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Guerini M, Sorace D, Bobbio Pallavicini F, Codullo V, Lucioni M, Fraticelli S, Viganò J, Quaretti P, Delvino P. Massive abdominal haemorrhage due to sequential omental vasculitis and ruptured aneurysms in a patient with granulomatosis with polyangiitis. Scand J Rheumatol 2024; 53:149-151. [PMID: 38085533 DOI: 10.1080/03009742.2023.2286118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/17/2023] [Indexed: 02/27/2024]
Affiliation(s)
- M Guerini
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - D Sorace
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Bobbio Pallavicini
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - V Codullo
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - M Lucioni
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Unit of Pathology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Fraticelli
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Unit of Pathology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - J Viganò
- General Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - P Quaretti
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - P Delvino
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, 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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Mauro A, Mazza S, Scalvini D, Lusetti F, Bardone M, Quaretti P, Cobianchi L, Anderloni A. The Role of Cholangioscopy in Biliary Diseases. Diagnostics (Basel) 2023; 13:2933. [PMID: 37761300 PMCID: PMC10528268 DOI: 10.3390/diagnostics13182933] [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: 07/07/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 09/29/2023] Open
Abstract
Endoscopy plays a central role in diagnostic and therapeutic approaches to biliary disease in both benign and malignant conditions. A cholangioscope is an endoscopic instrument that allows for the direct exploration of the biliary tree. Over the years, technology has improved endoscopic image quality and allowed for the development of an operative procedure that can be performed during cholangioscopy. Different types of instruments are available in this context, and they can be used in different anatomical access points according to the most appropriate clinical indication. The direct visualization of biliary mucosa is essential in the presence of biliary strictures of unknown significance, allowing for the appropriate allocation of patients to surgery or conservative treatments. Cholangioscopy has demonstrated excellent performance in discriminating malignant conditions (such as colangiocarcinoma) from benign inflammatory strictures, and more recent advances (e.g., artificial intelligence and confocal laser endomicroscopy) could further increase its diagnostic accuracy. Cholangioscopy also plays a primary role in the treatment of benign conditions such as difficult bile stones (DBSs). In this case, it may not be possible to achieve complete biliary drainage using standard ERCP. Therapeutic cholangioscopy-guided lithotripsy allows for stone fragmentation and complete biliary drainage. Indeed, other complex clinical situations, such as patients with intra-hepatic lithiasis and patients with an altered anatomy, could benefit from the therapeutic role of cholangioscopy. The aim of the present review is to explore the most recent diagnostic and therapeutic advances in the roles of cholangioscopy in the management of biliary diseases.
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Affiliation(s)
- Aurelio Mauro
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
| | - Stefano Mazza
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
| | - Davide Scalvini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Francesca Lusetti
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Marco Bardone
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
| | - Pietro Quaretti
- Unit of Interventional Radiology, Department of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Lorenzo Cobianchi
- Department of General Surgery, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Andrea Anderloni
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
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Quaretti P, Corti R, D'Agostino AM, Cionfoli N. U-bent Viabahn stent graft in the main left pulmonary artery in a hemodialysis patient after asymptomatic migration: Percutaneous removal and technical considerations. J Vasc Access 2023:11297298231158545. [PMID: 37439244 DOI: 10.1177/11297298231158545] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Stent grafts (SG) have gained the highest level of evidence for superior management over angioplasty of arteriovenous graft (AVG) venous outflow stenosis, which increases their use in hemodialysis patients. Migration to the heart and lungs is the most feared complication of SG of the venous system. METHOD We present a previously unreported case of asymptomatic migration of a 10-cm-long Viabahn lodged in a U-shaped configuration in the main left pulmonary artery after AVG intervention in a 50 year old male hemodialysis patient. RESULTS Through a single femoral access percutaneous retrieval of migrated SG was accomplished. Technique of coaxial buddy snaring technique is described. CONCLUSION Our technique may expand the endovascular likelihood of successful stent removal.
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Affiliation(s)
- Pietro Quaretti
- Interventional Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Riccardo Corti
- Interventional Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Nicola Cionfoli
- Interventional Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Forneris G, Savio D, Quaretti P, Lodi M, Comelli S, Morale W, Spina M, Di Maggio L, Cornacchiari M, Punzi M, Gatta G, Cecere P, Pozzato M, Marciello A, Roccatello D. Report on an Italian survey of 72 stuck hemodialysis catheters. J Nephrol 2023; 36:359-365. [PMID: 36269492 DOI: 10.1007/s40620-022-01474-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 10/01/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Reports of stuck hemodialysis catheters have been on the rise in recent years. Aim of this work is to report how this complication has been managed and the relative outcomes in a multicente Italian survey. METHODS Since 2012, the Italian Society of Nephrology (SIN) Project Group of Vascular Access has collected data among nephrologists on this complication. Data regarding 72 cases of stuck tunnelled central venous catheter (tCVC) in 72 patients were retrieved thanks to this survey. RESULTS In 11 patients (15%) the stuck catheter was directly buried or left in place. Sixty-one cases were managed through advanced removal techniques. Among these, 47 (77%) stuck tunnelled central venous catheters were successfully removed, while 14 (23%) failed to be withdrawn. Considering removed tCVCs, the use of endoluminal balloon dilatation alone or in combination with other tools showed a percentage of success of 88%. The removal procedure involved numerous specialists. Some complications occurred, such as breakage of the line or bleeding, and two cases of haemopericardium during an advanced procedure. CONCLUSION The survey shows how the stuck catheter complication was managed in different ways, with conflicting results. When utilized, endoluminal balloon dilatation proved to be the most effective and most often utilized technique, while some cases had suboptimal management or failure. This underlines how delicate the procedure is, and the need for both precise knowledge of this complication and timely organization of removal attempts.
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Affiliation(s)
- Giacomo Forneris
- CMID-Nephrology and Dialysis Unit (ERK-Net), Center of Research of Nephrology, Rheumatology and Rare Disease, Coordinating Center of the Network of Rare Disease of Piedmont and Aosta Valley, G. Bosco Hospital and University of Turin, Piazza del Donatore di Sangue 3, 10154, Turin, Italy.
