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Fior D, Pileri M, Rovere A, Moramarco LP, Santucci D, Grasso RF, Faiella E. Endovascular management of KILT syndrome and COVID-19-related extensive deep vein thrombosis in a pregnant patient: A case report. Radiol Case Rep 2024; 19:2277-2281. [PMID: 38559648 PMCID: PMC10978467 DOI: 10.1016/j.radcr.2024.02.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
We report on a 20-year-old pregnant woman who tested positive for SARS-CoV-2 and was diagnosed with KILT syndrome, a rare condition that increases the risk of thrombotic events. The patient showed signs of deep vein thrombosis that extended from the bilateral iliac vein to the inferior vena cava (IVC), which was treated with placement of an IVC filter and endovascular thromboaspiration/thrombolysis. The IVC was successfully recanalized; however, during follow-up, thrombotic restenosis occurred at the filter level, requiring filter removal. This case highlights the potential benefits of endovascular thromboaspiration/thrombolysis and IVC filter placement in patients with KILT syndrome presenting with acute thrombotic events.
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Affiliation(s)
- Davide Fior
- Department of Radiology, Sant'Anna Hospital, ASST Lariana, Via Ravona 20, San Fermo della Battaglia, 22042 Como, Italy
| | - Matteo Pileri
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Antonio Rovere
- Department of Diagnostic Radiology, San Gerardo Hospital, ASST Monza, Via Gian Battista Pergolesi 33, 20900, Monza, Italy
| | - Lorenzo Paolo Moramarco
- Department of Radiology, Sant'Anna Hospital, ASST Lariana, Via Ravona 20, San Fermo della Battaglia, 22042 Como, Italy
| | - Domiziana Santucci
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Rosario Francesco Grasso
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Eliodoro Faiella
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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Faiella E, Pileri M, Santucci D, Pusceddu C, Fior D, Riva F, Tagliaferri C, Moramarco LP, Zobel BB, Grasso RF. Transoral percutaneous radiofrequency ablation with a steerable needle and cementoplasty under CBCT and infrared augmented reality navigation system guidance for the treatment of a C1 solitary plasmacytoma: A case report. Radiol Case Rep 2024; 19:890-894. [PMID: 38188956 PMCID: PMC10770508 DOI: 10.1016/j.radcr.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 01/09/2024] Open
Abstract
We report a case of a 40-year-old female with a solitary plasmacytoma of the right transverse apophysis of C1 who underwent combined transoral ablation using a curved steerable needle and cementoplasty under CBCT and infra-red augmented reality navigation system. An imaging work-up revealed an osteolytic lesion determining partial collapse of the right lateral mass of C1 and involving the vertebral foramen. After a biopsy, that revealed a solid tissue consistent with plasmacytoma, it was decided to proceed with radiation therapy. Subsequent PET-CT restaging scans showed residual tumors treated with a transoral percutaneous approach, combining ablation and cementoplasty. This report evaluates the benefits of this combined procedure and the transoral approach, focusing on the advantages of steerable devices and navigation systems.
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Affiliation(s)
- Eliodoro Faiella
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Matteo Pileri
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Domiziana Santucci
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Claudio Pusceddu
- Department of Oncological and Interventional Radiology, Businco Hospital, Cagliari, Italy
| | - Davide Fior
- Department of Radiology, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy
| | - Federica Riva
- Department of Radiology, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy
| | - Chiara Tagliaferri
- Department of Radiology, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy
| | | | - Bruno Beomonte Zobel
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Rosario Francesco Grasso
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
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Quaretti P, Corti R, D'Agostino AM, Bozzani A, Moramarco LP, Cionfoli N. Covered stent assisted coil embolization of large Buhler aneurysm in setting of chronic celiac trunk occlusion. CVIR Endovasc 2024; 7:9. [PMID: 38198119 PMCID: PMC10781915 DOI: 10.1186/s42155-023-00416-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/07/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The arc of Bühler (AOB) is a residual embryonal anastomosis between the celiac artery (CA) and the superior mesenteric artery (SMA). Although usually asymptomatic, it has clinical relevance when compensatory reverse flow between the SMA and the CA in response to celiac artery obstruction leads to aneurysm formation and bleeding. Endovascular coiling is the mainstay therapy because of the deep AOB retropancreatic location, which hinders open surgery. CASE PRESENTATION We herein report a case of a 2.8-cm AOB saccular aneurysm and LAM compression of celiac trunk in a 47-year-old man during rehabilitation following motorcycle trauma and vertebral surgery. The patient was considered unsuitable for surgery. Neither conventional coiling nor bare-metal stent and balloon-assisted techniques for coiling were suitable because of the wide necked saccular shape of AOB aneurysm interposed between the SMA and the floor of celiac trunk. To exclude the aneurysm from direct SMA inflow and permit safe and efficient coiling to rule out retrograde sac perfusion, a 9-mm polytetrafluoroethylene stent graft (Viabahn; Gore, Phoenix, AZ, USA) was positioned in the mesenteric artery, followed by antegrade periprosthetic high-density packed coiling of the aneurysm. The AOB remained excluded from mesenteric perfusion. The patient's clinical condition and abdominal contrast-enhanced multislice computed tomographic findings were unremarkable at the 9-year follow-up. CONCLUSION The 9 year long-term efficacy in our case raises the possibility that perigraft coiling following stent-graft deployment in the SMA may represent a valuable technical option for large Bühler aneurysms that are not amenable to stand-alone coiling.
