9:45a Presidential WelcomeRennie Mohabir, MBA, RT(R) (no CE)
10:00a Evolution not Revolution - Indispensable CARE - Dr Janice Newsome, Shari Ulman Gold Medal Lecture Recipient, sponsored by Medtronic
10:50a Complex Hemodialysis Access - Dr Mark Lessne
11:40a Covid-19 - Dr Tania Bubb
1:00p Prostate Artery Embolization - Dr Kavi Devulapalli
2:00p PAD Inflow - Dr Kumar Madassery
2:40p Medtronic Presentation (no CE)
2:50p PE Interventions - Dr Charles Ritchie
3:45p Combating Burnout - Dr Agnes Solberg
4:20p Radiation Safety - Dr Lawrence Dauer
5:00p Business Meeting/Awards (no CE)
Purpose: To compare the utility of low-dose versus standard cone-beam computed tomography (CT) angiography protocols in
identifying nontarget embolization (NTE) during prostatic artery embolization (PAE).
Materials and Methods: A prospective, single-center, Phase-1 study (NCT02592473) was conducted for lower urinary tract
symptoms in benign prostatic hyperplasia. Prostate volume, international prostate symptom score (IPSS), quality of life score (QoL),
International Index of Erectile Function (IIEF), peak flow rate, UCLA Prostate Cancer Index (UCLA-PCI), and postvoid residual were
recorded at baseline and 1, 3, 6, 12, and 24-months after PAE. Six-second (standard protocol, n 1⁄4 29) or 5-second (low-dose protocol
n 1⁄4 45) rotations were made. Images were selected and matched in pairs by areas of NTE and compared by readers using a binomial
generalized estimating equation model. Procedural outcomes were analyzed using a linear mixed model.
Results: Seventy-four cone-beam CT angiographies were performed in 21 patients. IPSS and QoL scores significantly improved (P
<.05). There was no change in UCLA-PCI or IIEF scores. Dose area product of the low- and standard-dose protocol were 37,340.82
mGy$cm2 ± 104.66 and 62,645.66 mGy$cm2 ± 12,711.48, respectively, representing a dose reduction of 40.4%. A total of 120
comparisons showed no preference between the 2 protocols (P 1⁄4.24). Observers identified 76 and 69 instances of NTE in the standard-
and low-dose protocols, respectively (P 1⁄4.125).
Conclusions: Low-dose cone-beam CT angiography achieved equivalent clinical utility in identifying NTE during PAE, with the
advantage of a lower radiation dose.
Purpose: To compare patients treated with large-volume paracentesis (LVP), transjugular intrahepatic portosystemic shunt (TIPS), and
peritoneovenous shunt (PVS) for ascites.
Materials and Methods: A retrospective study of 192 patients treated with LVP (94), TIPS (75), or PVS (23) was performed.
Records were reviewed for patient characteristics and outcomes. The patients’ age differed (LVP, 59.5 years; TIPS, 58.8 years; and PVS,
65.6 years; P 1⁄4 .003). Nonalcoholic steatohepatitis was the most common etiology in the PVS cohort (11/23, 47%), and hepatitis C in
the TIPS (27/75, 36%), and LVP cohorts (43/94, 46%) (P 1⁄4.032). The model for end-stage liver disease score was significantly different
(LVP, 14; TIPS, 13; and PVS, 8; P 1⁄4 .035). Hepatocellular carcinoma was higher in the PVS cohort (6/23 patients, 25%) than in the
TIPS (4/75, 5%), and LVP (12/94, 12%) cohorts (P 1⁄4 .03).
Results: Emergency department visits and hospital readmissions were the highest in the LVP cohort (40%, 2 readmissions, P <
.001). Patients required fewer LVPs after TIPS (1.5 to 0.14, P < .001) or PVS (2.1 to 0.5, P 1⁄4 .019). In an unadjusted Cox model,
patients in the TIPS cohort were found to have a 58% reduction in the risk of death compared with patients in the LVP cohort (P 1⁄4.003).
Transplant-free survival (PVS, 44 days; TIPS, 155 days; and LVP, 213 days) differed (log rank 1⁄4 0.001).
Conclusions: The survival in the PVS and TIPS cohorts was similar, with less healthcare utilization than the LVP cohort. PVS is a
satisfactory alternative to LVP.
Purpose: This study sought to define thromboembolic risk and mortality in patients with heparin-induced thrombocytopenia (HIT)
undergoing inferior vena cava filter (IVCF) placement, in light of the American Society of Hematology’s 2018 guidelines against routine
use of IVCFs in this population.
Methods: A total of 26 patients with HIT who received IVCFs were retrospectively reviewed, and the outcomes of this group were
compared with those of 4,707 controls with either HIT or IVCFs alone and with reported outcomes in prior studies.
Results: The patient group demonstrated 6- and 12-month mortality rates of 26.9% and 30.8%, respectively, which did not differ
significantly from those of the control groups and were in line with published mortality rates in the literature. The measured throm-
boembolic risk of 19.2% in the patient group was also within the range of published rates for patients with HIT or IVCF alone.
Conclusions: IVCF placement did not significantly increase the risk of thromboembolism or death in patients with HIT and may be a
viable option in the subset of these patients who are not candidates for anticoagulation.