| | - Daniele Savio
- Interventional Radiology Unit, Radiology Department, G. Bosco Hospital, Turin, Italy
| | - Pietro Quaretti
- Interventional Radiology Unit, Radiology Department, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Massimo Lodi
- Nephrology and Dialysis, Spirito Santo Hospital, Pescara, Italy
| | - Simone Comelli
- Division of Neuroradiology and Interventional Radiology, AO Brotzu, Cagliari, Italy
| | - Walter Morale
- Nephrology and Dialysis, A.O. Cannizzaro, Catania, Italy
| | - Monica Spina
- Nephrology and Dialysis, NS di Bonaria, San Gavino Monreale, VS, Italy
| | - Luca Di Maggio
- Interventional Radiology Unit, Radiology Department, G. Bosco Hospital, Turin, Italy
| | | | - Massimo Punzi
- Vascular Access Service for Hemodialysis, Nephrocare, Rome, Italy
| | - Giuseppe Gatta
- Department of Nephrology and Dialysis, Scientific Institute for Research and Health Care "Casa Sollievo della Sofferenza" IRCCS, San Giovanni Rotondo, Italy
| | - Pasqualina Cecere
- CMID-Nephrology and Dialysis Unit (ERK-Net), Center of Research of Nephrology, Rheumatology and Rare Disease, Coordinating Center of the Network of Rare Disease of Piedmont and Aosta Valley, G. Bosco Hospital and University of Turin, Piazza del Donatore di Sangue 3, 10154, Turin, Italy
| | - Marco Pozzato
- CMID-Nephrology and Dialysis Unit (ERK-Net), Center of Research of Nephrology, Rheumatology and Rare Disease, Coordinating Center of the Network of Rare Disease of Piedmont and Aosta Valley, G. Bosco Hospital and University of Turin, Piazza del Donatore di Sangue 3, 10154, Turin, Italy
| | - Antonio Marciello
- Division of Nephrology and Dialysis, ASL TO3 di Collegno Pinerolo, PO "Edoardo Agnelli", Pinerolo, Italy
| | - Dario Roccatello
- CMID-Nephrology and Dialysis Unit (ERK-Net), Center of Research of Nephrology, Rheumatology and Rare Disease, Coordinating Center of the Network of Rare Disease of Piedmont and Aosta Valley, G. Bosco Hospital and University of Turin, Piazza del Donatore di Sangue 3, 10154, Turin, Italy
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Colaneri M, Lombardi A, Maffezzoni M, Sambo M, Fabbiani M, Quaretti P, Asperges E, Moramarco L, Sacchi P, Bruno R. The infection risk after transjugular intrahepatic portosystemic shunt: A multiple competing risk analysis from a tertiary care center. Dig Liver Dis 2022; 54:1686-1690. [PMID: 35697589 DOI: 10.1016/j.dld.2022.05.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/07/2022] [Accepted: 05/13/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Infections following transjugular intrahepatic portosystemic shunt (TIPS) placement have been poorly described. We aim to investigate the rate and the potential predictors of infections occurring after TIPS placement. METHODS Single center, retrospective, observational study. All patients who had undergone TIPS placement in the last 10 years with a minimum 1-year FU, were considered. Multiple competing risk analyses were performed to identify infection risk factors and a multivariable Cox proportional-hazard regression model to evaluate the predictors of death. RESULTS Forty-nine patients were considered. Among these, 23 (46%) developed at least 1 infection during the FU, at a median time of 237.7 days (IQR 151.5) from the TIPS placement. We did not find any predictor of infection, while MELD score and cancer were associated with death (p = .04; HR 1.14; CI 1.00- 1.30). CONCLUSION We found a high rate of all-type infections during the FU times. However, most of these infections occurred as late-onset infections and were caused by Gram-positive microorganisms. Thus, TIPS procedure itself does not seem to be burdened with high infectious perioperative risk.
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Affiliation(s)
- Marta Colaneri
- Infectious Diseases I Unit, IRCCS San Matteo, Pavia, Italy and Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, V.le Golgi, 19, PV, 27100, Padiglione n. 42, Pavia, Italy.
| | - Andrea Lombardi
- Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy; Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Marcello Maffezzoni
- Infectious Diseases I Unit, IRCCS San Matteo, Pavia, Italy and Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, V.le Golgi, 19, PV, 27100, Padiglione n. 42, Pavia, Italy
| | - Margherita Sambo
- Infectious Diseases I Unit, IRCCS San Matteo, Pavia, Italy and Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, V.le Golgi, 19, PV, 27100, Padiglione n. 42, Pavia, Italy
| | - Massimiliano Fabbiani
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Pietro Quaretti
- Diagnostic Radiology and General Interventional Radiology, IRCCS San Matteo, Pavia, Italy
| | - Erika Asperges
- Infectious Diseases I Unit, IRCCS San Matteo, Pavia, Italy and Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, V.le Golgi, 19, PV, 27100, Padiglione n. 42, Pavia, Italy
| | - Lorenzo Moramarco
- Diagnostic Radiology and General Interventional Radiology, IRCCS San Matteo, Pavia, Italy
| | - Paolo Sacchi
- Infectious Diseases I Unit, IRCCS San Matteo, Pavia, Italy and Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, V.le Golgi, 19, PV, 27100, Padiglione n. 42, Pavia, Italy
| | - Raffaele Bruno
- Infectious Diseases I Unit, IRCCS San Matteo, Pavia, Italy and Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, V.le Golgi, 19, PV, 27100, Padiglione n. 42, Pavia, Italy; Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, 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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Bozzani A, Farè C, Arici V, Ragni F, Quaretti P, Sterpetti AV. Aortic septotomy with scissor-technique. JTCVS Tech 2022; 16:14-15. [PMID: 36510537 PMCID: PMC9735318 DOI: 10.1016/j.xjtc.2022.08.006] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Camilla Farè
- General Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Arici
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Franco Ragni
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Pietro Quaretti
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Bozzani A, Arici V, Ragni F, Sterpetti AV, Quaretti P, Arbustini E. Re: "The Impact of Degenerative Connective Tissue Disorders on Outcomes Following Endovascular Aortic Intervention in the Global Registry for Endovascular Aortic Treatment". Ann Vasc Surg 2022; 83:e3-e4. [PMID: 35337929 DOI: 10.1016/j.avsg.2022.03.003] [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: 02/19/2022] [Accepted: 03/04/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, ITALY.