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Affiliation(s)
- Pietro Quaretti
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, V.Le Golgi 19, Pavia, 27100, Italy.
| | - Riccardo Corti
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, V.Le Golgi 19, Pavia, 27100, Italy
| | - Antonio Mauro D'Agostino
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, V.Le Golgi 19, Pavia, 27100, Italy
| | - Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Paolo Moramarco
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, V.Le Golgi 19, Pavia, 27100, Italy
| | - Nicola Cionfoli
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, V.Le Golgi 19, Pavia, 27100, Italy
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Fontana F, Piacentino F, Curti M, Ierardi AM, Coppola A, Macchi E, De Marchi G, Faiella E, Santucci D, Moramarco LP, Del Grande F, Piffaretti G, Tozzi M, Imperatori A, Carcano G, Basile A, D'Angelo F, Carrafiello G, Venturini M. Pulmonary Artery Pseudoaneurysms Embolization: Bicentric Experience and Review of the Literature. J Clin Med 2023; 12:jcm12113796. [PMID: 37297991 DOI: 10.3390/jcm12113796] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
The purpose of this bicentric case series was to report the safety, efficacy, and clinical outcome of transcatheter embolization in pulmonary artery pseudoaneurysms (PAPAs). Between January 2016 and June 2021, eight patients with PAPA were subjected to transcatheter embolization. The total number of patients was eight, of which five were female, with a mean age of 62 ± 14 years (average ± standard deviation). Etiology was traumatic in 2/8 cases and iatrogenic in 6/8 cases (after positioning a Swan-Ganz catheter in 5/6 cases and a temporary pacemaker in the latter case). In a single case, the PAPA was incidentally discovered during a routine X-ray, in the remaining 7 cases, the procedure was performed in emergency settings. PAPA embolization was performed using detachable coils alone in 3 cases; coils and glue in 1 case; coils, glue, and vascular plug in 1 case; coils and non-adhesive liquid embolic agents (Onyx and Squid respectively) in 2 cases; and non-adhesive liquid embolic agent alone (Onyx) in 1 case. No peri-procedural or post-procedural complications were recorded. Both the technical and clinical success rates were 100.0%. In conclusion, endovascular embolization is a technically feasible and safe therapeutic option for patients with PAPAs.
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Affiliation(s)
- Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Marco Curti
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Anna Maria Ierardi
- Radiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20021 Milan, Italy
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Edoardo Macchi
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Giuseppe De Marchi
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Eliodoro Faiella
- Radiology Unit, Sant'Anna Hospital, San Fermo della Battaglia, 22042 Como, Italy
- Department of Radiology, Campus Bio-Medico University, 00128 Rome, Italy
| | - Domiziana Santucci
- Radiology Unit, Sant'Anna Hospital, San Fermo della Battaglia, 22042 Como, Italy
- Department of Radiology, Campus Bio-Medico University, 00128 Rome, Italy
| | | | - Filippo Del Grande
- Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale EOC, 6900 Lugano, Switzerland
| | - Gabriele Piffaretti
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- Vascular Surgery Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Matteo Tozzi
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- Vascular Surgery Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Andrea Imperatori
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- Thoracic Surgery Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Giulio Carcano
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- General Surgery Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Antonio Basile
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", 95123 Catania, Italy
| | - Fabio D'Angelo
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- Orthopedic Surgery Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Gianpaolo Carrafiello
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
- Radiology Unit, Sant'Anna Hospital, San Fermo della Battaglia, 22042 Como, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
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Fior D, Di Provvido S, Leni D, Corso R, Moramarco LP, Pileri M, Grasso RF, Santucci D, Faiella E. Spontaneous Soft Tissue Hematomas in Patients with Coagulation Impairment: Safety and Efficacy of Transarterial Embolization. Tomography 2023; 9:1083-1093. [PMID: 37368541 DOI: 10.3390/tomography9030089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
The aim of this study is to report the authors' experience of percutaneous transarterial embolization (TAE) in patients with spontaneous soft tissue hematomas (SSTH) and active bleeding with anticoagulation impairment. The study retrospectively identified 78 patients who received a diagnosis of SSTH by CT scan and underwent TAE between 2010 and 2019 in a single trauma center. The patients were stratified using Popov classification into categories: 2A, 2B, 2C, and 3. The patient's 30-day survival after TAE was considered the primary outcome; immediate technical success, the need for additional TAE, and TAE-related complications were considered secondary outcomes. Immediate technical success, complication rate, and risk factors for death were analyzed. Follow-up stopped on day 30 from TAE. 27 patients (35%) fell into category 2A, 8 (10%) into category 2B, 4 (5%) into category 2C, and 39 (50%) into category 3. Immediate technical success was achieved in 77 patients (98.7%). Complications included damage at the arterial puncture site (2 patients, 2.5%) and acute kidney injury (24 patients, 31%). Only 2 patients (2.5%) had been discharged with a new diagnosis of chronic kidney disease. The 30-day overall mortality rate was 19% (15 patients). The mortality rate was higher in hemodynamically unstable patients, in Popov categories 2B, 2C, and 3, and in patients with an initial eGFR < 30 mL/min × 1.73 m2. The study demonstrated a higher mortality risk for categories 2B, 2C, and 3 compared to category 2A. Nonetheless, TAE has proven effective and safe in type 2A patients. Even though it is unclear whether type 2A patients could benefit from conservative treatment rather than TAE, in the authors' opinion, a TAE endovascular approach should be promptly considered for all patients in ACT with active bleeding demonstrated on CT scans.
