JVIR ’ Scientific Session Monday ’ S69

of uterus, leading to interrogation and embolization of the Intervention, KK Women’s and Children’s Hospital,
ovarian arteries. Singapore, Singapore; 2Department of Maternal Fetal
Results: The mean added DAP in cGycm2 from the CBCT is Medicine, KK Women’s and Children’s Hospital,
higher the mean added aortogram dose reported in literature Singapore, Singapore; 3Department of Diagnostic
(1). Our cohort had a substantially higher BMI than aortogram Radiology, Singapore General Hospital, Singapore,
cohort which may account for some of the added radiation Singapore
dose. The fraction of the total dose attributable to the CBCT is
8% compared to 20% in aortogram study. Of the 16 patients in Purpose: To review the clinical outcomes of placenta conserva-
our cohort one patient (6.25%) were deemed to have tion and adjunct uterine artery embolization versus caesarean
inadequate embolization and underwent OA embolization. hysterectomy in the management of patients with placenta
Conclusion: CBCT may be of potential benefit to asses accreta.
adequacy of UFE by evaluating for contrast trapping. Although Materials and Methods: Retrospective review of 42 patients
CBCT may involve a higher radiation dose than aortogram, it with placenta accreta between Sep 2005 to Feb 2013 was
can give more information, potentially justifying its use. 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)
References
and 16 patients had placenta and uterus conserved (PUC)
1. White AM, et al. Radiology 2007; 244:291–298.
following CD. All patients in the PUC group underwent
2. Miller DL, et al. JVIR 2003; 14:711–727.
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

4:24 PM Abstract No. 142 excluded from analysis.
Results: Median intra-operative blood loss for TH group was
Results in endovascular treatment of pelvic significantly higher at 2.3L (0.5-12L) compared to 0.5L (0.3-
congestion syndrome 1.5L) for PUC group (po0.01). Median length of hospitaliza-
F. Nasser1, R.N. Cavalcante1, B. De Fina1, F.B. Travassos1, tion was similar at 5 days, ranging 3-12 days and 3-26 days for
F.L. Galastri1, B.B. Affonso1, J.E. Amorim2; TH and PUC groups respectively (p¼NS). Seven of 22 patients
1
Interventional Radiology, Albert Einstein Hospital, São (32%) in TH group and none in PUC group had bladder injury
Paulo, Brazil; 2Vascular Surgery, Universidade Federal de requiring surgical repair (p¼0.01) during CD. There was no
São Paulo, São Paulo, Brazil significant complication arising from internal iliac artery
balloon placement or UAE. Six patients (38%) in the PUC
Purpose: Evaluate the effectiveness of the treatment of pelvic
group eventually underwent hysterectomy at median of 54 days
congestion syndrome using embolization with metal coils and
(6-128 days) after CD due to severe secondary post partum
identify prognostic factors associated with clinical success.
hemorrhage (PPH). Eight of the remaining 10 patients in PUC
Materials and Methods: Embolization with metallic coils was
group required re-admission for management of per vaginal
performed by endovascular access in one hundred and thirteen
bleed. Serial ultrasound follow up showed complete placental
women with pelvic varicose veins, with symptoms of dysmenor-
resorption in 3 patients while median remnant placenta size of
rhea, dyspareunia, urinary urgency and sensation of discomfort
2.2cm (0.6-14.6cm) were noted in the remaining 7 patients after
in lower limbs. Assessment of the pain score was performed
median followup of 269 days (27-670days).
using a visual analogue scale before and after the procedure.
Conclusion: Placenta and uterus conservation with adjunct
Clinical follow-up was performed in 1,3,6 and 12 months.
UAE is associated with significantly lower intra operative
Results: During 12 months of follow up, technical success rate
blood loss and risk of bladder injury compared to caesarean
was 100%, with 47% of patients referring pain reduction, 53%
hysterectomy and may be a viable strategy for management of
of patients without pelvic pain, and 37% of patients had
patients with placenta accreta. The main downside is secondary
complete relief of pain and associated symptoms. The pain
PPH requiring prolonged clinical/imaging follow up, read-
score using visual analogue scale was 7.34 pre-procedure and
missiona and even hysterectomy in severe cases.
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 4:42 PM Abstract No. 144
lower limbs. Overall complication rate was low, 4.42% (5/113).
Conclusion: Transcatheter embolization is a safe and effective Internal iliac artery balloon occlusion placement
treatment for pelvic congestion syndrome. Lower limb symp- for management of placenta accreta: a
toms, urinary urgency and varicosities are associated with retrospective study
incomplete clinical success. 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,
4:33 PM Abstract No. 143 QC, Canada
Placenta conservation and adjunct uterine artery Purpose: Inflation of occlusion balloons in the internal iliac
embolisation versus caesarean hysterectomy in arteries can be performed in women with abnormal placental
placenta accreta implantation at high risk of hemorrhage during surgery in the
K. Lim1, H. Toh1, S. Tagore2, R. Lo3, B. Tan3, K. Kwek2, hopes of decreasing morbidity and mortality. However, due to
K. Tay3; 1Department of Diagnostic Imaging and the limited literature, this remains a controversial technique.
 S70 ’ Monday Scientific Session ’ JVIR