| | - Vittorio Arici
- Vascular and Endovascular Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, ITALY
| | - Franco Ragni
- Vascular and Endovascular Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, ITALY
| | | | - Pietro Quaretti
- Interventional Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, ITALY
| | - Eloisa Arbustini
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Department of Medical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, ITALY
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Caporali C, Turco L, Prampolini F, Quaretti P, Bianchini M, Saltini D, Miceli F, Casari F, Felaco D, Garcia‐Pagan JC, Trebicka J, Senzolo M, Guerrini GP, Di Benedetto F, Torricelli P, Villa E, Schepis F. Proximal Splenic Artery Embolization to Treat Refractory Ascites in a Patient With Cirrhosis. Hepatology 2021; 74:3534-3538. [PMID: 34218452 PMCID: PMC9292732 DOI: 10.1002/hep.32037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 06/12/2021] [Accepted: 06/28/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Cristian Caporali
- Division of RadiologyAzienda Ospedaliero‐Universitaria di Modena and University of Modena and Reggio EmiliaModenaItaly
| | - Laura Turco
- Division of GastroenterologyAzienda Ospedaliero‐Universitaria di Modena and University of Modena and Reggio EmiliaModenaItaly
| | - Francesco Prampolini
- Division of RadiologyAzienda Ospedaliero‐Universitaria di Modena and University of Modena and Reggio EmiliaModenaItaly
| | - Pietro Quaretti
- Unit of Interventional Radiology ‐ Radiology DepartmentIRCCS Policlinico San Matteo FoundationPaviaItaly
| | - Marcello Bianchini
- Division of GastroenterologyAzienda Ospedaliero‐Universitaria di Modena and University of Modena and Reggio EmiliaModenaItaly
| | - Dario Saltini
- Division of GastroenterologyAzienda Ospedaliero‐Universitaria di Modena and University of Modena and Reggio EmiliaModenaItaly
| | - Francesca Miceli
- Division of GastroenterologyAzienda Ospedaliero‐Universitaria di Modena and University of Modena and Reggio EmiliaModenaItaly
| | - Federico Casari
- Division of RadiologyAzienda Ospedaliero‐Universitaria di Modena and University of Modena and Reggio EmiliaModenaItaly
| | - Davide Felaco
- Division of RadiologyAzienda Ospedaliero‐Universitaria di Modena and University of Modena and Reggio EmiliaModenaItaly
| | - Juan Carlos Garcia‐Pagan
- Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS and CIBERehdHealth Care Provider of the European Reference Network on Rare Liver Disorders (ERN‐Liver)BarcelonaSpain
| | - Jonel Trebicka
- Department of Internal Medicine IUniversity of FrankfurtFrankfurtGermany
| | - Marco Senzolo
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and GastroenterologyPadova University HospitalPadovaItaly
| | - Gian Piero Guerrini
- Hepato‐Pancreato‐Biliary Surgery and Liver Transplantation UnitUniversity of Modena and Reggio EmiliaModenaItaly
| | - Fabrizio Di Benedetto
- Hepato‐Pancreato‐Biliary Surgery and Liver Transplantation UnitUniversity of Modena and Reggio EmiliaModenaItaly
| | - Pietro Torricelli
- Division of RadiologyAzienda Ospedaliero‐Universitaria di Modena and University of Modena and Reggio EmiliaModenaItaly
| | - Erica Villa
- Division of GastroenterologyAzienda Ospedaliero‐Universitaria di Modena and University of Modena and Reggio EmiliaModenaItaly
| | - Filippo Schepis
- Division of GastroenterologyAzienda Ospedaliero‐Universitaria di Modena and University of Modena and Reggio EmiliaModenaItaly
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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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12
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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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13
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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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14
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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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15
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Crimi G, Moramarco L, Mandurino‐Mirizzi A, Quaretti P, Ferrario M. The combined use of stent retriever and neuro‐aspiration as successful bail‐out reperfusion strategy in a patient with embolic myocardial infarction. Catheter Cardiovasc Interv 2019; 94:E78-E81. [DOI: 10.1002/ccd.28167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/19/2019] [Accepted: 02/09/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Gabriele Crimi
- Division of CardiologyFondazione IRCCS Policlinico San Matteo Foundation Pavia Italy
| | - Lorenzo Moramarco
- Unit of Interventional Radiology, Radiology DepartmentIRCCS Policlinico San Matteo Foundation Pavia Italy
| | | | - Pietro Quaretti
- Unit of Interventional Radiology, Radiology DepartmentIRCCS Policlinico San Matteo Foundation Pavia Italy
| | - Maurizio Ferrario
- Division of CardiologyFondazione IRCCS Policlinico San Matteo Foundation 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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17
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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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18
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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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19
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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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20
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Mangiarotti M, D'Ercole L, Quaretti P, Moramarco L, Lafe E, Zappoli Thyrion F. EVALUATION OF AN ACTIVE PERSONAL DOSIMETRY SYSTEM IN INTERVENTIONAL RADIOLOGY AND NEURORADIOLOGY: PRELIMINARY RESULTS. Radiat Prot Dosimetry 2016; 172:483-487. [PMID: 26656079 DOI: 10.1093/rpd/ncv502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 10/25/2015] [Accepted: 11/04/2015] [Indexed: 06/05/2023]
Abstract
Active personal dosimeters (APD) supply real-time data on radiation dose rates and equivalent doses, enabling reduction of operator exposure to radiation in diagnostic and surgical procedures. Data from the use of the Raysafe i2 APD system in an angiography room are reported. Preliminary characterisation of the APD system was first carried out in terms of angular dependence and of Hp(10) response during the simulation of five typical surgical protocols. Reference measurements, simultaneously obtained from TLDs, were used to obtain a correction factor. APD data for patients and for primary and secondary operators were then recorded over 52 surgical procedures. The correlation between kerma air product (KAP) and reference point air kerma (Kar) and operator dose as a function of position with respect to the source of radiation is reported. The data indicate that the APD system could help operators to optimise behaviours and use of room protection to effectively minimise radiation dose.
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Affiliation(s)
- M Mangiarotti
- Struttura di Fisica Sanitaria, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - L D'Ercole
- Struttura di Fisica Sanitaria, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - P Quaretti
- Struttura di Radiologia e Neuroradiologia Diagnostica ed Interventistica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - L Moramarco
- Struttura di Radiologia e Neuroradiologia Diagnostica ed Interventistica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - E Lafe
- Struttura di Radiologia e Neuroradiologia Diagnostica ed Interventistica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Zappoli Thyrion
- Struttura di Radiologia e Neuroradiologia Diagnostica ed Interventistica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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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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Maestri M, Bocca G, Galafassi J, Lionetto G, Monti E, Costantini G, Murgante N, Peloso A, Gerardini S, Vaccaro V, Brugnatelli S, Pagani A, Moramarco L, Romanini L, Quaretti P. 240 Expanding indications to liver surgery by CD34+ autologous cells administration: An overview of 401 consecutive cases at a single institution. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30127-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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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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Forneris G, Comelli S, Savio D, Cecere P, Agostinucci A, Quaretti P, Fiorina I, Pozzato M, Roccatello D. SP58137 CASES OF STUCK CATHETER: RESULTS OF AN ITALIAN SURVEY. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv198.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Forneris G, Savio D, Quaretti P, Fiorina I, Cecere P, Pozzato M, Trogolo M, Roccatello D. Dealing with stuck hemodialysis catheter: state of the art and tips for the nephrologist. J Nephrol 2014; 27:619-25. [DOI: 10.1007/s40620-014-0150-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022]
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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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Peloso A, Franchi E, Canepa MC, Barbieri L, Briani L, Ferrario J, Bianco C, Quaretti P, Brugnatelli S, Dionigi P, Maestri M. Combined use of intraoperative ultrasound and indocyanine green fluorescence imaging to detect liver metastases from colorectal cancer. HPB (Oxford) 2013; 15:928-34. [PMID: 23458105 PMCID: PMC3843610 DOI: 10.1111/hpb.12057] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 12/21/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Surgical excision is the standard strategy for managing liver metastases from colorectal carcinoma. The achievement of negative (R0) margins is a major determinant of disease-free survival in these patients. Current imaging techniques are of limited value in achieving this goal. A new approach to the intraoperative detection of colorectal liver metastatic tissue based on the emission of indocyanine green (ICG) fluorescence was evaluated. METHODS A total of 25 consecutive patients with liver metastases from primary colorectal cancers who were eligible for liver resection received a bolus of ICG (0.5 mg/kg body weight) 24 h before surgery. During surgery, ICG fluorescence, which accumulates around lesions as a result of defective biliary clearance, was detected with a near-infrared camera system, the Photodynamic Eye (PDE). Numbers of lesions detected by, respectively, PDE + ICG, intraoperative ultrasound (IOUS) and preoperative computed tomography (CT) were recorded. RESULTS The near-infrared camera plus ICG revealed a total of 77 metastatic liver nodules. Preoperative CT demonstrated 45 (58.4%) and IOUS showed 55 (71.4%). Preoperative CT and IOUS alone were inferior to the combined use of PDE + ICG and IOUS in the detection of lesions of ≤ 3 mm in size. CONCLUSIONS This experience suggests that PDE + ICG, combined with IOUS, may represent a safe and effective tool for ensuring the complete surgical eradication of liver metastases from colorectal cancer.