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Affiliation(s)
- Davide Fior
- Department of Radiology, Sant'Anna Hospital, ASST Lariana, Via Ravona 20, San Fermo della Battaglia, 22042 Como, Italy
| | - Stefano Di Provvido
- Department of Radiology, Desio Hospital, ASST Brianza, Via Giuseppe Mazzini 1, Desio, 20832 Monza, Italy
| | - Davide Leni
- Department of Diagnostic Radiology, San Gerardo Hospital, ASST Monza, Via Gian Battista Pergolesi 33, 20900 Monza, Italy
| | - Rocco Corso
- Department of Diagnostic Radiology, San Gerardo Hospital, ASST Monza, Via Gian Battista Pergolesi 33, 20900 Monza, Italy
| | - Lorenzo Paolo Moramarco
- Department of Radiology, Sant'Anna Hospital, ASST Lariana, Via Ravona 20, San Fermo della Battaglia, 22042 Como, Italy
| | - Matteo Pileri
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Rosario Francesco Grasso
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Domiziana Santucci
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Eliodoro Faiella
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
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Faiella E, Santucci D, Fior D, Riva F, Tagliaferri C, Demelas L, D' Aniello G, Muraca RM, Bignami M, Moramarco LP. Case of IV Stage Juvenile Nasopharyngeal Angiofibroma Presurgically Treated with a Single ECA Stop-Flow Embolization Technique Using Onyx 18. Case Rep Otolaryngol 2023; 2023:1351982. [PMID: 37181231 PMCID: PMC10175024 DOI: 10.1155/2023/1351982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 05/16/2023] Open
Abstract
Background Juvenile nasopharyngeal angiofibroma (JNA) is a rare tumor that mainly affects young boys. Its intervention may be complex due to its high vascularity, location, and extension. Preoperative embolization is used to prevent intrasurgical and postsurgical bleeding. Two main kinds of embolization are described in literature: intratumoral and transarterial, and numerous embolic materials are used. Case Presentation. We want to present a case of presurgical embolization of a stage IV JNA, performed using a single stop-flow balloon assisted technique with the balloon cuffed exclusively in the external carotid artery and using Onyx 18 as an embolic agent. Conclusions The embolization with an exclusive external carotid artery single stop-flow technique using Onyx 18 is a safe, effective, and a definitive approach.
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Affiliation(s)
- Eliodoro Faiella
- Department of Radiology, Sant' Anna Hospital, Via Ravona 22042, San Fermo Della Battaglia, Como, Italy
| | - Domiziana Santucci
- Department of Radiology, Sant' Anna Hospital, Via Ravona 22042, San Fermo Della Battaglia, Como, Italy
- Unit of Computer Systems and Bioinformatics, Department of Engineering, Campus Bio-Medico University, Via Alvaro Del Portillo 21- 00128, Rome, Italy
| | - Davide Fior
- Department of Radiology, Sant' Anna Hospital, Via Ravona 22042, San Fermo Della Battaglia, Como, Italy
| | - Federica Riva
- Department of Radiology, Sant' Anna Hospital, Via Ravona 22042, San Fermo Della Battaglia, Como, Italy
| | - Chiara Tagliaferri
- Department of Radiology, Sant' Anna Hospital, Via Ravona 22042, San Fermo Della Battaglia, Como, Italy
| | - Laura Demelas
- Department of Radiology, Sant' Anna Hospital, Via Ravona 22042, San Fermo Della Battaglia, Como, Italy
| | - Giovanni D' Aniello
- Medicine and Surgery Faculty, Agostino Gemelli University Polyclinic, IRCCS, Via Della Pineta Sacchetti 217, Rome, Italy
| | - Rosa Maria Muraca
- Department of Radiology, Sant' Anna Hospital, Via Ravona 22042, San Fermo Della Battaglia, Como, Italy
| | - Maurizio Bignami
- Department of Otolaryngology, Sant'Anna Hospital, Via Ravona 22042, San Fermo Della Battaglia, Como, Italy
| | - Lorenzo Paolo Moramarco
- Department of Radiology, Sant' Anna Hospital, Via Ravona 22042, San Fermo Della Battaglia, Como, Italy
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Faiella E, Calabrese A, Santucci D, Corti R, Cionfoli N, Pusceddu C, de Felice C, Bozzini G, Mazzoleni F, Muraca RM, Moramarco LP, Venturini M, Quaretti P. Green Tattoo Pre-Operative Renal Embolization for Robotic-Assisted and Laparoscopic Partial Nephrectomy: A Practical Proof of a New Technique. J Clin Med 2022; 11:jcm11226816. [PMID: 36431293 PMCID: PMC9693545 DOI: 10.3390/jcm11226816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/03/2022] [Accepted: 11/13/2022] [Indexed: 11/19/2022] Open
Abstract
