Abstract No. 451: Inferior vena cava diameter: comparison of fluoroscopic measurement to computed tomographic measurement in patients undergoing routine filter placement

No. 451 Inferior vena cava diameter: comparison of fluoroscopic measurement to computed tomographic measurement in patients undergoing routine filter placement T.C. Raggio, J. Pavlus, J.S. Lee; Radiology, Georgetown University Hospital, Washington, DC Purpose: To compare the diameter of the inferior vena cava (IVC) as measured under fluoroscopy during routine IVC filter placement to the dimensions measured using computed tomography (CT) to determine if fluoroscopy is a reliable method of measurement. Materials and Methods: A five-year retrospective review of all patients undergoing IVC filter placement was performed. All patients with a pre-filter CT scan were extracted from the database. Measurements corresponding to an anterior-posterior projection as well as maximal caval diameter were obtained from the CT at a level approximately 1 cm below the lowest renal vein. These measurements were compared to the fluoroscopically obtained diameter from the procedural venogram. Results: From 2006 through 2009, a total of 676 IVC filters were placed. 179 patients had both a pre-placement CT scan and a venogram for comparison. The average projected anterior-posterior IVC diameter measured on CT was 21.6 mm and the average maximal diameter was 23.9 mm. The average caval diameter on meausred during venography was 19.0 mm. The maximal diameter of the IVC as measured on CT was on average 5 mm greater than the diameter meausred on the venogram. Conclusion: Anterior-posterior venographic measurement of the IVC diameter underestimates the true maximal IVC diameter. Routine venographic measurement of the IVC diameter prior to filter placement may lead to improper filter choice in circumstances of large caval diameters. Comparison of Fluoroscopic Measurement to CT Measurement Measurement (mm) Difference from Fluoroscopic Venogram (mm) Fluoroscopic Venogram 19.0 N/A Projected Venogram (CT) 21.6 2.8 Maximum Diameter (CT) 23.9 5.0 Educational Exhibit Abstract No. 452 Single session management of SVC syndrome and complex central vein occlusion A.T. Rucks, Z. Haskal, H.M. Richard, III, R.S. Patel; University of Maryland, Baltimore, MD Learning Objectives: 1) The reader will learn an algorithmic approach to single session treatment of extensive central vein occlusions in SVC Syndrome: i.e. techniques, tools, results and evidence. 2) To learn an approach to vein stenting: i.e. double barrel, end-to-side, bare vs. covered, single side and best sizing. Background: Central vein occlusions (CVO) are common in end stage renal disease (ESRD) patients, due to chronic catheter use, and patients with thoracic malignancies. Symptoms include: facial, laryngeal, neck and/or upper extremity edema, and syncope. Clinical Findings/Procedure Details: The exhibit will review existing literature of techniques and results to treating CVOs and provide case examples from review of 23 consecutive patients, who were diversely treated for SVC syndrome at a single academic institution. The proposed algorithm to single session treatment of CVO’s will include description of patient procedural positioning, access site entry, procedural equipment and complex image guidance (i.e. sharp recanulization and echocardiography). Specific procedural techniques to treat single brachiocephalic, internal jugular, SVC occlusion and complex multi-vein occlusion of the SVC, brachiocephalic and internal jugular veins will be discussed and case examples presented. Diverse management strategies including a guide to catheter selection to maximize transversal of occlusions, balloon angioplasty, stenting (i.e. sizing, configuration, bare metal vs. covered), thrombolytic treatment with or without mechanical thrombolysis to achieve durable vessel patency in a single session will be presented. Conclusion and/or Teaching Points: To present an algorithmic approach to endovascular management of SVC Syndrome, including a range of endovascular tools to allow a reliable single session treatment of a broad range of anatomic central vein occlusions. Educational Exhibit Abstract No. 453 Strategies for pre-procedure and intra-procedural doppler ultrasound in dialysis access interventions D. Sheehan, A.R. Forauer; Interventional Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH Learning Objectives: Attendees will learn strategies for the use of Doppler ultrasound (US) prior to and during dialysis access interventions. Demonstrated techniques will show how to improve pre-procedural planning, reduce the number of vascular punctures, and reduce procedure time, fluoroscopy time, and contrast dose. Background: Doppler US is a well-established modality in the evaluation of vascular disease. Its use in vascular access procedures by interventional radiologists is near universal. For planned dysfunctional dialysis access intervention, US is often used in the initial acquisition of vascular access. The availability of US in the procedure room allows for a focused examination of the dysfunctional access which may guide the location and direction for initial access and assist in planning specific aspects of the intervention. A pre-procedure US may preclude a portion of the angiographic examination and thereby reduce the procedure time, fluoroscopy time, and contrast dose. Clinical Findings/Procedure Details: The presentation will demonstrate how to correlate the procedure indication with US findings, such as identification of the number and location of venous outflow stenoses in patients with post-dialysis bleeding. Identification of stenoses in the expected location allows for vascular puncture in the proper location and direction. The presentation will demonstrate how portions of the angiographic procedure may be precluded by a diagnostic US examination, e.g. S178 Poster Sessions JVIR Po st er Se ss io ns