively, histological examination revealed circumferential neural degeneration of mild to severe degree in all animals treated with vincristine. In the other groups, neither a significant drop of NE values nor histological signs of nerve fibre degeneration were found. Conclusion: CT-guided periarterial injection of the different substances was feasible and safe. Renal sympathetic denervation was achieved with vincristine. In contrast, hyperosmolar saline, paclitaxel and guanethidine do not seem to be appropriate for renal denervation in a pig model at the dosage used. P-1901.2 Development and assessment of a temporary embolisation material for arterial transcatheter application in a rabbit kidney H. Wittgenstein, M. Stechele, J. Breinl, N. Stolzenburg, D. Geisel, J. Schnorr, B. Rudolph, C. Schmidt, B. Hamm, R.W. Günther, F. Streitparth; Berlin/DE Purpose: Evaluation of embolic effect, inflammatory response and resorption behaviour of a novel biodegradable embolic agent for transcatheter arterial embolisation in a rabbit kidney. Material and methods: Using a 3F Cobra catheter superselective renal embolization was performed with biodegradable polydioxanone microspheres (90-500 μm) in 24 New Zealand White rabbits (female; 2,5-3,5 kg; 12-16 weeks). Bland (n=15) and SPIO-loaded (n=9) microspheres were used. Four animals were sacrificed immediately after embolisation to assess particle distribution and handling properties. Twenty animals underwent control angiograms and MR-Imaging (T1-TSE pre/post-contrast, T2-TSE, T2*-GRE) 1 (n=3), 4 (n=3), 8 (n=3), 12 (n=8) and 16 weeks (n=3) post embolisation. Final angiograms were compared with those obtained immediately after embolisation evaluating the embolisation success and reperfusion. The kidneys were harvested for histopatho-

Berlin, January 12 – 14, 2017

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Poster Abstracts

logical analysis of embolic effect, inflammatory reaction and degradational changes of particles. Results: Evaluation of angiograms and MR-images showed successful selective embolisation of the lower renal pole in 18/20 animals. In two animals, the whole kidney was affected due to reflux of microspheres. Additionally MRI demonstrated the distributon of SPIO-microspheres within the kidneys. Histopathological analysis showed corresponding cell necrosis/infarct in the embolised areas. There was a mild acute inflammatory reaction visible at all time-points and a foreign body reaction at advanced time intervals. The embolic material was microscopically visible at all time points while being increasingly degraded at 16 weeks. Conclusion: The novel bioresorbable microspheres led to an effective occlusion of target vessels while simultaneously demonstrating good biocompatibility. The agent appeared largely reabsorbed at 16 weeks, thus offering advantages as a temporary embolic. SPIO-loaded microspheres allowed a non-invasive visualisation of the microspheres distribution. P-1901.3 CT-Perfusion of the kidney to assess novel biodegradable and established non-biodegradable microspheres – initial results using a swine model T. Reichenbacher, C.-M. Sommer, P. Flechsig, D. Vollherbst, T.L. Gockner, T.D. Do, S. MacherGoeppinger, H.-U. Kauczor, P.L. Pereira, C.L. Schlett; Heidelberg/DE Purpose: To assess renal perfusion by dynamic CT imaging after embolisation of the right kidney comparing biodegradable and non-biodegradable microspheres in a swine model. Material and methods: Transarterial embolisation of the right kidney was performed within 4 swines using two different microspheres: L1 as a prototype (PharmaCept, Germany) of biodegradable starch microspheres (estimated in-vivo biodegradation-time: <14d; size d50=569μm /d100=1240μm) and EmboSphere700-900 as commercially, non-biodegradable microspheres. Dynamic contrast-enhanced CT (Siemens Definition Flash) was performed pre-interventional, 1h and 7d post-interventional; blood flow (BF) was derived from CT using Syngo Volume-Perfusion-CT-Body software. BF was measured across the entire kidney at the hilus (covering 10mm z-axis) as well as stratified into anatomic regions (dorsal vs. ventral segments). Results: CT perfusion allows BF measurements in the kidney deriving physiological values of

