Transradial access to treat severe obesity with gastric artery embolization - Zoltan Ruzsa

1. Transradial access to treat severe
obesity with gastric artery
embolization
Ruzsa Z., Végh E., Nemes B., Bellavics R., Hüttl A, Hüttl K., Merkely B.

2. Financial disclosures
• None

3. What can be done in severe obesity??
• Diet/ exercise
• Difficult to sustain
• Medications
• Average 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 single center register with 7 pts - now national prospective study
• Inclusion criteria
• Severe obesity: BMI >40
• End points
• Primary - Success of the intervention, Complications
• Secondary – Clincal success of the interventions (Weight 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 2 and 12 month
• 161.1 (136.4-185.9)
• 149.6 (129.5-169.6) (p=0.09)
• Procedural details
• Procedure time: 31.8 ±21 min
• Fluoroscopy time 975 ± 922 sec
• Contrast consumption: 208.7 ± 123.6 ml
• Ghrellin decrease: No data
• Endoscopy: No data, but no clinically relevant pain

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
- 1 pts paradox appetite

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)