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Affiliation(s)
- Andrea Peloso
- General Surgery, Fondazione IRCCS Policlinico San Matteo Pavia and University of PaviaPavia, Italy
| | - Eloisa Franchi
- General Surgery, Fondazione IRCCS Policlinico San Matteo Pavia and University of PaviaPavia, Italy
| | - Maria C Canepa
- General Surgery, Fondazione IRCCS Policlinico San Matteo Pavia and University of PaviaPavia, Italy
| | - Letizia Barbieri
- General Surgery, Fondazione IRCCS Policlinico San Matteo Pavia and University of PaviaPavia, Italy
| | - Laura Briani
- General Surgery, Fondazione IRCCS Policlinico San Matteo Pavia and University of PaviaPavia, Italy
| | - Jacopo Ferrario
- General Surgery, Fondazione IRCCS Policlinico San Matteo Pavia and University of PaviaPavia, Italy
| | - Carolina Bianco
- General Surgery, Fondazione IRCCS Policlinico San Matteo Pavia and University of PaviaPavia, Italy
| | - Pietro Quaretti
- Interventional Radiology, Fondazione IRCCS Policlinico San Matteo PaviaPavia, Italy
| | - Silvia Brugnatelli
- Oncology and Immunohaematology, Fondazione IRCCS Policlinico San Matteo PaviaPavia, Italy
| | - Paolo Dionigi
- General Surgery, Fondazione IRCCS Policlinico San Matteo Pavia and University of PaviaPavia, Italy
| | - Marcello Maestri
- General Surgery, Fondazione IRCCS Policlinico San Matteo Pavia and University of PaviaPavia, 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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30
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Canepa MC, Quaretti P, Perotti C, Vercelli A, Rademacher J, Peloso A, Barbieri L, Franchi E, Briani L, Gaspari A, Brugnatelli S, Pedrazzoli P, Dionigi P, Maestri M. Autologous CD133+ cells augment the effect of portal embolization. MINERVA CHIR 2013; 68:163-168. [PMID: 23612229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM The standard to treat liver tumors is a resection. When the future liver remnant (FLRV) is below 30% (healthy livers) or 40% (cirrhotic livers or previous chemotherapy), surgery carries the risk of severe complications. Portal vein embolization (PVE) gained a worldwide diffusion as a tool to augment the FLRV. Cell therapies are recent players at the frontiers of medicine. This study presents a clinical experience to evaluate the synergistic effect of combined PVE and autologous CD133+ cells coadministration. METHODS Sixteen patients have been enrolled in the study up today. Inclusion criteria were: primary or metastatic liver malignancy with a FLRV<30% or 40%. A baseline volumetric CT-scan was obtained. CD34+ were mobilized to the blood stream by G-CSF administration and collected by immunomagnetic separation. Simultaneously with PVE, cells were administered to the non occluded liver segments. Follow-up CT scans were taken at 30th post treatment day. RESULTS The patients (N.=6) showed an increased volume gain (Mann-Whitney test P<0.001, two sided) compared to a set of cases whose treatment was PVE only (N.=10). DISCUSSION The use of autologous stem cells as an augmenter of liver regeneration has a clinical potential to improve the resectability of liver tumors.
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Affiliation(s)
- M C Canepa
- Department of General Surgery I, University of Pavia, Pavia, Italy.
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31
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Mizandari M, Pai M, Xi F, Valek V, Tomas A, Quaretti P, Golfieri R, Mosconi C, Guokun A, Kyriakides C, Dickinson R, Nicholls J, Habib N. Percutaneous intraductal radiofrequency ablation is a safe treatment for malignant biliary obstruction: feasibility and early results. Cardiovasc Intervent Radiol 2012; 36:814-9. [PMID: 23232859 DOI: 10.1007/s00270-012-0529-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 11/03/2012] [Indexed: 02/06/2023]
Abstract
PURPOSE Previous clinical studies have shown the safety and efficacy of this novel radiofrequency ablation catheter when used for endoscopic palliative procedures. We report a retrospective study with the results of first in man percutaneous intraductal radiofrequency ablation in patients with malignant biliary obstruction. METHODS Thirty-nine patients with inoperable malignant biliary obstruction were included. These patients underwent intraductal biliary radiofrequency ablation of their malignant biliary strictures following external biliary decompression with an internal-external biliary drainage. Following ablation, they had a metal stent inserted. RESULTS Following this intervention, there were no 30-day mortality, hemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the 39 patients, 28 are alive and 10 patients are dead with a median survival of 89.5 (range 14-260) days and median stent patency of 84.5 (range 14-260) days. One patient was lost to follow-up. All but one patient had their stent patent at the time of last follow-up or death. One patient with stent blockage at 42 days postprocedure underwent percutaneous transhepatic drain insertion and restenting. Among the patients who are alive (n = 28) the median stent patency was 92 (range 14-260) days, whereas the patients who died (n = 10) had a median stent patency of 62.5 (range 38-210) days. CONCLUSIONS In this group of patients, it appears that this new approach is feasible and safe. Efficacy remains to be proven in future, randomized, prospective studies.
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Affiliation(s)
- Malkhaz Mizandari
- Department of Radiology, Tbilisi State Medical University, Tbilisi, Georgia
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Canepa M, Peloso A, Quaretti P, Perotti C, Brugnatelli S, Pedrazzoli P, Dionigi P, Maestri M. Autologous CD34+ cells augment the effect of portal vein embolization (PVE). Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sottani C, Poggi G, Quaretti P, Regazzi M, Montagna B, Quaquarini E, Imbriani M, Leoni E, Di Cesare P, Riccardi A, Bernardo G, Minoia C. Serum pharmacokinetics in patients treated with transarterial chemoembolization (TACE) using two types of epirubicin-loaded microspheres. Anticancer Res 2012; 32:1769-1774. [PMID: 22593459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM The purpose of this study was the pharmacokinetic (PK) profile assessment in the serum of patients affected by hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) with drug-eluting beads. PATIENTS AND METHODS This study included 20 patients, 12 treated with DC Bead® and 8 with HepaSphere Microsphere®, preloaded with epirubicin. No patient randomization was used for the inclusion in one group or in the other. Peripheral blood samples were obtained from all patients after the treatment, until 24 hours past the procedure. RESULTS The pharmacokinetic study showed low peak serum epirubicin concentrations with greater drug exposure for the DC Bead® group (p<0.05). The highest drug concentration after microsphere injection was observed at 5 minutes in all 20 patients. In the time interval between 1 and 24 hours after TACE, persisting levels of epirubicin were detected in peripheral blood samples. CONCLUSION A persistent and sustained drug elution for both types of microparticles was found.