142,4±15,5mL/100mL/min pre-interventional. Post-interventional, overall BF was reduced to 55.7% at 1h and recovered after 7d to 85.4% of the pre-interventional value. Overall BF was comparable between biodegradable and non-biodegradable microspheres, regardless of the point in time. However, both particle types demonstrated a higher decrease of BF in the dorsal as compared to the ventral segments of the kidney (at 1h: -103.9 vs. -38.0mL/100mL/min, at 7d: -80.5 vs. +18.4mL/100mL/ min change in BF, respectively) and there might be a trend that this difference was larger using biodegradable than non-biodegradable microspheres. Conclusion: Overall renal BF measured by CT perfusion demonstrated similar kinetics between biodegradable vs. non-biodegradable microspheres. Both particles altered BF more strongly in the dorsal segments, given the supine position potential gravitational effects on the distribution must be further evaluated in larger samples. P-2002.1 Visible embolic materials: Lipiodol versus The40μmVisibleBead T.L. Gockner1, D. Vollherbst2, R. Oberle1, P. Flechsig2, T.D. Do2, C.L. Schlett2, H.U. Kauczor2, P.L. Pereira3, G.M. Richter4, C.M. Sommer2; 1Mainz/DE, 2Heidelberg/DE, 3Heilbronn/DE, 4Stuttgart/DE Purpose: Visible embolic materials are promising to optimise the outcome of transarterial embolisation. Beside Lipiodol, an established liquid x-ray visible embolic agent, interventional oncology research is trying to introduce microspheres with x-ray visibility. Material and methods: In four landrace pigs, transarterial embolisation of the right liver was performed using two different embolic materials: Lipiodol or calibrated microspheres with a diameter of 40±10μm (The40μmVisibleBead). The40μmVisibleBeads are modified commercially available microspheres, which should achieve x-ray visibility by minimal changes in the production process. The embolisation endpoint was defined as peripheral stasis with persistence of flow in the central liver arteries. The study goal was the evaluation of the visibility of the embolic agents during and directly after embolisation under angiography and CT. Results: In pig 1 and 2, Lipiodol was visible during and directly after embolisation under angiography and CT showing strong arterial and parenchymal contrast. The40μmVisibleBead was not visible during embolisation under angiography in pig 3 and 4, but could be detected in pig 3 directly after embolisation under angiography. Under CT, The40μmVisibleBead was visible in both pigs with strong arterial and parenchymal contrast in pig 3

Poster Abstracts

and plane diffuse contrast in pig 4. Conclusion: X-ray visibility can be obtained by minimal changes in production process of commercially available microspheres. The new embolic agent – The40μmVisibleBead – shows a weaker contrast after transarterial application compared with Lipiodol, but the distribution pattern under angiography and CT was comparable. By modification of the embolisation technique, the x-ray visibility of The40μmVisibleBead could be further improved. P-2002.2 Marginal veins and interventional radiology W. Uller; Regensburg/DE Marginal veins are remnant primitive embryonic vessels. These abnormal superficial veins are located on the lateral lower extremity or the thoracoabdominal wall. In order to reduce symptoms like venous thromboembolism and complications related to venous insufficiency, treatment of the marginal venous system is essential. We demonstrate the results of endovenous radiofrequency-powered thermal ablation (RFA) of the marginal venous system in patients with venous malformations. P-2002.3 Validation of the scoring system SNACOR (tumour Size and Number, baseline Alpha-fetoprotein, Child-Pugh, and Objective radiological Response) after TACE R. Klöckner, M.B. Pitton, A. Mähringer-Kunz, C. Düber, I. Schmidtmann, S. Koch, P.R. Galle, A. Weinmann; Mainz/DE Purpose: TACE is the standard of care for intermediate stage HCC. Deciding to what extent treatment should be repeated remains challenging. Hence, we conduct an external validation of the SNACOR risk prediction model. Material and methods: From 01/2000 to 09/2015 a total of 933 patients with HCC underwent TACE at our institution. SNACOR is based on several variables at baseline: tumour size and number, baseline Alpha-fetoprotein, and Child-Pugh score. After the first TACE radiological response is also measured. The score can range from 0 – 10 points. Survival was calculated for three risk groups (low (0-2 points), intermediate (3-6 points), and high (7-10 points)). Harrell‘s C-index and the integrated Brier score were calculated. In order to identify independent predictors of survival Cox regression was performed. Results: The number of patients finally included was 251. Median survival in the low, intermediate, and high risk groups were 24.9, 18.8 und 9.9 months, respectively.

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Harrell‘s C-index was 0.596 and IBS was 0.136. Independent predictors of survival were Child-Pugh and treatment response. Conclusion: Although the SNACOR score showed some correlation with survival, its predictive ability was only moderate. Hence, this risk prediction model can only serve as one of several components in clinical decision making. P-2002.4 Endovascular treatment of head and neck arteriovenous malformations – long-term angiographic and quality of life results D. Grieb, D. Meila, B.A. Greling, M. Hechtner, C. Jacobs, K. Melber, M. Schlunz-Hendann, F. Brassel; Duisburg/DE Purpose: We present the long-term angiographic and subjective results of patients with head and neck arteriovenous malformations (HNAVM) after endovascular treatment. Material and methods: We retrospectively analysed the medical files of 14 patients with high-flow HNAVM (treated 2000-2014). The endovascular procedure of choice was primarily a transarterial superselective embolization using liquid embolic agents. Depending of localisation and angioarchitecture of the HNAVM, a combined transarterial/transvenous approach or direct puncture with percutaneous embolisation were required. Patients were asked to answer a quality of life (QOL) questionnaire about the following symptoms before and after treatment: pain, functional impairment, cosmetic deformity, impairment in daily life and bleeding. Results: Complete or >90% closure of the AVM was achieved in 6 of 14 patients (43%). 10 patients (71%) had >50% shunt reduction. 3 complications were encountered in 86 sessions. All patients answered the questionnaire. 6 patients (43%) presented with bleeding which could be cured in all cases. 4 of 14 patients (29%) specified pain which could be resolved in 2 of them. Another 6 patients (43%) presented with functional impairment. 4 of them could be cured, 2 noted an improvement. All patients presented with cosmetic concerns. 4 patients were cured and 8 experienced a clearly visible improvement. 9 patients (69%) presented with impairment in daily life which could be resolved in 5 of them, 4 reported an improvement. Conclusion: Endovascular embolisation is a well-tolerated therapy for HNAVM with a low complication rate. Good angiographic results, positive subjective results and improvement in different aspects of QOL can be achieved.