(1) Background: Our aim is to describe a new mixed indocyanine-non-adhesive liquid embolic agent (Onyx-18) pre-operative renal embolization technique for assisted-robotic and laparoscopic partial nephrectomy with near-infra-red fluorescence imaging. (2) Methods: Thirteen patients with biopsy-proven renal tumors underwent pre-operative mixed indocyanine-ethylene vinyl alcohol (EVOH) embolization (Green-embo) between June 2021 and August 2022. All pre-operative embolizations were performed with a super selective stop-flow technique using a balloon microcatheter to deliver an indocyanine-EVOH mixture into tertiary order arterial branch feeders and the intra-lesional vascular supply. Efficacy (evaluated as complete embolization, correct tumor mapping on infra-red fluorescence imaging and clamp-off surgery) and safety (evaluated as complication rate and functional outcomes) were primary goals. Clinical and pathological data were also collected. (3) Results: Two male and eleven female patients (mean age 72 years) received pre-operative Green-embo. The median tumor size was 29 mm (range 15-50 mm). Histopathology identified renal cell carcinoma (RCC) in 9 of the 13 (69%) patients, oncocytoma in 3 of the 13 (23%) patients and sarcomatoid RCC in 1 of the 13 (8%) patients. Lesions were equally distributed between polar, meso-renal, endo- and exophytic locations. Complete embolization was achieved in all the procedures. A correct green mapping was identified during all infra-red fluorescence imaging. All patients were discharged on the second day after the surgery. The median blood loss was 145 cc (10-300 cc). No significant differences were observed in serum creatinine levels before and after the embolization procedures. (4) Conclusions: The Green-tattoo technique based on a mixed indocyanine-non-adhesive liquid embolic agent (Onyx-18) is a safe and effective pre-operative embolization technique. The main advantages are the excellent lesion mapping for fluorescence imaging, reduction in surgical time, and definitive, complete and immediate tumor devascularization based on the deep Onyx-18 penetration, leading to a very low intra-operative blood loss.
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Affiliation(s)
- Eliodoro Faiella
- Department of Radiology, Sant’Anna Hospital, Via Ravona, San Fermo della Battaglia, 22042 Como, Italy
- Correspondence: ; Tel.: +39-331-455-7202
| | - Alessandro Calabrese
- Department of Radiological Sciences, Oncology and Pathology, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 105, 00161 Rome, Italy
| | - Domiziana Santucci
- Department of Radiology, Sant’Anna Hospital, Via Ravona, San Fermo della Battaglia, 22042 Como, Italy
- Unit of Computer Systems and Bioinformatics, Department of Engineering, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Riccardo Corti
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Nicola Cionfoli
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Claudio Pusceddu
- Regional Referral Center for Oncologic Disease, Department of Oncological and Interventional Radiology, Businco Hospital, A.O. Brotzu, 09100 Cagliari, Italy
| | - Carlo de Felice
- Department of Radiological Sciences, Oncology and Pathology, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 105, 00161 Rome, Italy
| | - Giorgio Bozzini
- Department of Radiology, Sant’Anna Hospital, Via Ravona, San Fermo della Battaglia, 22042 Como, Italy
| | - Federica Mazzoleni
- Department of Radiology, Sant’Anna Hospital, Via Ravona, San Fermo della Battaglia, 22042 Como, Italy
| | - Rosa Maria Muraca
- Department of Radiology, Sant’Anna Hospital, Via Ravona, San Fermo della Battaglia, 22042 Como, Italy
| | - Lorenzo Paolo Moramarco
- Department of Radiology, Sant’Anna Hospital, Via Ravona, San Fermo della Battaglia, 22042 Como, Italy
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Ospedale di Circolo e Fondazione Macchi, University of Insubria, 21100 Varese, Italy
| | - Pietro Quaretti
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
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Messana G, Ambrosi L, Moramarco LP, Cionfoli N, Maestri M, Quaretti P. Testicular artery originating from the inferior mesenteric artery: an alert for interventionalists - A case report. Radiol Case Rep 2021; 16:2710-2713. [PMID: 34336075 PMCID: PMC8318830 DOI: 10.1016/j.radcr.2021.06.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/20/2021] [Indexed: 11/19/2022] Open
Abstract
Testicular arteries usually arise from the abdominal aorta. During an elective embolization of superior rectal arteries for hemorrhoidal disease performed in a 52-year-old male patient, a previously unreported vascular variant was identified. On selective angiography, the inferior mesenteric artery split into left colic artery and left testicular artery, without any evidence of vascular supply to the hemorrhoidal cushions. Superior rectal arteries were embolized after catheterization of the median sacral artery. A thorough knowledge of vascular variations is essential for interventional radiologists in order to recognize them and avoid potential complications.
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Affiliation(s)
- Gaia Messana
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi, 19 27100 Pavia PV, Italy
- Corresponding author.
