Endovascular management of uterine arteriovenous malformations: causes, clinical presentation, technique and outcomes

No. 430 Comparison of procedure cost of various percutaneous tumor ablation modalities: microwave ablation, radiofrequency ablation, cryoablation, and irreversible electroporation S. Astani, M.L. Brown, T.M. Getzen, K. Steusloff; Radiology, Henry Ford Hospital, Detroit, MI Purpose: Microwave ablation, radiofrequency ablation, cryoablation, and irreversible electroporation (Nanoknife ablation) are four percutaneous ablation modalities commonly employed to treat tumors. Cost of similarly effective procedures can be an important factor in choosing a treatment option. There is paucity of data regarding the cost of aforementioned ablation modalities. In particular, no prior study has directly compared the cost of these procedures. We compare the procedure cost of treating the same lesion with each of the 4 modalities. Materials and Methods: An interactive model was created for each ablation modality, estimating the cost of treating a tumor based on the number of probes required, which is estimated by the tumor size. Total cost of treating a 3 cm kidney lesion with each modality was separately calculated by mapping out the operation process, material and equipment required as well as time and contribution of involved personnel.In order to validate the cost modules, 62 cases of various percutaneous ablations performed by interventional radiology treating a variety of lesions from July 2010 to March 2012 were identified retrospectively. Cost of each procedure was determined and then compared with the estimated cost based on the modules developed. Results: The cost of treating a 3 cm kidney lesion is $8,123 for microwave ablation, $8,289 for radiofrequency ablation, $10,103 for cryoablation, and $12,984 for irreversible electroporation. There was a strongly positive and statistically significant relationship between estimated cost based on the cost modules and actual cost for all procedures combined, microwave ablations, radiofrequency ablations, cryoablations, and irreversible electroporations. Conclusion: Number of required probes is the most variable and dominant factor in determining the cost of an ablation procedure. In average, cryoablation requires a greater number of probes than microwave or radiofrequency ablations, and is therefore more expensive. Irreversible electroporation requires more ablation probes than cryoablation for the same lesion, which makes it the most expensive procedure between the four ablation modalities. Educational Exhibit Abstract No. 431 Treating complex vascular anomalies with novel techniques D.J. Aria, S. Vatsky, R. Kaye, C. Schaefer, R.B. Towbin; Phoenix Children0s, Phoenix, AZ Learning Objectives: To highlight the use of a minimally invasive novel technique for treatment of a large, symptomatic portacaval shunt.To offer a less costly and time-consuming alternative to traditional surgery/intravascular coil embolization. Background: An 8 year-old girl with a complex medical history including trisomy 21, multiple cardiac anomalies, and chronic anemia of mixed etiology, presented with gastrointestinal bleeding. Over the preceding year, she had become cyanotic and on physical examination, digital clubbing was noted. Laboratory evaluation revealed elevated serum ammonia levels. Abdominal ultrasound demonstrated a congenital portacaval shunt. Clinical Findings/Procedure Details: Due to the large size of the shunt, traditional embolization agents such as coils could not safely be utilized. Although not generally used for this purpose, the decision was made to occlude the fistula with a 14mm Amplatzer ASD occlusion [clamshell] device. The Amplatzer device was deployed at the inferior vena cava and portal vein communication without immediate complication. The patient’s post-operative course was uneventful and the patient was discharged on post-operative day #2. Follow-up visits demonstrated resolution of the clinical signs and symptoms and imaging demonstrated closure of the shunt. Conclusion and/or Teaching Points: This experience highlights the use of a novel technique for treatment of a large, symptomatic portacaval shunt. Educational Exhibit Abstract No. 432 Patient safety checklist in interventional radiology: are they being used and do they work? S. Byott, A. Craig; NHS, Manchester, United Kingdom JVIR ’ Posters and Exhibits S187