{"\ufeffMYSIR\u2019s Abstracts 1\nMalaysian Society of Interventional Radiology\n\nDOI: https://doi.org/10.32896/tij.v3n4.19-25\nPublished: 31/12/2023\nOP01\nENDOVASCULAR MANAGEMENT OF IATROGENIC BRACHIOCEPHALIC ARTERY INJURY USING BALLOON TAMPONADE\nT. Sivapragasam1, M. H. Husin1, M. E. Aziz1\n1Department of Radiology, Hospital Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia\n\nIntroduction: Arterial puncture is a recognized complication of central venous catheterization. Early recognition and aggressive management are vital in avoiding catastrophic complications. Several removal methods are available, and multiple factors must be considered for decision-making regarding catheter removal. We describe a case of an inadvertent central venous catheter into the brachiocephalic artery, which was successfully removed using a balloon tamponade method.\n\nReport: A 41-year-old lady underwent a central venous catheter insertion and was complicated with iatrogenic brachiocephalic artery injury. She was then referred to interventional radiology for endovascular treatment and underwent balloon tamponade to remove the catheter. A balloon was placed in the subclavian/brachiocephalic artery prior to the catheter removal, and a series of inflations were performed afterward. The procedure was successful without any complications. \n\nConclusion: Inadvertent placement in the brachiocephalic artery is not common. Open repair and stenting are the methods of choice in treating this complication. Due to its location, pull and pressure technique may pose a danger as this vessel is not easily compressible. Balloon tamponade is a technique described for the management of posttraumatic arterial injuries. However, it has shown promising evidence in treating iatrogenic vascular injuries.\n\n\nOP02\nTHE EFFECT OF EYE HEIGHTS ON THE ENTRANCE SURFACE DOSES (ESD) OF SKULL PHANTOMS AT THE RADIOLOGIST AND NURSE LOCATIONS IN PTBD PROCEDURE\nH. A. Radzi1, N. Sohaimi1, A. R. M. Ralib2,3\n1Kulliyah of Allied Health Sciences, International Islamic University Malaysia, Malaysia\n2Kulliyah of Medicine, International Islamic University Malaysia, Malaysia\n3Department of Radiology, Sultan Ahmad Shah Medical Centre (SASMEC) @ IIUM, Malaysia\n\nIntroduction: Understanding the factors that affect the staff eye doses for those working in angiographic procedures is important. This research explored the effect of eye heights on the ESD measurements at the radiologist and nurse locations in the Percutaneous Transhepatic Biliary Drainage (PTBD) procedure. \n\nMaterials and Methods: An upper-body phantom simulating a patient (Kyoto Kagaku PBU-31) was exposed to X-ray radiation using a Siemens Artis Q angiographic system with technical factors for the PTBD procedure in three radiographic projections. The ESD was measured using the nanoDotTM optically stimulated luminescence dosimeters (OSLD) at four eye heights: 135, 145, 155 and 165 cm. Three regions on skull phantoms (simulated staff) were measured: the right and left eyes and the left outer canthus. The recorded radiation doses were read in mGy units and normalised to the dose area product (mGym2) of each exposure. Line graphs and scatter plots were used to analyse the results descriptively.\n\nResults: In posteroanterior (PA) projection, the radiologist phantom had higher ESD values at 135 and 145 cm eye height but lower values at 155 and 165 cm compared to the nurse phantom. In the 25\u00b0 right anterior oblique (RAO) position, the phantom nurse received higher eye doses than the radiologist phantom. The radiologist phantom\u2019s eyes were shielded by the flat panel detector (FD) at higher eye heights in PA projection and all eye heights in the 25\u00b0 RAO position. However, the radiologist was not shielded and received higher eye doses in the 25\u00b0 left anterior oblique (LAO) position. Besides, the left regions received higher doses than the right eye for the nurse phantom. There were also decreased eye doses with increased eye heights for both phantoms.\n\nConclusion: This study found that eye doses of staff are affected by the shielding provided by the FD, eye heights and location of the staff.\n\nOP03\nFISH BONE INJURY CAUSING TRAUMATIC ARTERIOVENOUS FISTULA, SUCCESSFULLY TREATED WITH EMBOLIZATION.