| | - Ludovico Ambrosi
- Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi, 19 27100 Pavia PV, Italy
| | - Lorenzo Paolo Moramarco
- Unit of Interventional Radiology - Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi, Pavia PV, Italy
| | - Nicola Cionfoli
- Unit of Interventional Radiology - Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi, Pavia PV, Italy
| | - Marcello Maestri
- Department of General Surgery I, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi, Pavia PV, Italy
| | - Pietro Quaretti
- Unit of Interventional Radiology - Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi, Pavia PV, Italy
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Moramarco LP, Capodaglio CA, Quaretti P, Cionfoli N, Fiorina I, Disabella E, D'agostino AM, Urtis M, Arbustini E. Multivessel endovascular therapy for undiagnosed vascular type Ehlers-Danlos syndrome. Successful percutaneous transcatheter coil embolization of hepatic artery pseudoaneurysm with stenting of right renal and iliac arteries in emergency setting. BJR Case Rep 2020; 6:20200025. [PMID: 33299587 PMCID: PMC7709055 DOI: 10.1259/bjrcr.20200025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/17/2020] [Accepted: 06/21/2020] [Indexed: 11/05/2022] Open
Abstract
Among Ehlers-Danlos syndromes, the vascular type is the most severe because of its vascular complications. Transcatheter embolization of medium-sized arteries has become the first-line therapy for life-threatening hemorrhage. Ongoing multiple lesions causing hemorrhagic or ischemic complications in the acute phase can challenge patient management. Multivessel endovascular treatment has never been reported. In this study, we report successful single-session treatment by coiling of a ruptured pseudoaneurysm of the hepatic artery with stenting of dissected right renal and iliac arteries in a 46-year-old female. Percutaneous transfemoral approach was gained and sealed with a plug-based closure device. Genetic disease was subsequently confirmed by molecular analysis.
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Affiliation(s)
| | | | - Pietro Quaretti
- Unit of Interventional Radiology and Department of Radiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Nicola Cionfoli
- Unit of Interventional Radiology and Department of Radiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Ilaria Fiorina
- Unit of Interventional Radiology and Department of Radiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Eliana Disabella
- Centre for Inherited Cardiovascular Diseases of Cardio-Thoracic-Vascular Surgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | | | - Mario Urtis
- Centre for Inherited Cardiovascular Diseases of Cardio-Thoracic-Vascular Surgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases of Cardio-Thoracic-Vascular Surgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
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Quaretti P, Cionfoli N, Moramarco LP, Leati G, Corti R. Durability of Stent-Grafts for Radiocephalic Fistulas. J Endovasc Ther 2019; 26:887. [PMID: 31736426 DOI: 10.1177/1526602819875486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Pietro Quaretti
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Nicola Cionfoli
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | - Giovanni Leati
- Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Riccardo Corti
- Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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Quaretti P, Cionfoli N, Moramarco LP, Corti R, Togni G. Transjugular Balloon-Assisted Retrograde Ethylene-Vinyl Alcohol Copolymer Embolization of a Main Pulmonary Artery Defect Discovered during Removal of a Malpositioned Dialytic Central Venous Catheter. J Vasc Interv Radiol 2019; 30:742-743. [PMID: 31029390 DOI: 10.1016/j.jvir.2018.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Pietro Quaretti
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo, Viale Golgi 19, Pavia, Italy.
| | - Nicola Cionfoli
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo, Viale Golgi 19, Pavia, Italy
| | - Lorenzo Paolo Moramarco
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo, Viale Golgi 19, Pavia, Italy
| | - Riccardo Corti
- Radiology Department, IRCCS Policlinico San Matteo, Viale Golgi 19, Pavia, Italy
| | - Giorgio Togni
- Radiology Department, IRCCS Policlinico San Matteo, Viale Golgi 19, Pavia, Italy
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Quaretti P, Leati G, Moramarco LP, Cionfoli N, Corti R, Tinelli C, Fiorina I, Galli F. Percutaneous Transanastomotic Stent Graft Deployment to Salvage Dysfunctional Native Forearm Radiocephalic Fistulae: Feasibility and Primary Patency at 12 Months. J Vasc Interv Radiol 2018; 29:986-992. [DOI: 10.1016/j.jvir.2018.02.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/18/2018] [Accepted: 02/25/2018] [Indexed: 10/16/2022] Open
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de Martinis L, Groppelli G, Corti R, Moramarco LP, Quaretti P, De Cata P, Rotondi M, Chiovato L. Disabling portosystemic encephalopathy in a non-cirrhotic patient: Successful endovascular treatment of a giant inferior mesenteric-caval shunt via the left internal iliac vein. World J Gastroenterol 2017; 23:8426-8431. [PMID: 29308002 PMCID: PMC5743513 DOI: 10.3748/wjg.v23.i47.8426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/20/2017] [Accepted: 11/01/2017] [Indexed: 02/06/2023] Open
Abstract
Hepatic encephalopathy is suspected in non-cirrhotic cases of encephalopathy because the symptoms are accompanied by hyperammonaemia. Some cases have been misdiagnosed as psychiatric diseases and consequently patients hospitalized in psychiatric institutions or geriatric facilities. Therefore, the importance of accurate diagnosis of this disease should be strongly emphasized. A 68-year-old female patient presented to the Emergency Room with confusion, lethargy, nausea and vomiting. Examination disclosed normal vital signs. Neurological examination revealed a minimally responsive woman without apparent focal deficits and normal reflexes. She had no history of hematologic disorders or alcohol abuse. Her brain TC did not demonstrate any intracranial abnormalities and electroencephalography did not reveal any subclinical epileptiform discharges. Her ammonia level was > 400 mg/dL (reference range < 75 mg/dL) while hepatitis viral markers were negative. The patient was started on lactulose, rifaximin and low-protein diet. On the basis of the doppler ultrasound and abdomen computed tomography angiography findings, the decision was made to attempt portal venography which confirmed the presence of a giant portal-systemic venous shunt. Therefore, mechanic obliteration of shunt by interventional radiology was performed. As a consequence, mesenteric venous blood returned to hepatopetally flow into the liver, metabolic detoxification of ammonia increased and hepatic encephalopathy subsided. It is crucial that physicians immediately recognize the presence of non-cirrhotic encephalopathy, in view of the potential therapeutic resolution after accurate diagnosis and appropriate treatments.