Purpose: To retrospectively assess the safety and efficacy of percutaneous arteriovenous fistula (PAVF) creation with the WavelinQ 4-F EndoAVF System. Materials and Methods: From February 2018 to June 2020, 30 PAVFs were created in 30 consecutive patients (men; age, 55.3 years = 13.6). Of the 30 patients, 21 (70%) were already on hemodialysis using a central venous catheter. The primary outcome measures were technical success, complications, and cannulation rate. The secondary outcome measures included the number of secondary procedures needed for cannulation, maintenance time to cannulation, and PAVF survival. Results: Technical success was 100%. The adverse event rate was 6.7% (2/30), including a pseudoaneurysm of the brachial artery that developed immediately after sheath removal and an aneurysm of the anastomosis 17 days after the procedure, which was treated with a covered stent placed in the arterial side. The mean follow-up was 547 days 315.7 (range, 14–1,071 days). The cannulation rate was 86.7% (26/30). The mean time to cannulation was 61.3 days = 32.5 (range, 15-135 days). The mean follow-up after cannulation was 566.2 days + 252.7 (range, 35–1,041 days). Four PAVFs were thrombosed after cannulation, with 2 of them successfully declotted. Sixteen interventions were needed to achieve can nulation after the index procedure in 15 patients (overall, 0.53 procedures/patient). Seven maintenance endovascular interventions (following cannulation) were performed during the follow-up period in 6 patients (overall, 0.27 procedures/ patient, 0.17 procedures/patient-years). For the PAVFs that were cannulated, patency was 96% at 1 year, and 82% at 2 and 3 years, according to the Kaplan-Meier survival analysis. Conclusions: This initial experience suggests that PAVF creation is safe and can be successfully performed with high maturation and long-term patency rates. Larger-scale prospective studies are needed to validate the results.
Purpose: Although many studies have examined the efficiency of various protective devices for reducing the dose of
radiation exposure to physicians during interventional pain procedures, no study has compared the protective effect of
these devices when they are used in combination. The purpose of this prospective experimental study was to determine the
best combination of radiation-shielding devices.
Materials and Methods: Using anthropomorphic phantoms of a physician and patient, we measured the radiation pro-
tection efficiency (RPE) of each of the following protection methods and in combination during C-arm–guided simulated
lumbar epidural injection: (a) personal protective equipment (PPE), (b) bedside curtain shield (Curtain), (c) x-ray tube filter
(Filter), and (d) fluoroscopic collimation method (Collimation). We measured exposure doses using personal electronic
dosimeters at the eye, thyroid, and gonad levels for 1 minute. Each experiment was repeated 15 times.
Results: The radiation exposure dose and RPE with the best single-, double-, and triple-protection methods were as
follows: PPE for the single-protection method (11.82 μSv/min, 80.04%), PPE + Collimation for the double-combination
method (4.68 μSv/min, 92.09%), and PPE + Collimation + Curtain for the triple-combination method (3.08 μSv/min,
93.39%). Additionally, PPE + Collimation + Curtain + Filter for the quadruple-combination method resulted in a radiation
exposure and RPE of 2.91 μSv/min and 93.61%, respectively, compared with nonprotection.
Conclusions: The best single-, double-, and triple-protection method was PPE, PPE + Collimation, and PPE + Collima-
tion + Curtain, respectively. While preparing protective equipment, we recommend prioritizing equipment in this order.
Purpose: To evaluate the feasibility and technical outcomes of retrograde access via occluded pedal arteries in endovascular treatment
of critical limb ischemia (CLI) when the conventional antegrade approach fails.
Materials and Methods: One hundred fifty-one patients with CLI (age 69 y ± 10.5; 116 men) who were not surgical candidates and
were treated via retrograde pedal access between January 2016 and January 2018 were evaluated retrospectively. Seventy patients in
whom retrograde access was performed through occluded arteries constituted the occluded group, and 81 patients who were treated via
retrograde access from patent arteries constituted the nonoccluded group. Pedal access success, lesion crossing success, angiographic
success, overall technical success, and procedure-related complications were evaluated and compared between groups.
Results: Pedal access success (74 of 78 vs 83 of 87 attempts; P 1⁄4.873) and lesion crossing success (64 of 78 vs 77 of 87 lesions; P 1⁄4
.340) were comparable between subgroups. Angiographic success (54 of 78 vs 77 of 87 lesions; P 1⁄4.012) and overall technical success
(48 of 70 vs 72 of 81 patients; P 1⁄4 .004) rates were lower in the occluded group. Procedure-related complications were similar between
groups (P 1⁄4 .096).
Conclusions: Retrograde pedal access from occluded pedal arteries is a feasible option when an antegrade approach fails in endo-
vascular treatment of CLI. Although it has lower technical success, its use enables angiosome-directed therapy and has the potential to
improve the outcomes of the procedure.
Purpose: To evaluate the impact of a versatile flexible ceiling-mounted C-arm on active table and gantry repositioning during in-
terventions and its effect on operator discomfort, system usability, and patient safety compared with a traditional ceiling-mounted
Materials and Methods: There were 100 IR procedures studied: 50 in a traditional IR system (standard group) and 50 with a novel
multiaxis ceiling-mounted system (test group). FlexArm was capable of multiple gantry rotation points allowing increased access to the
patient in addition to 236 cm of lateral x-ray detector travel. For each procedure, both the table and the gantry repositioning were
measured. Patient safety, patient/equipment repositioning effort, and physical discomfort were evaluated through an operator survey.
Results: Table repositioning was reduced from 42 to 16 instances per procedure (P < .001) in the test group compared with the
standard group. The operators perceived less table and gantry repositioning effort (P < .0001) and decreased risks of equipment col-
lisions, displacement of vascular access, and dislodgment of tubes/lines with the test group (P < .0001). Operator discomfort was
reduced for all body areas in the test group over the standard group (P < .0001).
Conclusions: The FlexArm system geometry enhances operator ergonomics, as there was a decrease need to move the table, leading
to a perceived decrease in patient risk and decrease operator physical discomfort when compared to a traditional imaging system.