JVIR ’ Scientific Session
of uterus, leading to interrogation and embolization of the
ovarian arteries.
Results: The mean added DAP in cGycm2 from the CBCT is
higher the mean added aortogram dose reported in literature
(1). Our cohort had a substantially higher BMI than aortogram
cohort which may account for some of the added radiation
dose. The fraction of the total dose attributable to the CBCT is
8% compared to 20% in aortogram study. Of the 16 patients in
our cohort one patient (6.25%) were deemed to have
inadequate embolization and underwent OA embolization.
Conclusion: CBCT may be of potential benefit to asses
adequacy of UFE by evaluating for contrast trapping. Although
CBCT may involve a higher radiation dose than aortogram, it
can give more information, potentially justifying its use.
References
1. White AM, et al. Radiology 2007; 244:291–298.
2. Miller DL, et al. JVIR 2003; 14:711–727.
4:24 PM Abstract No. 142
Results in endovascular treatment of pelvic
congestion syndrome
F. Nasser1, R.N. Cavalcante1, B. De Fina1, F.B. Travassos1,
F.L. Galastri1, B.B. Affonso1, J.E. Amorim2;
1
Interventional Radiology, Albert Einstein Hospital, São
Paulo, Brazil; 2Vascular Surgery, Universidade Federal de
São Paulo, São Paulo, Brazil
Purpose: Evaluate the effectiveness of the treatment of pelvic
congestion syndrome using embolization with metal coils and
identify prognostic factors associated with clinical success.
Materials and Methods: Embolization with metallic coils was
performed by endovascular access in one hundred and thirteen
women with pelvic varicose veins, with symptoms of dysmenor-
rhea, dyspareunia, urinary urgency and sensation of discomfort
in lower limbs. Assessment of the pain score was performed
using a visual analogue scale before and after the procedure.
Clinical follow-up was performed in 1,3,6 and 12 months.
Results: During 12 months of follow up, technical success rate
was 100%, with 47% of patients referring pain reduction, 53%
of patients without pelvic pain, and 37% of patients had
complete relief of pain and associated symptoms. The pain
score using visual analogue scale was 7.34 pre-procedure and
0.47 post-procedure. Prognostic factors influencing the diminu-
tion of clinical success rate of endovascular treatment were
urinary urgency, lower limb symptoms and vulvar varicose and
lower limbs. Overall complication rate was low, 4.42% (5/113).
Conclusion: Transcatheter embolization is a safe and effective
treatment for pelvic congestion syndrome. Lower limb symp-
toms, urinary urgency and varicosities are associated with
incomplete clinical success.
4:33 PM Abstract No. 143
Placenta conservation and adjunct uterine artery
embolisation versus caesarean hysterectomy in
placenta accreta
K. Lim1, H. Toh1, S. Tagore2, R. Lo3, B. Tan3, K. Kwek2,
K. Tay3; 1Department of Diagnostic Imaging and
Monday ’ S69
Intervention, KK Women’s and Children’s Hospital,
Singapore, Singapore; 2Department of Maternal Fetal
Medicine, KK Women’s and Children’s Hospital,
Singapore, Singapore; 3Department of Diagnostic
Radiology, Singapore General Hospital, Singapore,
Singapore
Purpose: To review the clinical outcomes of placenta conserva-
tion and adjunct uterine artery embolization versus caesarean
hysterectomy in the management of patients with placenta
accreta.
Materials and Methods: Retrospective review of 42 patients
with placenta accreta between Sep 2005 to Feb 2013 was
performed. All patients had peri-operative placement of inter-
nal iliac artery occlusion balloons before caesarean delivery
(CD). Twenty two patients underwent total hysterectomy (TH)
and 16 patients had placenta and uterus conserved (PUC)
following CD. All patients in the PUC group underwent
adjunct uterine artery embolization (UAE) immediately fol-
lowing abdominal wound closure. The remaining 4 patients
had uterus conserved following removal of placenta and were
MONDAY: Scientific Sessions
excluded from analysis.
Results: Median intra-operative blood loss for TH group was
significantly higher at 2.3L (0.5-12L) compared to 0.5L (0.3-
1.5L) for PUC group (po0.01). Median length of hospitaliza-
tion was similar at 5 days, ranging 3-12 days and 3-26 days for
TH and PUC groups respectively (p¼NS). Seven of 22 patients
(32%) in TH group and none in PUC group had bladder injury
requiring surgical repair (p¼0.01) during CD. There was no
significant complication arising from internal iliac artery
balloon placement or UAE. Six patients (38%) in the PUC
group eventually underwent hysterectomy at median of 54 days
(6-128 days) after CD due to severe secondary post partum
hemorrhage (PPH). Eight of the remaining 10 patients in PUC
group required re-admission for management of per vaginal
bleed. Serial ultrasound follow up showed complete placental
resorption in 3 patients while median remnant placenta size of
2.2cm (0.6-14.6cm) were noted in the remaining 7 patients after
median followup of 269 days (27-670days).
Conclusion: Placenta and uterus conservation with adjunct
UAE is associated with significantly lower intra operative
blood loss and risk of bladder injury compared to caesarean
hysterectomy and may be a viable strategy for management of
patients with placenta accreta. The main downside is secondary
PPH requiring prolonged clinical/imaging follow up, read-
missiona and even hysterectomy in severe cases.