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Affiliation(s)
- Luca de Martinis
- Unit of Endocrinology and Internal Medicine, University of Pavia, ICS Maugeri SPA Società Benefit, Pavia 27100, Italy
| | - Gloria Groppelli
- Unit of Endocrinology and Internal Medicine, University of Pavia, ICS Maugeri SPA Società Benefit, Pavia 27100, Italy
| | - Riccardo Corti
- Unit of Interventional Radiology, Radiology Department, IRCCS Fondazione Policlinico San Matteo, Pavia 27100, Italy
| | - Lorenzo Paolo Moramarco
- Unit of Interventional Radiology, Radiology Department, IRCCS Fondazione Policlinico San Matteo, Pavia 27100, Italy
| | - Pietro Quaretti
- Unit of Interventional Radiology, Radiology Department, IRCCS Fondazione Policlinico San Matteo, Pavia 27100, Italy
| | - Pasquale De Cata
- Unit of Endocrinology and Internal Medicine, University of Pavia, ICS Maugeri SPA Società Benefit, Pavia 27100, Italy
| | - Mario Rotondi
- Unit of Endocrinology and Internal Medicine, University of Pavia, ICS Maugeri SPA Società Benefit, Pavia 27100, Italy
| | - Luca Chiovato
- Unit of Endocrinology and Internal Medicine, University of Pavia, ICS Maugeri SPA Società Benefit, Pavia 27100, Italy
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Corti R, Quaretti P, Galli F, Moramarco LP, Cionfoli N, Leati G, Corbetta R, Tozzi M. New therapeutic options provided by off-label deployment of stent graft for tailored arteriovenous access salvage: Two cases. SAGE Open Med Case Rep 2017; 5:2050313X17741827. [PMID: 29163957 PMCID: PMC5692143 DOI: 10.1177/2050313x17741827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/17/2017] [Indexed: 11/20/2022] Open
Abstract
A tailored therapy to patient requirements by combining endovascular and surgical steps can be necessary to prolong the life of a vascular access. Stent grafts play a growing role for the therapy of dialytic access complications. Randomized multi-center trials, however, support the on-label use of stent grafts in the treatment of graft venous outflow and in-stent restenosis. The main contraindication to their use is an ongoing infection. We report two cases of new off-label application of Viabahn (Gore, flagstaff, USA) stent graft. In the first case, the failure of a radiocephalic early cannulation graft was treated by stent graft placement on the arterial inflow anastomosis, when emergent angiographic examination revealed the previously unknown high takeoff of the radial artery from the axillary artery. At 13-month follow-up, the target lesion remained untreated. In the second case, elbow stent graft occlusion with extended thrombosis occurred in a right radiocephalic fistula after 3 years of unassisted patency. Being the last option for vascular access, successful endovascular recanalization was carried out. After 3 months, however, the clinical setting relapsed. A two-stage hybrid strategy with vascular surgeon was arranged due to ongoing signs of local infection. Flow was restored by emergent thromboaspiration associated with a new stent graft placement as a endovascular bridge to subsequent surgical treatment. After 2 days, the overlapped stent grafts were excised as planned. Surgical rerouting was completed by polytetrafluoroethylene prosthetic bridge implantation across the elbow. At 4 months, the follow-up remained uneventful. In selected instances, the off-label use of stent grafts may expand the therapeutic options of the vascular access team.
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Affiliation(s)
- Riccardo Corti
- Unit of Interventional Radiology, Department of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Pietro Quaretti
- Unit of Interventional Radiology, Department of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Franco Galli
- Nephrology and Dialysis, IRCCS Fondazione Salvatore Maugeri, Pavia, Italy
| | - Lorenzo Paolo Moramarco
- Unit of Interventional Radiology, Department of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Nicola Cionfoli
- Unit of Interventional Radiology, Department of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giovanni Leati
- Unit of Interventional Radiology, Department of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Riccardo Corbetta
- Vascular Surgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Tozzi
- Vascular Surgery Department, Center For Research on Organ Transplantation, University of Insubria, Varese, Italy
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Pelizzo G, Quaretti P, Moramarco LP, Corti R, Maestri M, Iacob G, Calcaterra V. One step minilaparotomy-assisted transmesenteric portal vein recanalization combined with transjugular intrahepatic portosystemic shunt placement: A novel surgical proposal in pediatrics. World J Gastroenterol 2017; 23:2811-2818. [PMID: 28487619 PMCID: PMC5403761 DOI: 10.3748/wjg.v23.i15.2811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/14/2016] [Accepted: 01/17/2017] [Indexed: 02/06/2023] Open
Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) placement is a standard procedure for the treatment of portal hypertension complications. When this conventional approach is not feasible, alternative procedures for systemic diversion of portal blood have been proposed. A one-step interventional approach, combining minilaparotomy-assisted transmesenteric (MAT) antegrade portal recanalization and TIPS, is described in an adolescent with recurrent esophageal varice bleeding and portal cavernoma (PC). A 16-year-old girl was admitted to our Unit because of repeated bleeding episodes over a short period of time due to esophageal varices in the context of a PC. A portal vein recanalization through an ileocolic vein isolation with the MAT approach followed by TIPS during the same session was performed. In the case of failed portal recanalization, this approach, would also be useful for varice endovascular embolization. Postoperative recovery was uneventful. Treatment consisting of propanolol, enoxaparin and a proton pump inhibitor was prescribed after the procedure. One month post-op, contrast enhanced computed tomography confirmed the patency of the portal and intrahepatic stent grafts. No residual peritoneal fluid was detected nor opacification of the large varices. Endoscopy showed good improvement of the varices. Doppler ultrasound confirmed the accelerated flow in the portal stent and hepatopetal flow inside the intrahepatic portal branches. Three months post-op, TIPS maintained its hourglass shape despite a slight expansion. Portal hypertension and life threatening conditions related to PC would benefit from one-step portal recanalization. MAT-TIPS is feasible and safe for the treatment of PC even in children. This minimally invasive procedure avoids or delays surgical treatment or re-transplantation when necessary in pediatric patients.