Berlin, January 12 – 14, 2017

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Poster Abstracts

P-2002.5 Clinical Intervention Modeling, Planning and Proof for Ablation Cancer Treatment – ClinicIMPPACT M. Eibisberger1, H. Portugaller1, H. Deutschmann1, P. Stiegler1, P. Vogelreiter1, J. Futterer2, R. Flanagan3, M. Pollari4, M. Kolesnik5, M. Moche6; 1Graz/AT, 2Nijmegen/NL, 3Dundalk/IE, 4Aalto/FI, 5St. Augustin/DE, 6Leipzig/DE Purpose: Radiofrequency ablation is an established method for therapy of malignant liver tumours. For many RFAs performed in the liver, there is still a significant mismatch between expected and truly induced lesion size. This is mainly due to several individual factors related to inner body structures (e.g. vessel flow, liver tissue properties, tumour type and perfusion, proximity to vessels and liver surface etc.) that substantially affect the size and configuration of the ablated lesion and are not taken into account by the manufacturer‘s ablation protocol. This can lead to over-treatment with severe injuries (up to 9% major complications), or under-treatment with tumour recurrence (up to 40%). The aim of ClinicIMPPACT is the prospective evaluation of a previously generated simulation-algorithm and workflow for planning, simulation and validation of RFAs in the liver. Material and methods: By means of a pre-interventional (at least one day before the intervention) 3 phase CT-Scan (arterial, portal venous and late venous phase) the software automatically generates a liver-model that takes into account the distribution of the hepatic arterial, portal venous and hepatic venous vessels. With a perfusion-CT of the liver the individual liver- and tumour-perfusion is determined. Tumour-segmentation is performed semi-automatically. All RFAs are performed under CT-guidance and the final needle positions are documented by CT and are registered by a point-based registration-algorithm either rigid or deformable to the pre-interventional liver-model. The transferred needleposition and known perfusion-data are the basis for the simulation. The simulated lesion is compared to the real ablated lesion in the one month CT-control, which is again registered to the pre-interventional liver-model, and validated by quantitative and semi-quantitative parameters (volume, absolute average error, DICE-Score, volume overlap). Until March 2017, we want to include approximately 60 patients in ClinicIMPPACT. The indication for the RFA is set in local tumour boards according to current guidelines. Results: Preliminary results of two of our first patients (MUG 101 and 104) show a good correlation of the simula-

ted and real ablated volume with a relative volume-difference of 3.9% and 12.8%. The average absolute error was 2.8mm respectively 1,7mm and the volume-overlap 61.8% respectively 63.3%. The corresponding DICE-scores were 75.8% and 77.1%. Conclusion: First results can be expected approximately by June 2017 and will give a closer look on the simulation-algorithm and practicability of the generated workflow. P-2002.6 Wunderlich Syndrom – successful coil embolisation of a ruptured angiomyolipoma of the kidney H. Gößmann, W. Uller; Regensburg/DE Angiomyolipomas are the most common benign tumours of the kidney. Bilateral and multiple angiomyolipomas occur in M. Bourneville Pringle and in Lymphangioleiomyomatosis (LAM). These benign tumours may be a source of spontaneous pararenal bleeding (“Wunderlich Syndrom”). We are reporting on successful coil embolisation of severe bleeding caused by an angiomyolipoma.