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Affiliation(s)
- Cristina Sottani
- Laboratory for Environmental and Toxicological Testing, IRCCS Fondazione S. Maugeri, Istituto Scientifico di Pavia, Pavia, Italy
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Ferlini M, Quaretti P, Cascella T, Cionfoli N, Ferrario M, Bramucci E. Percutaneous hepatic pseudoaneurysm exclusion using a pericardium covered stent. J Cardiovasc Med (Hagerstown) 2012; 14:472-3. [PMID: 22499003 DOI: 10.2459/jcm.0b013e3283536aff] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Visceral artery pseudoaneurysms (PA) are a rare complication of abdominal surgery. Their natural history is generally unknown and unpredictable, so a repair is recommended. We report the case of a 77-year-old male with a huge PA of the hepatic artery diagnosed by computed tomography (CT) and treated successfully with percutaneous exclusion using a pericardium-covered stent. A staged CT confirmed the good result of the procedure.
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Affiliation(s)
- Marco Ferlini
- UO Cardiologia, Laboratorio di Emodinamica, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy.
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Poggi G, Montagna B, Melchiorre F, Quaretti P, Delmonte A, Riccardi A, Tagliaferri B, Sottotetti F, Di Cesare P, Stella MG, Villani L, Zorzetto M, Greco G, Cornalba G, Bernardo G. Hepatic intra-arterial cetuximab in combination with 5-fluorouracil and cisplatin as salvage treatment for sorafenib-refractory hepatocellular carcinoma. Anticancer Res 2011; 31:3927-3933. [PMID: 22110221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Sorafenib is the only therapy approved for advanced hepatocellular carcinoma no longer eligible for transcatheter arterial chemoembolization. Hepatic intra-arterial chemotherapy has been shown to be an effective and safe therapy for advanced hepatocellular carcinoma. Cetuximab has been administered intravenously to patients with advanced hepatocellular carcinoma, showing encouraging results in terms of its safety and toxicity profile. AIM Our purpose was to evaluate the safety and feasibility of hepatic arterial chemotherapy with cetuximab, cisplatin and 5-fluoruracil for patients with advanced hepatocellular carcinoma, not responsive or not eligible for sorafenib therapy. PATIENTS AND METHODS From January 2010 to January 2011, 12 patients received a 2-day course of chemotherapy consisting of repeated daily hepatic arterial administration of 20 mg of cisplatin as 2-h infusion, 5-fluorouracil at 500 mg/m(2) as 5-h infusion and cetuximab 500 mg/m(2) as 12-h infusion. Cycles were repeated every 14 days. RESULTS After a mean of four months of therapy, computed tomography revealed five partial responses, five cases of stable disease and two of progressive disease. The toxicity profile was favourable, with no G4 gastrointestinal, hematologic or skin side-effects, or severe deterioration of liver function. CONCLUSION Hepatic intra-arterial chemotherapy with cetuximab is a safe and feasible treatment for advanced hepatocellular carcinoma, with promising results in patients with initial poor prognosis.
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Affiliation(s)
- Guido Poggi
- Department of Oncology, IRCCS S. Maugeri Foundation, 10 Maugeri Street, 27100 Pavia, Italy.
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Rossi S, Ravetta V, Rosa L, Ghittoni G, Viera FT, Garbagnati F, Silini EM, Dionigi P, Calliada F, Quaretti P, Tinelli C. Repeated radiofrequency ablation for management of patients with cirrhosis with small hepatocellular carcinomas: a long-term cohort study. Hepatology 2011; 53:136-47. [PMID: 20967759 DOI: 10.1002/hep.23965] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 08/31/2010] [Indexed: 12/17/2022]
Abstract
UNLABELLED In most patients with cirrhosis, successful percutaneous ablation or surgical resection of hepatocellular carcinoma (HCC) is followed by recurrence. Radiofrequency ablation (RFA) has proven effective for treating HCC nodules, but its repeatability in managing recurrences and the impact of this approach on survival has not been evaluated. To this end, we retrospectively analyzed a prospective series of 706 patients with cirrhosis (Child-Pugh class ≤ B7) who underwent RFA for 859 HCC ≤ 35 mm in diameter (1-2 per patient). The results of RFA were classified as complete responses (CRs) or treatment failures. CRs were obtained in 849 nodules (98.8%) and 696 patients (98.5%). During follow-up (median, 29 months), 465 (66.8%) of the 696 patients with CRs experienced a first recurrence at an incidence rate of 41 per 100 person-years (local recurrence 6.2; nonlocal 35). Cumulative incidences of first recurrence at 3 and 5 years were 70.8% and 81.7%, respectively. RFA was repeated in 323 (69.4%) of the 465 patients with first recurrence, restoring disease-free status in 318 (98.4%) cases. Subsequently, RFA was repeated in 147 (65.9%) of the 223 patients who developed a second recurrence after CR of the first, restoring disease-free status in 145 (98.6%) cases. Overall, there were 877 episodes of recurrence (1-8 per patient); 577 (65.8%) of these underwent RFA that achieved CRs in 557 (96.5%) cases. No procedure-related deaths occurred in 1,921 RFA sessions. Estimated 3- and 5-year overall and disease-free (after repeated RFAs) survival rates were 67.0% and 40.1% and 68.0 and 38.0%, respectively. CONCLUSION RFA is safe and effective for managing HCC in patients with cirrhosis, and its high repeatability makes it particularly valuable for controlling intrahepatic recurrences.
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Affiliation(s)
- Sandro Rossi
- VI Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
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Poggi G, Pozzi E, Riccardi A, Tonini S, Montagna B, Quaretti P, Tagliaferri B, Sottotetti F, Baiardi P, Pagella C, Minoia C, Bernardo G. Complications of image-guided transcatheter hepatic chemoembolization of primary and secondary tumours of the liver. Anticancer Res 2010; 30:5159-5164. [PMID: 21187505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Image-guided transcatheter hepatic chemoembolization (TACE) is accepted worldwide as an effective treatment for patients with unresectable hepatocellular carcinoma (HCC) and for adequate preservation of liver function. Although considered relatively safe, TACE has been associated with several complications. The aim of this study was to determine the prevalence of the complications associated with TACE therapy and to correlate it with certain risk factors, either well-known or not yet evaluated. PATIENTS AND METHODS A total of 330 chemoembolization procedures performed in 170 patients (117 males and 53 females) over a period of 64 months were retrospectively analysed. Among the patients, 123 had hepatocellular carcinoma, 10 had intrahepatic cholangiocarcinoma and 37 had hepatic metastases. The variables considered were: tumour histotype, bilioenteric anastomosis, previous or combined treatment with radiofrequency thermal ablation, antibiotic prophylaxis, chemotherapeutic agents, use of new drug-eluting microspheres, comorbidities such as diabetes, patient age and the presence of vascular anatomical variations. RESULTS A total of 30 complications occurred in 27 procedures. The total complication rate per procedure was 9.1% and approximately 75% of patients had postembolization syndrome. The difference in the prevalence of complications was statistically significant in the group of diabetic patients (13.3%) compared to the remaining patients (6.3%) (p = 0.002) and in patients with biliary stents (25%) compared to those without stents (7.75%) (p = 0.027). CONCLUSION These data show that diabetes mellitus and the presence of bilioenteric anastomosis are risk factors for developing complications after TACE. The use of new drug-eluting microspheres did not increase the risk of complications.
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Affiliation(s)
- Guido Poggi
- Department of Oncology,IRCCS Fondazione S. Maugeri, Istituto Scientifico di Pavia, Italy.