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Quaretti P, Galli F, Moramarco LP, Corti R, Leati G, Fiorina I, Tinelli C, Montagna G, Maestri M. Stent Grafts Provided Superior Primary Patency for Central Venous Stenosis Treatment in Comparison with Angioplasty and Bare Metal Stent: A Retrospective Single Center Study on 70 Hemodialysis Patients. Vasc Endovascular Surg 2016; 50:221-30. [PMID: 27097842 DOI: 10.1177/1538574416639149] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To compare patency in dialysis patients following different endovascular treatment of symptomatic central venous stenosis. MATERIALS AND METHODS A 10-year retrospective evaluation in 70 patients (32 men) dialyzing through vascular access (33, 47%) and tunneled catheters (37, 53%) was made. Three cohorts were compared: angioplasty alone (22), bare metal stent (28), and stent graft (20). Patencies were described with Kaplan-Meier method, and Cox uni- and multivariate models were analyzed to find factors associated. RESULTS All patients had a favorable anatomical and clinical outcome. Restenosis occurred in 22 (31%) of 70 patients requiring 41 additional interventions; 34 of 70 patients died (median follow-up 19.4 months). Primary patency at 3, 6, 12, and 24 months was 100%, 100%, 100%, and 84% for stent graft versus 90%, 79%, 58%, and 43% for angioplasty (P = .014) versus 84%, 80%, 75%, and 46% for bare-metal stent (P = .062). The overall comparison was more favorable for stent graft (P = .020) when the sites of lesions were matched. Patencies for angioplasty and bare-metal stents were equivalent (P = .141). A lower risk of restenosis (hazard rate [HR] 0.20, confidence interval [CI] 0.06-0.7) and fewer reinterventions (P < .01) were associated with stent graft, whereas age (HR 1.04, CI 1.001-1.08) and cardiovascular disease (HR 2.26, CI 1.06-4.84) influenced the overall survival. No difference in assisted primary patency was found. CONCLUSION Stent graft seems to improve primary patency for central venous stenosis and requires fewer reinterventions in a dialysis population with a high prevalence of long-term catheters.
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Affiliation(s)
- Pietro Quaretti
- Unit of Interventional Radiology-Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Franco Galli
- Nephrology and Dialysis, IRCCS Fondazione Salvatore Maugeri, Pavia, Italy
| | - Lorenzo Paolo Moramarco
- Unit of Interventional Radiology-Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Riccardo Corti
- Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Giovanni Leati
- Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Ilaria Fiorina
- Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Carmine Tinelli
- Clinical Epidemiology and Biometric Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Giovanni Montagna
- Nephrology and Dialysis, IRCCS Fondazione Salvatore Maugeri, Pavia, Italy
| | - Marcello Maestri
- Department of Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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Pelizzo G, Calcaterra V, Mannarino S, Moramarco LP, Leati G, Quaretti P. Aortopulmonary collateral artery in prenatal exposure to carbamazepine - endovascular therapy and technical considerations: a case report. J Med Case Rep 2015; 9:183. [PMID: 26311236 PMCID: PMC4551368 DOI: 10.1186/s13256-015-0645-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 06/30/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Aortopulmonary collateral arteries are an uncommon variant of alternative blood supply in cases of complex congenital heart disease. Although surgery may still be the classic approach for this condition, mini-invasive endovascular occlusion has been recently attempted as an alternative less traumatic procedure. Children born to women with epilepsy are at increased risk of congenital malformations. CASE PRESENTATION A cardiovascular malformation in a 6-year-old white boy with prenatal exposure to carbamazepine is described. At birth, he underwent atrial-ventricular septal defects repair. At 6 years of age, he was diagnosed to have an aberrant aortopulmonary artery from the descending aorta. He presented with recurrent respiratory infections and no cardiovascular signs, but there was associated right upper lobe hyperperfusion. Collateral percutaneous plug embolization was performed because of risk for cardiorespiratory infections, pulmonary hypertension and atrioventricular dilatation. The post-releasing control showed a complete occlusion of the aberrant artery. A chest radiogram and computed tomography showed normalization of vascular pattern of his right lung at 9-months follow-up. No complications and no respiratory infections in the first follow-up year were observed. A good growth gain was obtained. CONCLUSIONS Plug embolization in an aortopulmonary collateral artery is an interesting alternative to surgery and is suitable for children with minor congenital heart disease and without severe respiratory and/or cardiovascular symptoms. Management and long-term pediatric multidisciplinary follow-up is recommended. Prenatal exposure to carbamazepine could be considered in the pathogenesis and diagnosis of the malformation.
