SELECTED ABSTRACTS FROM ISET The International Symposium on Endovascular Therapy (ISET) 2015 January 31–February 4, 2015, Hollywood, Florida SELECTED ORAL PRESENTATIONS Femoral Crossover in Peripheral Vascular Interventions Initiated via a Transradial Approach: Incidence and Outcomes D. Biederman, J. Titano, E. Kim, R. Patel, F. Nowakowski, N. Tabori, R. Lookstein, A. Fischman Purpose: Transradial access (TRA) has been shown to lower morbidity and bleeding complications compared to transfemoral access (TFA) in percuta- neous coronary interventions. Transfemoral crossover has been used to describe instances where interventions are initiated via the radial artery but require a secondary access site for completion. In this study, we evaluate the incidence and outcomes of transfemoral crossover in peripheral vascular interventions. Material and Methods: A retrospective review was performed for all peripheral interventions for which the initial attempt at vascular access was the radial artery and either ipsilateral or contralateral femoral artery access was obtained prior to completion. A Barbeau test was first performed in all cases. Following this, access to the left radial artery was attempted under ultrasound guidance using a micropuncture with placement of a hydrophilic-coated sheath (5, 6 Fr). Following sheath placement, a standard solution of heparin (3000 units), verapamil (2.5 mg), and nitroglycerin (200 mcg) was administered intra-arterially. Upon completion, a TR-band (Terumo, Somerset, New Jersey) was used for hemostasis. Incidence of femoral crossover, reason for femoral crossover, secondary access site used, and major and minor adverse events were recorded. Results: From April 2012 to July 2014, a total of 960 procedures were performed in 633 patients for which the radial artery was intended as the primary access site. Of these, there were 18 procedures in 18 patients (66  13 years, 10 female, 8 male) completed with femoral access yielding an overall femoral crossover rate of 1.9%. Procedures performed were peripheral embolization (n ¼ 7), radioembolization (n ¼ 5), chemoembolization (n ¼ 3), and peripheral vascular stent placement (n ¼ 3). Causes of femoral crossover included vessel spasm/small vessel diameter (n¼7; 38%), radial loops (n¼5; 28%), proximal occlusion (n¼3; 17%), and catheter length limitations (n¼3; 17%). There were no complications in 14 of the 18 procedures. Other outcomes in transfemoral crossover cases that occurred in 1 patient each included Grade 2 hematoma in an endoleak repair performed at the contralateral site due to vessel spasm, bruising in a radioembolization performed at the ipsilateral site due to radial loop and bruising in another patient in a renal stent performed at the contralateral site due to vessel spasm, and radial spasm in a radioembolization performed at the ipsilateral site due to vessel spasm. Conclusions: In our experience, incidence of transfemoral crossover in periph- eral vascular interventions initiated via a transradial approach is extremely low. Recognizing anatomical and experience-related factors contributing to femoral crossover may be helpful in lowering access site complications while analysis of technical limitations may contribute to future product development. Safety and Feasibility of Transradial Access for Visceral Interventions in Patients with Thrombocytopenia J. Titano, D. Biederman, R. Patel, E. Kim, N. Tabori, F. Nowakowski, R. Lookstein, A. Fischman Purpose: Transradial access (TRA) has shown lower morbidity and decreased bleeding complications compared with transfemoral access (TFA). This study evaluates the safety and feasibility of TRA in patients with a platelet count of [lte] 50,000/mL for visceral interventions. Material and Methods: Patients who underwent visceral interventions via the radial artery with a platelet count [lte] 50,000/mL on the day of procedure were retrospectively reviewed. In all cases, a Barbeau test was performed. A 5F Glidesheath (Terumo Medical Corporation, Somerset, New Jersey) was placed in the left radial artery using ultrasound guidance. Following sheath placement, a combination of 3000 U heparin, 2.5 mg verapamil, and 200 mcg nitroglycerin was administered intra-arterially. A TR band (Terumo Medical Corporation, Somerset, New Jersey) was used for hemostasis upon completion of each procedure. Technical success, major and minor adverse events, and procedural details were recorded. Results: From 1 July 1 2012 to 1 September 2014, a total of 960 peripheral interventions via TRA were performed, of which 51 procedures were performed in 44 patients (Age: 63.8  10.2 years, 11 female, 33 male) with a platelet count [lte] 50,000/mL (median [interquartile range]: 39 [34 to 44.5]/mL). Interventions included chemoembolization (n ¼ 30), radioembolization mapping (n ¼ 15), radioembolization (n ¼ 2), splenic embolization (n ¼ 3), and renal embolization (n ¼ 1). Technical success was achieved in 50/51 (98%) cases. There was 1 case of severe vessel spasm requiring ipsilateral femoral crossover. There were no major adverse events at 30 days. Minor access site bruising occurred in 3 patients (6%) and was treated conservatively in all cases. Conclusions: Transradial visceral interventions in patients with thrombocyto- penia are both feasible and safe. Endoleak Outcomes of Suprarenal vs. Infrarenal Endovascular Aneurysm Repairs Outside Instructions for Use Standards R. Alexander, M. Rizer, R. Beasley Purpose: To determine if there are any differences in outcomes between infrarenal fixation (IF) and suprarenal fixation (SF) for the endovascular treatment of abdominal aortic aneurysms (AAAs) with aortic neck lengths (o 15 mm) outside instructions for use (IFU) standards. Material and Methods: A retrospective review of 561 endovascular aneurysm repairs (EVAR) procedures performed from 2004 to 2011 at a single institution. The charts and radiographic images of all patients were reviewed. Patients who underwent EVAR with AAA with short proximal neck lengths were stratified into 2 groups of IF (Gore Excluder) and SF (Cook Zenith). The primary end point of the study was the presence of endoleaks. The secondary end points were graft migration, postoperative rupture, and death. Results: A total of 561 EVARs were performed during this study period with 52 identified as having a short proximal aortic neck. Seventeen patients were in the IF group and 34 in the SF group. The mean follow up period was 33.9 months for the IF group and 23.4 months for the SF group. There was no difference in the average proximal neck length (8.8 mm IF vs. 9.9 mm SF; p ¼ not significant [NS]) or the preoperative AAA size (23.7 mm IF vs. 25.2 mm SF; p ¼ NS). There were no significant differences in age (74.7 years IF vs. 78.2 years SF; p ¼ NS), gender (IF 94% male vs. SF 88% male; p ¼ NS) or length of stay (2.2 days IF vs. 3 days SF; p ¼ NS). There was one type II endoleak in both the IF and SF groups at 90-day follow up. At 1 year, the type II endoleak in the IF group persisted while the 1 patient with a type II endoleak in the SF group died. There were no migrations noted in either group. There were no ruptures in the IF group and 1 rupture in the SF group (p ¼ NS). There were 5 deaths in the IF group and 5 deaths in the SF group (p ¼ NS). & SIR, 2015 J Vasc Interv Radiol 2015; 26:147–150 http://dx.doi.org/10.1016/j.jvir.2014.10.025 All ISET abstracts and posters are graded via blinded peer review based on scientific merit, originality, relevance, and clarity. SIR assumes no legal liability or responsibility for the completeness, accuracy, and correctness of the information presented in the abstracts. Abstracts will be published in the Journal of Vascular and Interventional Radiology as submitted by the authors, except for minor stylistic adjustments to ensure consistency of format and adherence to journal style. ISET Abstracts