Author Index

S397

AUTHOR INDEX Aubert P. ................................................................P-702.4 Binkert C.A. ...........................................................P-702.4 Böning G. .............................................................. P-702.5 Boor S. .................................................................P-1802.2 Brassel F. .............................. P-702.3, P-1802.5, P-2002.4 Breinl J. ................................................................ P-1901.2 Brockmann M.A. ..................................................P-1802.2 Chapiro J. ...............................................................P-702.5 Chapot R. ............................................................... P-702.1 Cunier M. .............................................................. P-702.4 Dambach J. ..........................................................P-1802.3 Deutschmann H. ................................................. P-2002.5 Do T.D. ..................................................P-1901.3, P-2002.1 Donners R. ........................................................... P-1901.1 Düber C. ................................. P-702.7, P-1802.1, P-2002.3 Eibisberger M. ....................................................P-2002.5 Flanagan R. ......................................................... P-2002.5 Flechsig P. ............................................P-1901.3, P-2002.1 Freyhardt P. ......................................................... P-1901.1 Futterer J. ........................................................... P-2002.5 Galle P.R. ............................................................. P-2002.3 Gebauer B. .............................................................P-702.5 Geisel D. .................................................P-702.5, P-1901.2 Gockner T.L. ........................................ P-1901.3, P-2002.1 Gößmann H. ........................................................P-2002.6 Greling B.A. ........... P-702.3, P-702.6, P-1802.5, P-2002.4 Grieb D. ................................ P-702.3, P-1802.5, P-2002.4 Günther R.W. ..........................P-702.5, P-1901.1, P-1901.2 Hamm B. ...............................................P-1901.1, P-1901.2 Hausegger K.A. ...................................................P-1802.3 Hechtner M. .......................................... P-702.3, P-2002.4 Heijkamp-Rösler M. .............................................. P-702.1 Helmberger T.K. ..................................................P-1802.6 Jacobs C. ............................................... P-702.3, P-2002.4 Jonczyk M. .............................................................P-702.5 Kampmann C. ......................................................P-1802.2 Kauczor H.U. ........................................P-1901.3, P-2002.1 Kirstein M. ...........................................................P-1802.4 Klöckner R. ........................... P-702.7, P-1802.1, P-2002.3 Koch S. ................................................................ P-2002.3 Kolesnik M. ......................................................... P-2002.5 Kröncke T. .............................................................P-702.2 Lüdemann W.M. ....................................................P-702.5 Macher-Goeppinger S. ......................................... P-1901.3 Mähringer-Kunz A. ............................................. P-2002.3 Marquardt S. ....................................................... P-1802.4 Matzdorf H. ..........................................................P-1802.5 Meila D. ................................. P-702.3, P-1802.5, P-2002.4

Melber K. .............................. P-702.3, P-1802.5, P-2002.4 Moche M. ............................................................ P-2002.5 Montag M. ............................................................. P-702.1 Müller-Hülsbeck S. ..............................................P-1802.3 Oberle R. ..............................................................P-2002.1 Olbrich D. ............................................................ P-1802.6 Pereira P.L. ...........................................P-1901.3, P-2002.1 Pitton M.B. ............................. P-702.7, P-1802.1, P-2002.3 Pollari M. ............................................................. P-2002.5 Portugaller H. ..................................................... P-2002.5 Puls R. .................................................................... P-702.1 Reichenbacher T. .................................................P-1901.3 Richter G.M. .........................................................P-2002.1 Riemert A. ........................................................... P-1901.1 Rinnenthal J.L. ..................................................... P-1901.1 Rudolph B. ........................................................... P-1901.2 Ruhnke H. ............................................................. P-702.2 Schlett C.L. ..........................................P-1901.3, P-2002.1 Schlunz-Hendann M. ........... P-702.3, P-1802.5, P-2002.4 Schmidt C. ........................................................... P-1901.2 Schmidtmann I. .................................................. P-2002.3 Schnapauff D. ........................................................P-702.5 Schneider P. .........................................................P-1802.6 Schnorr J. ..............................................P-1901.1, P-1901.2 Schoch E. ...............................................................P-702.4 Schotten S. ........................................... P-702.7, P-1802.1 Schröder H. ..........................................................P-1802.3 Sommer C.-M. ......................................P-1901.3, P-2002.1 Stahnke S. ...........................................................P-1802.3 Stauder M. .............................................................P-702.1 Stechele M. .......................................................... P-1901.2 Stiegler P. ............................................................ P-2002.5 Stolzenburg N. ......................................P-1901.1, P-1901.2 Streitparth F. ..........................P-702.5, P-1901.1, P-1901.2 Tacke J. ............................................................... P-1802.3 Tanyildizi Y. ..........................................................P-1802.2 Turk G. .................................................................P-1802.6 Uller W. ..............................................P-2002.2, P-2002.6 Vogel A. ...............................................................P-1802.4 Vogelreiter P. ...................................................... P-2002.5 Vollherbst D. ........................................P-1901.3, P-2002.1 Wacker F. .............................................................P-1802.4 Wagner W. ..........................................................P-1802.2 Weinmann A. ...................................................... P-2002.3 Wieners G. .............................................................P-702.5 Wirth G. .............................................................. P-1802.2 Wittgenstein H. .................................................. P-1901.2

Berlin, January 12 – 14, 2017

12

Poster Abstracts

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