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Affiliation(s)
- Gloria Pelizzo
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinico San Matteo Foundation and University of Pavia, P.le Golgi n.2, 27100, Pavia, Italy.
| | - Valeria Calcaterra
- Department of the Mother and Child Health, Pediatric Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy. .,Department of Internal Medicine, University of Pavia, Pavia, Italy.
| | - Savina Mannarino
- Department of the Mother and Child Health, Pediatric Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
| | - Lorenzo Paolo Moramarco
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation Pavia, Pavia, Italy.
| | - Giovanni Leati
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation Pavia, Pavia, Italy.
| | - Pietro Quaretti
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation Pavia, Pavia, Italy.
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Quaretti P, Galli F, Moramarco LP, Corti R, Leati G, Fiorina I, Maestri M. Dialysis catheter-related superior vena cava syndrome with patent vena cava: long term efficacy of unilateral Viatorr stent-graft avoiding catheter manipulation. Korean J Radiol 2014; 15:364-9. [PMID: 24843241 PMCID: PMC4023055 DOI: 10.3348/kjr.2014.15.3.364] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 02/23/2014] [Indexed: 11/17/2022] Open
Abstract
Central venous catheters are the most frequent causes of benign central vein stenosis. We report the case of a 79-year-old woman on hemodialysis through a twin catheter in the right internal jugular vein, presenting with superior vena cava (SVC) syndrome with patent SVC. The clinically driven endovascular therapy was conducted to treat the venous syndrome with a unilateral left brachiocephalic stent-graft without manipulation of the well-functioning catheter. The follow-up was uneventful until death 94 months later.
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Affiliation(s)
- Pietro Quaretti
- Unit of Interventional Radiology - Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
| | - Franco Galli
- Nephrology and Dialysis, IRCCS Fondazione Salvatore Maugeri, Pavia 27100, Italy
| | - Lorenzo Paolo Moramarco
- Unit of Interventional Radiology - Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
| | - Riccardo Corti
- Unit of Interventional Radiology - Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
| | - Giovanni Leati
- Unit of Interventional Radiology - Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
| | - Ilaria Fiorina
- Unit of Interventional Radiology - Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
| | - Marcello Maestri
- Department of General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
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Nakib G, Calcaterra V, Quaretti P, Moramarco LP, Bonalumi G, Brunero M, Pelizzo G. Chemotherapy and surgical approach with repeated endovascular embolizations: safe interdisciplinary treatment for kasabach-merritt syndrome in a small baby. Case Rep Oncol 2014; 7:23-8. [PMID: 24575011 PMCID: PMC3934804 DOI: 10.1159/000357300] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction Kasabach-Merritt syndrome (KMS) is a life-threatening disease. We describe a combined medical and multistep, endovascular embolization that was successfully performed with surgery. Case Report A 40-day-old female baby was referred because of an infiltrating pelvic mass. Blood tests showed severe anemia and thrombocytopenia with consumptive coagulopathy. The clinical aspect was pathognomonic for KMS. Administration of steroids and chemotherapy were started and coagulation parameters were normalized with tumor volume regression. Three months later, elective surgical treatment became possible, and dissection and ligature of the left internal iliac artery and sacral artery were performed. The main arterial supply of the mass was embolized with Spongostan®. Two months later, a second hybrid approach was adopted for embolization of the main vascular supply of the tumor occupying the left thigh. Via a third contralateral hybrid femoral approach and under fluoroscopy, selective catheterization of the left profunda femoris artery was performed. The arterial feeder of the tumor, localized at the left gluteus, was seen on a CT scan 2 months later and was embolized with Onyx-18. Conclusion Chemotherapy and a tailored hybrid approach comprising repeated endovascular embolizations seem to be a safe treatment in cases of unresectable and life-threatening tumors in small babies.
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Affiliation(s)
- Ghassan Nakib
- Unit of Pediatric Surgery, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Valeria Calcaterra
- Department of Internal Medicine, University of Pavia, Pavia, Italy ; Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Pietro Quaretti
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | - Giovanni Bonalumi
- Division of Vascular Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Marco Brunero
- Unit of Pediatric Surgery, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Gloria Pelizzo
- Unit of Pediatric Surgery, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
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Arici V, Quaretti P, Bozzani A, Moramarco LP, Rossi M, Carlino M. Neck-targeted, stand-alone coiling for successful treatment of type 1A endoleak following endovascular repair. Vasc Endovascular Surg 2013; 48:61-4. [PMID: 24212406 DOI: 10.1177/1538574413510619] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endovascular repair is a standard of treatment for patients with abdominal aortic aneurysm who are unfit for open surgery. Type 1A endoleak (T1A-E) is defined as persistent blood flow outside the lumen of the endograft due to a failure of the graft to seal the proximal landing zone adequately. Accordingly, T1A-E treatment is mandatory, and endovascular options, when possible, consist of standard adjuncts as cuffs and stents or sometimes mere ballooning. Alternatively, different embolization techniques have been described in little or case series. We describe a successful management of large T1A-E with solely coil embolization of the isolated leakage area.
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Affiliation(s)
- Vittorio Arici
- 1Department of Vascular Surgery, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
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