Abstract No. 294 EE: Limb salvage utilizing pedal arterial access: The SAFARI technique, appropriate...

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rologic disease (3.3%), end-staged liver disease (2.2%),advanced frailty (2.2%), and end-staged heart disease(0.7%) made up the hospice and palliative care cases. Basedon the above information, interventional radiologists satisfyall of the requirements to sit for the certifying exam exceptfor the 100 hours (over 2 years) of participation with ahospice and palliative care team.

Conclusion: Interventional radiologists are at the forefrontof hospice and palliative care medicine because we arealready providing hospice and palliative care to 80% of ourpatients. Interventional radiologists meet all of the require-ments to sit for the certifying examination with the excep-tion of the 100 hours of participation with a hospice orpalliative care team.

Abstract No. 293

Closing the loop: Improving retrieval rates of temporaryIVC filtersC. Meade, S.D. Samuelson, M. Recker, P. Harrod-Kim,J.P. Gerding, S. Amberson, C. Baker, T. Dykes,R. Pezzuti; Maine Medical Center, Portland, ME.

Purpose: To determine if employing a simple clinical fol-low-up protocol of patients with retrievable IVC filtersresults in higher IVC filter retrieval rates.

Materials and Methods: Beginning in 2009, all patients thathad a retrievable IVC filter placed were automaticallyscheduled for an outpatient visit in the IR clinic. If anOptease IVC Filter was placed, a follow-up visit in 2-3weeks was scheduled; if a Celect IVC Filter was placed, afollow-up visit was scheduled 2 months post-placement.Patient histories, lab values and any recent significant events(planned surgeries, coagulation status, complications) werereviewed at their office visits. SIR Guidelines for placementand retrieval of IVC Filters were implemented. Using aCPT-based search, the number of IVC Filter placement andretrieval procedures were calculated before and after utili-zation of this clinical follow-up protocol. The number ofoffice visits generated were also calculated. Comparison ofthe rate of IVC Filter retrieval procedures and changes inoffice visit volume pre- and post-implementation of theclinical follow-up protocol was carried out using the Fish-er’s exact test and Student’s t-test respectively.

Results: From 2007-2009 fiscal years, 132 retrievable IVCfilters were placed. In FY 2007 and 2008, 3/42 and 4/44retrievable IVC filters were scheduled for removal. Techni-cal success was 85%. After implementation of the clinicalfollow-up protocol(FY 2009), 12 IVC filters were retrievedout of 46 placed (26%)with 92% technical success. Therewas significantly higher rate of IVC filter retrieval post-implementation of the clinical follow-up protocol (26% vs7% or 9%, Fisher’s, p�0.05). Due to the follow-up proto-col, there was a 15% increase in office visits over theprevious 2 years (p�0.05).

Conclusion: By having the Interventional Radiologists con-tinue to follow patients with retrievable IVC filters, there isa dramatic improvement in retrieval rates by ensuring pa-tients are not lost to follow-up.

IVC Filter Retrieval ProceduresYear Filter Retrieval Filter Placement2007 3 422008 4 44

Abstract No. 294 EE

Limb salvage utilizing pedal arterial access: The SA-FARI technique, appropriate case selection and patientfollowupM.A. Meuse, M.R. Gossage, S.S. Sabri, J.F. Angle,U.C. Turba; University of Virginia, Charlottesville, VA.

Learning Objectives:1. To demonstrate the importance of diagnosis, preproce-dural planning and case selection with appropriate diagnos-tic imaging.2. To provide an understanding of the details of the endo-vascular technique of subintimal arterial flossing with ante-grade-retrograde intervention (SAFARI).3. To provide guidelines for clinical and radiographic fol-lowup.

Background: The SAFARI technique can be useful forcompleting subintimal recanalization when there is failureto reenter the distal true lumen from an antegrade approachor when there is limited distal target artery available forreentry. The SAFARI technique improves technical successin the performance of subintimal recanalization. Masteringthe techique allows limb salvage in patients who lack sur-gical revacularization options and would otherwise faceamputation.

Clinical Findings/Procedure Details: Proper case selectionand importance of diagnostic imaging is discussed. TheSAFARI technique is detailed using step-by-step imageswith attention to pedal arterial access, creating the subinti-mal channel, obtaining through-and-through access (“floss-ing”), and balloon dilatation with or without stenting of thesubintimal tract. We conclude with a discussion regardingclinical and radiographic follow-up guidelines.

Conclusion and/or Teaching Points: There is a crucial rolefor endovascular therapy in patients with critical limb isch-emia who lack surgical options. Long arterial occlusions areparticularly challenging to interventionalists, and technicalsuccess of recanalization is dependent on operator experi-ence. Clinical diagnosis, proper case selection, optimal tech-nique and close followup are essential facets in the man-agement of these patients.

References: Spinosa DJ, Harthun NL, Bissonette EA, et al.Subintimal arterial flossing with antegrade-retrograde inter-vention (SAFARI) for subintimal recanalization to treatchronic critical limb ischemia. J Vasc Interv Radiol 2005;16:37–44.

Abstract No. 295

Hypoxia induces a phenotypic switch of fibroblasts tomyofibroblasts through a MMP-2/TIMP mediated path-way: Implications for venous stenosis formation in he-modialysis vascular access failureS. Misra, A.A. Fu, K.D. Misra, U. Shergill; Mayo Clinic,Rochester, MN.

Purpose: Hemodialysis grafts fail because of venous neo-intimal hyperplasia (VNH) formation caused by adventitialfibroblasts which have become myofibroblasts (�-smoothmuscle actin (�-SMA) positive cells) and migrated to theneointima. There is increased expression of hypoxia induc-ible factor-1 alpha (HIF-1�) in VNH formation in experi-mental animal model and clinical samples. We hypothesizedthat under hypoxic stimulus (HIF-1�), fibroblasts will con-vert to myofibroblasts through a matrix metalloproteinase-2

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