4:42 PM Abstract No. 144
Internal iliac artery balloon occlusion placement
for management of placenta accreta: a
retrospective study
A. Bessissow, P. Delli Fraine, R. Bera, K. Muchantef,
T. Cabrera, C. Torres, F. Aris, D.A. Valenti, L.N. Boucher;
Interventional Radiology, McGill University, Montreal,
QC, Canada
Purpose: Inflation of occlusion balloons in the internal iliac
arteries can be performed in women with abnormal placental
implantation at high risk of hemorrhage during surgery in the
hopes of decreasing morbidity and mortality. However, due to
the limited literature, this remains a controversial technique.
 S70 ’ Monday
The primary objective of our study is to review the outcomes of
such cases at our institution.
Materials and Methods: A search was performed to retro-
spectively identify all patients with abnormal placental implan-
tation and pre-operative balloons placed between January 1st
2006 and June 30th 2013 at our institution. Data extracted
included demographics, hemoglobin levels, blood transfusions,
pathology and need for hysterectomy.
Results: 17 patients fulfilled the criteria, representing one of the
largest samples ever published of this type of study. The
indication for pre-operative balloon placement was placenta
accreta in 11 patients, placenta increta in 1 patient and placenta
percreta in 5 patients. Intra-operative balloon inflation was
performed in 11 (65%) patients: 6 (65%) with placenta accreta,
1 (100%) with placenta increta (100%), and 4 (80%) with placenta
percreta. The estimated operative blood loss for patients in
whom the balloons were inflated was 750-4000mL (average
1450mL) versus 800-3000mL (average 1825mL) in patients in
whom the balloons were not inflated (p¼0.65). The average drop
in hemoglobin between the group with and without inflation of
MONDAY: Scientific Sessions
balloon was 22Hgb/L and 31Hgb/L, respectively (p¼0.21).
Conclusion: Despite a trend toward decrease blood loss in
patients with balloon inflation our data fails to demonstrated a
statistically significant difference. While the data may seem to
indicate the lack of usefulness of this technique, since the
balloons are only inflated during surgery if bleeding is deemed
excessive, both groups are not easily comparable. Assuming the
surgeon’s impression of increased bleeding was correct, then
balloon inflation may have been the only reason that this group
of patients did not lose on average more blood than the other
group. Carefully designed prospective studies will likely be
needed to prove the usefulness of this technique.
4:51 PM Abstract No. 145
Transvaginal drainage of pelvic collections: a 5
years retrospective review in a tertiary
gynaecology center
C. Chong1,2, L. Toh2,1, C. Ong2; 1Department of
Diagnostic Radiology, Singapore General Hospital,
Singapore, Singapore; 2Department Of Diagnostic
Radiology, Kandang Kerbau Hospital, Singapore,
Singapore
Scientific Session ’ JVIR
Purpose: The purpose of this study was to review our
5 years experience with sonographically guided transvaginal
drainage procedures, complication rates and long term
success.
Materials and Methods: Between 2008 to 2012, we identified
70 sonographically guided transvaginal drainage procedures on
65 patients (mean age 45.9, youngest 23, oldest 86) from our
Radiology Information System. Pertinent medical records and
images were reviewed. Clinical success was defined as no need
for surgery.
Results: Thirty seven aspirations and 33 catheter drainage
procedures were performed on 65 patients. Indications for the
procedures include tuboovarian abscess unresponsive to med-
ical therapy (n¼23), pelvic collection (n¼30), endometriotic
cysts (n¼6), symptomatic ovarian cysts (n¼4), haematocolpos
(n¼1) and haemometra (n¼1). There was one minor complica-
tion of abdominal wall haematoma in a patient who underwent
concurrent transabdominal aspiration. No procedure related
complications were found in patients who underwent either
needle aspiration or transvaginal catheter drainage. Clinical
success rate was achieved in 56 of 65 cases (86%), 26 of 30
pelvic collection cases (87%) and 19 of 23 tuboovarian abscess
cases (83%). Seven patients underwent surgery due to non
resolution after transvaginal drainage procedures. There was
two patient deaths due to progression of advanced pelvic
malignancy.
Conclusion: Transvaginal aspiration and catheter drainage
procedures are effective and are viable alternatives to surgery.
The majority of tuboovarian abscesses and pelvic collection
can be safely treated using transvaginal drainage methods, with
high degree of clinical success.
References
1. Saokar A, Arellano RS, Gervais DA, et al. Transvaginal Drai-
nage of Pelvic Fluid Collections: Results, Expectations and
Experience. AJR 2008; 191:1352–1358.
2. O0 Neill MJ, Rafferty EA, Lee SI, et al. Transvaginal Interven-
tional Procedures: Aspiration, Biopsy, and Catheter Drainage.
Radiographics 2001; 21:657–672.
3. Feld R, Eschelman DJ, Sagerman JE, et al. Treatment of Pelvic
Abscesses and Other Fluid Collections: Efficacy of Transvaginal
Sonographically Guided Aspiration and Drainage. AJR 1994; 163:
1141–1145.