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Poggi G, Quaretti P, Montagna B, Sottotetti F, Tagliaferri B, Pozzi E, Amatu A, Pagella C, Bernardo G. Acute thrombocytopenia: an unusual complication occurring after drug-eluting microspheres transcatheter hepatic chemoembolization. Cardiovasc Intervent Radiol 2010; 34 Suppl 2:S190-4. [PMID: 20848100 DOI: 10.1007/s00270-010-9983-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2010] [Accepted: 08/20/2010] [Indexed: 01/05/2023]
Abstract
Image-guided transcatheter hepatic chemoembolization (TACE) is accepted worldwide as an effective treatment for patients with unresectable hepatocellular carcinoma and liver metastases from neuroendocrine tumors, colorectal carcinomas, and uveal melanomas. Although the technique is relatively safe, it has been associated with several complications. We report the cases of two patients with colorectal liver metastases who developed acute thrombocytopenia a few hours after TACE. To our knowledge, acute thrombocytopenia occurring after TACE with drug-eluting microspheres has not yet been reported. Here we discuss the hypothetical etiopathogenetic mechanisms.
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Affiliation(s)
- Guido Poggi
- Department of Oncology, IRCCS Fondazione S. Maugeri, Istituto Scientifico di Pavia, 27100 Pavia, Italy.
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Poggi G, Amatu A, Montagna B, Quaretti P, Minoia C, Sottani C, Villani L, Tagliaferri B, Sottotetti F, Rossi O, Pozzi E, Zappoli F, Riccardi A, Bernardo G. OEM-TACE: a new therapeutic approach in unresectable intrahepatic cholangiocarcinoma. Cardiovasc Intervent Radiol 2010; 32:1187-92. [PMID: 19727937 DOI: 10.1007/s00270-009-9694-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 07/22/2009] [Indexed: 12/30/2022]
Abstract
Intrahepatic cholangiocarcinoma (ICC) is a rare life-threatening disease, whose only treatment with potential for cure is surgical resection. However, only 27% of patients at most are suitable for surgery when first diagnosed. For patients with unresectable disease, therapeutic options are chemotherapy or chemoradiation. We evaluated the feasibility and safety of oxaliplatin-eluting microspheres transarterial chemoembolization (OEM-TACE) associated with chemotherapy (ChT) in patients affected by unresectable ICC. Between December 2005 and May 2008 we treated nine patients (six female and three male) with unresectable ICC. All patients had undergone OEM-TACE associated with chemotherapy with oxaliplatin and gemcitabine. A retrospective comparison was carried out with a historical group of 11 patients treated with ChT only, estimating the prevalence of adverse effects and the median survival of the two groups. A total of 30 TACEs were performed during the observational time (ranging from one to seven procedures per patient). OEM-TACEs were followed by few adverse effects (AEs), without G4 AEs, according to CTACAE 3.0. According to RECIST criteria, 44% (4/9) of patients achieved partial responses and 56% (5/9) stabilization of disease. Overall survival analysis in the two groups showed a significantly increased survival in patients treated with ChT and OEM-TACE, with respect to those treated with ChT (30 vs. 12.7 months; p=0.004). In conclusion, in our experience OEM-TACE associated with ChT in the treatment of advanced unresectable ICC is a safe and feasible treatment causing no major adverse events. Although RECIST criteria can underestimate the rate of responses in patients treated with locoregional therapies, we achieved very encouraging results. A randomized multicentric trial is warranted to assess the actual superiority of OEM-TACE associated with ChT compared to conventional chemotherapy.
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Affiliation(s)
- Guido Poggi
- Division of Medical Oncology II, Department of Interventional Radiology, IRCCS S. Maugeri Foundation, Maugeri Street 10, 27100 Pavia, Italy.
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Sottani C, Leoni E, Porro B, Montagna B, Amatu A, Sottotetti F, Quaretti P, Poggi G, Minoia C. Validation of an LC-MS/MS method for the determination of epirubicin in human serum of patients undergoing drug eluting microsphere-transarterial chemoembolization (DEM-TACE). J Chromatogr B Analyt Technol Biomed Life Sci 2009; 877:3543-8. [PMID: 19783235 DOI: 10.1016/j.jchromb.2009.08.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 08/04/2009] [Accepted: 08/25/2009] [Indexed: 10/20/2022]
Abstract
Drug Eluting Microsphere-Transarterial Chemoembolization (DEM-TACE) is a new delivery system to administrate drugs in a controlled manner useful for application in the chemoembolization of colorectal cancer metastases to the liver. DEM-TACE is focused to obtain higher concentrations of the drug to the tumor with lower systemic concentrations than traditional cancer chemotherapy. Therefore a specific, precise and sensitive LC-ESI-MS/MS assay procedure was properly designed to detect and quantify epirubicin at the concentrations expected from a transarterial chemoembolization with microspheres. Serum samples were kept acidic (pH approximately of 3.5) and sample preparation consisted of a solid phase extraction (SPE) procedure with HLB OASIS cartridges using a methylene chloride/2-propanol/methanol mixture solution to recover epirubicin. The analyses consisted of reversed-phase high-performance liquid chromatography (rp-HPLC) coupled with tandem mass spectrometry (MS/MS). Accuracy, precision and matrix effect of this procedure were carried out by analyzing four quality control samples (QCs) on five separate days. The validation parameters were assessed by recovery studies of spiked serum samples. Recoveries were found to vary between 92 and 98% at the QC levels (5, 40, 80 and 150 microg/L) with relative standard deviation (RSD) always less than 3.7%. The limit of detection (LOD) was set at 1 microg/L. The developed procedure has been also applied to investigate the different capability of two types of commercially available microspheres to release epirubicin into the human circulatory system.
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Affiliation(s)
- Cristina Sottani
- Laboratory for Environmental and Toxicological Testing, IRCCS Pavia, S. Maugeri Foundation, via S. Maugeri 10, Pavia, Italy.
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Poggi G, Quaretti P, Minoia C, Bernardo G, Bonora MR, Gaggeri R, Ronchi A, Saluzzo CM, Azzaretti A, Rodolico G, Montagna M, Amatu A, Teragni C, Palumbo I, Traverso E, Tonini S, Villani L, Scelsi M, Baiardi P, Felisi MG, Sottotetti F, Tagliaferri B, Riccardi A. Transhepatic arterial chemoembolization with oxaliplatin-eluting microspheres (OEM-TACE) for unresectable hepatic tumors. Anticancer Res 2008; 28:3835-3842. [PMID: 19192637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND While conventional transhepatic arterial chemoembolization (TACE) is accepted worldwide as an effective treatment for patients with unresectable hepatocellular carcinoma (HCC), its use in other hepatic tumors is not supported by randomized studies. Preliminary results have shown that new drug-eluting microspheres (DEM) seem to optimize TACE procedures. The aim of this study was to evaluate the capability of HepaSphere to load oxaliplatin and their pharmacokinetic outcome. The feasibility and safety of treatment with oxaliplatin-eluting microspheres (OEM-TACE) was also evaluated in patients with unresectable liver metastasis of colorectal cancer and unresectable intrahepatic cholangiocarcinoma. PATIENTS AND METHODS An inductively coupled plasma mass spectrometer (ICP-MS) was used to quantify the oxaliplatin bound to microspheres and the oxaliplatin in liver biopsies. Fifteen patients (8 with colorectal carcinoma liver metastases, 7 with intrahepatic cholangiocarcinoma) were treated with 27 sessions of OEM-TACE. RESULTS The data suggested that the microspheres can bind oxaliplatin entirely. The pharmacokinetic parameters were significantly different between the OEM-TACE patients and a control group of patients treated with oxaliplatin chemotherapy. The mean oxaliplatin concentration within the tumor was twenty-times higher than the extratumoral liver concentration in the OEM-TACE patients. According to response evaluating criteria in solid tumors (RECIST), stable disease was observed in 8 out of the 15 patients (53.3%), a partial response in 2 (13.3%) and intrahepatic or extrahepatic tumor progression in 5 out of the 15 patients (33.3%). No major adverse event (AE G3/4) occurred. CONCLUSION TACE with oxaliplatin-loaded microspheres is a safe and feasible treatment without major adverse events and with a favorable pharmacokinetic profile.