\nA. K. Ahmad Kabir1,2, S. A. Amourisva2,3, A. S. Muda2, H. Abu Hasan2, A. B. Nasir Alam3, M. S. F. Md Noh2, E. Abdul Rahim2, M. F. A. K. Khamis2, M. Arumugam3, S. Tarmalinggam3\n1Department of Radiology, KPJ Ampang Puteri Specialist Hospital, 68000 Ampang, Selangor, Malaysia\n2Department of Radiology, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia\n3Department of Radiology, Universitas Brawijaya, Jawa Timur 65145, Indonesia \n4Orthopaedic Department, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia\n\nIntroduction: An arteriovenous fistula (AVF) is an abnormal direct communication between an artery and a vein, which leads to blood shunting between the two vessels. While some AVFs may be present at birth, many are commonly caused by iatrogenic as a result of increasing number of invasive medical procedures. Non-iatrogenic injuries from penetrating accidents that cause direct arterial trauma can also result in AVF formation. Non-iatrogenic traumatic arteriovenous fistula of the upper extremity is relatively uncommon. We report a case of fish bone injury causing non-iatrogenic traumatic arteriovenous fistula of the ulnar artery and ulnar vein which was successfully treated with embolization.\n\nMaterials and Method: 18 G branula, 5 Fr arterial sheath, 5 Fr vertebral catheter, Terumo 0.035\u2019 150cm guidewire, Headway microcatheter 150cm, Boston Transend guidewire and Polidocanol injection.\n\nReport: A 50 year old lady presented to the orthopaedic team with right hand pain and swelling after alleged fish bone puncture to her hand. The swelling at her hand was increasing in size and associated with pain. Her vital sign was stable. Her physical examination of right hand was erythematous swelling noted at the right hypothenar eminence with pulsation felt. MRI right hand shows well defined multilobulated subcutaneous lesion seen at the lateral (ulnar) aspect of the hypothenar eminence of the right hand at its palmar aspect. A diagnostic right upper limb angiogram done revealed highly vascularised lesion seen at the right hypothenar region, approximately measuring 1.9cm x 2.2cm (W x CC) with arterial supply likely from the common palmar digital arteries of the superficial palmar arch (from right ulnar artery). Its venous drainage is likely to the deep palmar venous arches and into the right ulnar vein. No real nidus is seen within the angiogram. After explaining the necessity of the procedure and obtaining the patient\u2019s informed consent, the embolization of right hand arteriovenous fistula was done by using polidocanol injection. The polidocanol injection was done through direct puncture at the lesion. Post embolization revealed absence of arteriovenous fistula from angiogram and procedure completed.\n\n\n\nConclusion: Arteriovenous fistulas are typically acquired lesions that lack a nidus discernible on vascular malformation imaging studies. Masses with arteriovenous fistula components, commonly encountered in clinical practice are frequently iatrogenic in origin resulting from prior surgical interventions or trauma. Polidocanol exhibits properties as sclerotherapy agent.  Percutaneous embolization is a minimally invasive and efficacious alternative to open surgery for the treatment of AVF.\n\nOP04\nA 5 YEAR RETROSPECTIVE STUDY OF POST TRANSARTERIAL EMBOLIZATION FOR GASTROINTESTINAL BLEED IN UNIVERSITY MALAYA MEDICAL CENTRE, MALAYSIA\nS. Jayaprakasam1, W. L. Ng1, S. U. Norazmi1, N. A. A. Hamid1, K. H. Chuah1, S. Mahadeva1\n1Universiti Malaya Medical Centre, 50603 Petaling Jaya, Selangor, Malaysia\n\nBackground: Transarterial embolization (TAE) is a minimal invasive treatment for gastrointestinal bleeding. There are limited data on the outcome of TAE in this region. We aimed to study the outcome of TAE. Factors associated with negative outcome (without clinical success), the technical success (cessation of bleeding after TAE) of the procedure itself and TAE associated complications were further evaluated.\n\nMaterial and Methods: Total of 78 patients were analysed. Retrospective study of all patients who underwent TAE in University Malaya Medical Centre from 2017 to 2021 was conducted. 44 male and 34 female. Mean age was 66 years old. 62 procedures were for upper GI bleed and another 16 procedures were for lower GI bleed. Clinical success was defined as survival or no recurrent bleeding within 30 days.\n\nResults: Technical success and clinical success were achieved in 93.6% and 65.4% of patients respectively. On univariate analysis, patients with coagulation disorders (66.7% vs 41.2%, p": null, " 2 male) were investigated. The median age was 48 (IQR 23). Lower limb symptoms affected 28 patients (two right, four left, 22 bilateral), pelvic symptoms in 14 patients and both lower limb and pelvic symptoms in 13 patients. GVI was seen in 52 patients (21 left, 7 right and 24 bilateral). Common iliac vein (CIV) compression was seen in 34 patients (19 left, 1 right, 14 bilateral). Nutcracker Syndrome was not identified in any patient.\n\nConclusion: Cone-beam CT offers the advantages of CT and fluoroscopy in detailing aetiology, level, laterality and severity of CIV compression. Further within the limitations of this observational study, we find that bilateral GVI and CIV compression may be an under-recognised cause for PVCS.": null}