Transradial access to treat severe obesity with gastric artery embolisation, Z Ruzsa

1. Zoltán Ruzsa MD PhD
GASTRIC ARTERY EMBOLISATION
VIA RADIAL ARTERY ACCESS

2. DISCLOSURES
• I do not have any potential conflict of interest

3. WHAT CAN BE DONE??
• Diet/ exercise
• Difficult to sustain
• Medications
• Sverage wt. loss: 6-10 lbs
• Surgery
• Average weight loss: 88 lbs
• Diabetes: 77% resolved
• Hypertension: 62% resolved reolved
• Hypercholesterolemia: 87% imprved
• Sleep Apnoe: 86%
• BUT
• Mortality: 1-2%
• Wound Complications: 7%

4. “BARIATRIC EMBOLISATION”
• Pioneered by Aravind Arepally, MD
Concept: Interventional radiologist can decrease cells
by limiting the blood supply
• Most ghrelin secreting cells in the fundus
• Interventional radiologist are experts at finding and
targeting specific arteries.

5. VASCULAR ANATOMY OF THE STOMACH

6. (Lely et al., 2004)

7. TRIALS
• Kipshidze results (n=5)
• All were obese; the average body mass index (BMI) was 42.3 kg/m2,
with a range of 33.9 kg/m2 to 52.8 kg/m2.
• the average BMI dropped to 37.9 kg/m2, with an average weight loss of
29.2 pounds.
• At one month, levels had fallen 29 percent from baseline (p<
• BEAT OBESITY (early results)
• Pts. 7
• Average weight loss: 5.9%- 9.5%- 13.3 %
• Average appetite loss (index): 81% at 2 weeks
• Average ghrellin level decrease: 17.5% at 3 months
• BEAT- Obesity trial- Ongoing (Clifford Weiss, MD) (Bariatric Embolization of
the Arteries for the Treatment of Obesity), Baltimore, MD and NYC 300-500 u
Embospheres
• GET LEAN (Gastric Artery Embolization Trial for the Lessening of Appetite
Nonsurgically), Dayton, Ohio, 300-500 u Beadblock)
• Albany Study, Albany NY 500-700 u PVA

8. BACKGROUND- TRANSRADIAL ACCESS IN OBESITY
JACC Cardiovascular Interventions 2012
Access site complications: Radial 0% vs femoral 10%

9. METHODS
• Prospective register with 7 pts---- later prospective study
• Inclusion criteria
• Severe obesity: BMI >40
• End points
• Primary - Success of the intervention, Complications
• Secondary – Clincal success of the interventions (Weoght loss), Procedural data
• Angiography
• Embolisation
• 300-500 micron PVA particles
• Follow up
• Obesitology (weight, BMI, RR, HR)
• Hormon levels (leptin, ghrellin, Insulin resistance, cortisol level, ..)
• Endoscopy (only in the study)

10. METHODS- ANGIOGRAPHY

11. METHODS- SELECTIVE CANNULATION
AND EMBOLISATION

12. CASE 1 DIAGONAL PCI AND GASTRIC EMBOLISATION

13. CASE 2- GASTRIC EMBOLISATION

14. CASE 3- GASTRIC EMBOLISATION

15. CASE 4. GASTRIC EMBOLISATION

16. DEMOGRAPHIC DATA
N (%)
Hypertension 7 (100)
Hyperlipidaemia 7 (100)
Diabetes mellitus 7 (100)
Coronary artery disease 3 (42.8)
Peripheral artery disease 2 (28.6)
Renal failure 1 (14.2)
COPD 5 (71.4)

17. PROCEDURAL RESULTS
• Technical success: 100%
• Clinical success:
• Weight loss at 1 month
• From 140.7 ± 34.9 to 134.8 ± 32.7 kg
• Procedural details
• Procedure time: 31.8 ±21 min
• Fluoroscopy time 975 ± 922 sec
• Contrast consumption: 208.7 ± 123.6 ml
• Ghrellin decrease: No data

18. COMPLICATIONS
Complications N (%)
Vascular access complications
- Minor
- Major
0 (0)
0 (0)
Gastrointestinal
- Major bleeding
- Pancreatitis
- Gastric ulcer (symptomatic)
- Other (pancreatitis)
0 (0)
0 (0)
0 (0)
0 (0)
Symptoms:
6 pts transient pain, but after dual omeprazol resolved

19. CONCLUSION
• Bariatric embolization, or gastric (stomach) artery
embolization promising treatment for obesity
• We need more data about
• Complications
• Real efficacy
• Radial access offers:
• Zero major access complications rate
• It can be done outpatient

20. GHRELIN - HUNGER HORMONE
• The pattern of ghrelin release suggests that it
governs feelings of hunger.
• Circulating ghrelin levels are increased by fasting,
and fall after a meal. Central or peripheral
administration of acylated ghrelin to rats acutely
stimulates food intake and growth hormone
release, and chronic administration causes weight
gain.
• Intravenous infusion or subcutaneous injection of
ghrelin to humans increases both feelings of
hunger and food intake.

21. (Cummings and Overduin., 2004)