The primary objective of our study is to review the outcomes of Purpose: The purpose of this study was to review our
such cases at our institution. 5 years experience with sonographically guided transvaginal
Materials and Methods: A search was performed to retro- drainage procedures, complication rates and long term
spectively identify all patients with abnormal placental implan- success.
tation and pre-operative balloons placed between January 1st Materials and Methods: Between 2008 to 2012, we identified
2006 and June 30th 2013 at our institution. Data extracted 70 sonographically guided transvaginal drainage procedures on
included demographics, hemoglobin levels, blood transfusions, 65 patients (mean age 45.9, youngest 23, oldest 86) from our
pathology and need for hysterectomy. Radiology Information System. Pertinent medical records and
Results: 17 patients fulfilled the criteria, representing one of the images were reviewed. Clinical success was defined as no need
largest samples ever published of this type of study. The for surgery.
indication for pre-operative balloon placement was placenta Results: Thirty seven aspirations and 33 catheter drainage
accreta in 11 patients, placenta increta in 1 patient and placenta procedures were performed on 65 patients. Indications for the
percreta in 5 patients. Intra-operative balloon inflation was procedures include tuboovarian abscess unresponsive to med-
performed in 11 (65%) patients: 6 (65%) with placenta accreta, ical therapy (n¼23), pelvic collection (n¼30), endometriotic
1 (100%) with placenta increta (100%), and 4 (80%) with placenta cysts (n¼6), symptomatic ovarian cysts (n¼4), haematocolpos
percreta. The estimated operative blood loss for patients in (n¼1) and haemometra (n¼1). There was one minor complica-
whom the balloons were inflated was 750-4000mL (average tion of abdominal wall haematoma in a patient who underwent
1450mL) versus 800-3000mL (average 1825mL) in patients in concurrent transabdominal aspiration. No procedure related
whom the balloons were not inflated (p¼0.65). The average drop complications were found in patients who underwent either
in hemoglobin between the group with and without inflation of needle aspiration or transvaginal catheter drainage. Clinical
MONDAY: Scientific Sessions

balloon was 22Hgb/L and 31Hgb/L, respectively (p¼0.21). success rate was achieved in 56 of 65 cases (86%), 26 of 30
Conclusion: Despite a trend toward decrease blood loss in pelvic collection cases (87%) and 19 of 23 tuboovarian abscess
patients with balloon inflation our data fails to demonstrated a cases (83%). Seven patients underwent surgery due to non
statistically significant difference. While the data may seem to resolution after transvaginal drainage procedures. There was
indicate the lack of usefulness of this technique, since the two patient deaths due to progression of advanced pelvic
balloons are only inflated during surgery if bleeding is deemed malignancy.
excessive, both groups are not easily comparable. Assuming the Conclusion: Transvaginal aspiration and catheter drainage
surgeon’s impression of increased bleeding was correct, then procedures are effective and are viable alternatives to surgery.
balloon inflation may have been the only reason that this group The majority of tuboovarian abscesses and pelvic collection
of patients did not lose on average more blood than the other can be safely treated using transvaginal drainage methods, with
group. Carefully designed prospective studies will likely be high degree of clinical success.
needed to prove the usefulness of this technique.
References
4:51 PM Abstract No. 145 1. Saokar A, Arellano RS, Gervais DA, et al. Transvaginal Drai-
nage of Pelvic Fluid Collections: Results, Expectations and
Transvaginal drainage of pelvic collections: a 5 Experience. AJR 2008; 191:1352–1358.
years retrospective review in a tertiary 2. O0 Neill MJ, Rafferty EA, Lee SI, et al. Transvaginal Interven-
tional Procedures: Aspiration, Biopsy, and Catheter Drainage.
gynaecology center
Radiographics 2001; 21:657–672.
C. Chong1,2, L. Toh2,1, C. Ong2; 1Department of 3. Feld R, Eschelman DJ, Sagerman JE, et al. Treatment of Pelvic
Diagnostic Radiology, Singapore General Hospital, Abscesses and Other Fluid Collections: Efficacy of Transvaginal
Singapore, Singapore; 2Department Of Diagnostic Sonographically Guided Aspiration and Drainage. AJR 1994; 163:
Radiology, Kandang Kerbau Hospital, Singapore, 1141–1145.
Singapore