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Affiliation(s)
- Guido Poggi
- Departments of Oncology, University of Pavia, IRCCS Fondazione S. Maugeri, Istituto Scientifico di Pavia, Italy.
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Poggi G, Quaretti P, Minoia C, Palumbo I, Villani L, Amatu A, Teragni C, Scelsi M, Zappoli F, Bernardo G. Oxaliplatin-eluting microspheres for the treatment of intrahepatic cholangiocarcinoma: a case report. Anticancer Res 2008; 28:2987-2990. [PMID: 19031944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Intrahepatic cholangiocarcinoma account for 13% of annual cancer-related deaths worldwide and for 3% in the USA. Patient with unresectable disease can benefit from palliative therapies such as systemic chemotherapy. However, the only curative treatment for intrahepatic cholangiocarcinoma is complete surgical resection with histologically negative resection margins.
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Affiliation(s)
- Guido Poggi
- Department of Oncology, Fondazione S. Maugeri, Istituto Scientifico di Pavia, Italy.
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Zeller T, Saratzis N, Scheinert D, Minar E, Beregi JP, Schillinger M, Hausegger HA, Amor M, Quaretti P, Moratto R, Dorange C, Boone E, Krankenberg H. Non-randomized, prospective, multi-centre evaluation of the ABSOLUTE .035 peripheral self-expanding stent system for occluded or stenotic superficial femoral or proximal popliteal arteries (ASSESS Trial): acute and 30-day results. J Cardiovasc Surg (Torino) 2007; 48:719-726. [PMID: 17947929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
AIM The aim of the paper was to investigate the performance of the ABSOLUTE .035 Peripheral Self-Expanding Stent System in preventing restenosis of superficial femoral or proximal popliteal arteries. Due to a lack of large controlled trials proving its long-term durability femoropopliteal artery stenting is still a matter of debate. In this paper we report the study design, the acute and short-term results of a prospective European registry on the treatment of TASC B and C femoropopliteal lesions with the use of the ABSOLUTE stent. METHODS This prospective, non-randomized, multi-centre study enrolled 122 patients with symptomatic peripheral occlusive disease at 14 sites in Europe. Patients were included with obstructed femoropopliteal arteries. Key inclusion criteria were de novo lesions > or = 4.0 mm and < or = 7.0 mm in diameter, and > or = 40 mm and < or = 200 mm in length. Single target vessel treatment had to be performed with a maximum of three stents. RESULTS Mean target lesion length was 108 +/- 44 mm (range 22.2 to 200 mm) and mean reference vessel diameter 4.6 +/- 0.8 mm by quantitative angiography; 71% of the lesions analyzable by quantitative angiography (QA) had total occlusions. A total of 227 stents were implanted, 224 of which were deployed successfully (98.7%). Mean percentage of diameter stenosis was reduced from 90.9 +/- 15.5 % (range 41.3 to 100) to 19.0 +/- 8.4% (range 2.3 to 41.5). Device and procedural success were 83.6% each whereas technical success reached 100%. Sixteen lesions had a > or = 30% residual stenosis post-procedure, 6 of them (37.5%) rated as being calcified. Eleven patients experienced major complications (9.1%) and 6 patients experienced minor complications (5%) within 30 days. Duplex ultrasound based 1-month restenosis rate was 9.3%. Target lesion revascularization (TLR) and target vessel revascularization (TVR) rates were 0.8% and 1.7%, respectively and amputation rate was 0.8%. Mean ankle-brachial index (ABI) at rest and after exercise increased significantly from baseline to 30 days follow-up by 0.63 +/- 0.20 to 0.94 +/- 0.17 and from 0.44 +/- 0.23 to 0.85 +/- 0.21, respectively (P<0.001 each). CONCLUSION The treatment of TASC B and C femoro-popliteal lesions with use of the ABSOLUTE stent is safe and feasible. Short-term follow-up documents persistent improvement of hemodynamics. The 6- and 12-month data have to be awaited for further conclusions:
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Affiliation(s)
- T Zeller
- Department of Angiology, Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany.
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Poggi G, Riccardi A, Quaretti P, Teragni C, Delmonte A, Amatu A, Saini G, Mazzucco M, Bernardo A, Palumbo R, Canto A, Bernieri S, Bernardo G. Complications of percutaneous radiofrequency thermal ablation of primary and secondary lesions of the liver. Anticancer Res 2007; 27:2911-6. [PMID: 17695470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Hepatocellular carcinoma is one of the most common malignancies in the world, with the liver being the second most frequently involved organ in metastatic disease. Although the gold standard treatment for malignant liver disease is surgical resection, only few patients can undergo such an intervention. This explains the current great interest in various loco-regional therapies, of which radiofrequency thermal ablation (RFA) is the most common. To date, only a few studies have evaluated the complications associated with this treatment. The aim of this study was to determine the rate of complications, divided into major and minor, in patients treated with RFA. A total of 373 hepatic lesions in 250 patients were treated with 292 sessions of percutaneous ultrasound-guided RFA. According to our data, ten patients (4%) had major, complications, twelve patients (4.8%) had minor complications, no deaths occurred. Around 30% of patients had a body temperature increase of up to 38 'C. All complications, except one, were treated with nonsurgical therapies. One patient with massive hemoperitoneum required surgery. In conclusion, percutaneous RFA is a loco-regional therapy associated with a low incidence of side-effects and a negligible risk of death.
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Affiliation(s)
- Guido Poggi
- U.O Oncologia II, IRCCS Fondazione S. Maugeri, Istituto Scientifico di Pavia, Pavia, Italy.
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Zappoli Thyrion F, Azzaretti A, Di Maria F, Massa Saluzzo C, Quaretti P, Rodolico G, Scagnelli P, D'Ercole L, Mantovani L, Bocchiola M. Double stenting procedure and coil embolization in a patient with carotid stenosis and incidental ipsilateral intracranial aneurysm. A case report and dosimetric evaluation. Neuroradiol J 2007; 20:318-26. [PMID: 24299675 DOI: 10.1177/197140090702000313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 05/27/2007] [Indexed: 11/17/2022] Open
Abstract
We describe a case of incidental detection of an intracranial left ICA wide-necked aneurysm during digital subtraction angiography performed to assess a sub-occlusive and calcified stenosis in the extracranial portion of the same artery. Angioplasty and stenting of ICA stenosis, plus intracranial stent deployment across the aneurysm neck was performed during the same procedure. Aneurysm coil embolization was postponed to a further session one month later. The radiation dose and irradiated areas were also evaluated during endovascular procedures.
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Affiliation(s)
- F Zappoli Thyrion
- Department of Radiology, I.R.C.C.S. San Matteo Hospital; Pavia Italy -
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D'Ercole L, Mantovani L, Thyrion FZ, Bocchiola M, Azzaretti A, Di Maria F, Saluzzo CM, Quaretti P, Rodolico G, Scagnelli P, Andreucci L. A study on maximum skin dose in cerebral embolization procedures. AJNR Am J Neuroradiol 2007; 28:503-7. [PMID: 17353323 PMCID: PMC7977822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND AND PURPOSE It is essential to measure the skin dose of radiation received by patients during interventional neuroradiologic procedures performed under fluoroscopic guidance, such as embolization of cerebral aneurysms, which is regarded as a high-dose interventional radiology procedure. In this study, we report a method for evaluating maximum skin dose (MSD), an ideal marker of radiation-induced effects, based on an innovative use of radiochromic films. MATERIALS AND METHODS Forty-eight procedures were studied in 42 patients undergoing embolization of cerebral aneurysms. Fluoroscopic and digital dose-area product (DAP), fluoroscopy time, and total number of acquired images were recorded for all procedures. The MSD was measured using Gafchromic XR type R films. RESULTS The MSD was measured in one group of 21 procedures. The coefficient (kappa) of the interpolation line between the skin dose and the DAP (kappa = 0.0029 cm(-2)) was determined. An approximate value of MSD from the DAP for the remaining 27 procedures was estimated by means of an interpolation line. The mean MSD was found to be 1.16 Gy (range, 0.23-3.20 Gy). CONCLUSION The use of radiochromic XR type R films was shown to be an effective method for measuring MSD. These films have the advantage of supplying information on both the maximum dose and the distribution of the dose: this satisfies the most stringent interpretation of Food and Drug Administration, American College of Radiology, and international recommendations for recording skin dose.
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Affiliation(s)
- L D'Ercole
- Department of Medical Physics, Istituto di Ricovero e Cura a Carattere Scientifico, San Matteo Hospital, Pavia, Italy.
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Quaretti P, Di Maria F. Central Venous Catheter and Vascular Damage: Before Surrendering…. J Vasc Access 2006. [DOI: 10.1177/112972980600700467] [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] Open
Affiliation(s)
- P. Quaretti
- Interventional Radiology Unit, Policlinico San Matteo Foundation, Pavia - Italy
| | - F. Di Maria
- Interventional Radiology Unit, Policlinico San Matteo Foundation, Pavia - Italy
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Mantovani L, D'Ercole L, Lisciandro F, Quaretti P, Azzaretti A, Rodolico G, Saluzzo CM, Spinazzola A, Di Maria F, Ottolenghi A, Thyrion FZ, Andreucci L. Radiochromic Films for Improved Evaluation of Patient Dose in Liver Interventions. J Vasc Interv Radiol 2006; 17:855-62. [PMID: 16687752 DOI: 10.1097/01.rvi.0000217958.55401.9a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate a method for evaluation of the maximum skin dose (MSD) of radiation in patients undergoing interventional radiology procedures in the liver. MATERIALS AND METHODS Transarterial chemoembolization, transarterial embolization, portal vein embolization, and biliary interventions were the procedures considered in this study. Ninety procedures in 70 patients were studied. The complexity of the biliary interventions was taken into account during the analysis. The MSD was measured with use of GAF chromic XR type R films, whereas the dose-area product (DAP) was measured by a transmission chamber. RESULTS The MSD was measured in a group of 19 patients. The coefficient of the interpolation line between the skin dose and the DAP (0.0051 cm(-2)) was determined. An approximated value of MSD from the DAP for the remaining 71 procedures was estimated by means of an interpolation line. The mean MSD in the endovascular procedures was 4.4 Gy; for the three different levels of complexity of the biliary procedures, the mean MSDs were 0.4, 1.2, and 3 Gy, respectively. CONCLUSIONS Radiochromic films are an easy-to-use and efficient method for measuring skin entrance radiation dose and have the advantage of providing information on the MSD as well as the distribution of radiation to the skin. In light of these results, the authors suggest recording the dose for biliary and endovascular procedures as indicated by the International Commission on Radiological Protection and the United States Food and Drug Administration.
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Rossi S, Rosa L, Ravetta V, Cascina A, Quaretti P, Azzaretti A, Scagnelli P, Tinelli C, Dionigi P, Calliada F. Contrast-enhanced versus conventional and color Doppler sonography for the detection of thrombosis of the portal and hepatic venous systems. AJR Am J Roentgenol 2006; 186:763-73. [PMID: 16498104 DOI: 10.2214/ajr.04.1218] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE We conducted a prospective study to compare sonography, color Doppler sonography, and contrast-enhanced sonography for the detection and characterization of portal and hepatic vein thrombosis complicating hepatic malignancies. SUBJECTS AND METHODS Three hundred sixteen patients with biopsy-proved hepatic tumors were studied at baseline and 3 months later with sonography, color Doppler sonography, and contrast-enhanced sonography. Thrombosis was defined as the presence of intraluminal echogenic material at sonography, absence of intraluminal color signals at color Doppler sonography, and presence of nonenhancing intraluminal area at contrast-enhanced sonography. Thrombi were considered malignant if they displayed continuity with tumor tissue at sonography, intrathrombus color signals at color Doppler sonography, and enhancing signals at contrast-enhanced sonography, both having arterial waveforms at Doppler spectral examination. Definitive diagnoses were obtained by sonographically guided biopsy except for thrombi displaying at conventional sonography unequivocal continuity with tumor tissue. RESULTS Thrombosis was detected in 79 (25.0%) of 316 patients at baseline and in 83 (26.3%) of 316 patients after 3 months. Eighty-one (97.6%) of the 83 thrombi were malignant. Definitive diagnosis was performed by imaging in 60 (72.3%) of the 83 cases and by biopsy in 23 cases (27.7%). For thrombus detection, contrast-enhanced sonography displayed significantly higher sensitivity than color Doppler sonography (p = 0.004) and borderline superiority over sonography (p = 0.058). For thrombus characterization, contrast-enhanced sonography was significantly more sensitive than color Doppler sonography (p < 0.0005) and conventional sonography (p = 0.02). CONCLUSION Contrast-enhanced sonography is superior to sonography and color Doppler sonography for the detection and characterization of portal and hepatic vein thrombosis complicating hepatic malignancies.
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Affiliation(s)
- Sandro Rossi
- Department of Internal Medicine VI, IRCCS Policlinico "S. Matteo," viale Golgi 19, Pavia 27100, Italy.
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Rossi S, Garbagnati F, Rosa L, Azzaretti A, Belloni G, Quaretti P. Radiofrequency thermal ablation for treatment of hepatocellular carcinoma. Int J Clin Oncol 2002; 7:225-35. [PMID: 12202976 DOI: 10.1007/s101470200034] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sandro Rossi
- Operative Unit for Liver Cancer Diseases, Policlinico S. Matteo IRCCS, Piaz.le Golgi no.1, 27100, Pavia, Italy.
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