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Frattini F, Pino A, Matarese A, Carrano FM, Gambetti A, Boni L, Ierardi AM, Carrafiello G, Rausei S, Bertoli S, Dionigi G. Portomesenteric vein thrombosis following sleeve gastrectomy: Case report focusing on the role of pathogenetic factors. Obes Res Clin Pract 2022; 16:170-173. [PMID: 35396195 DOI: 10.1016/j.orcp.2022.03.005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Sleeve gastrectomy has currently become the most commonly performed bariatric. procedure worldwide according to the last IFSO survey, overtaking gastric bypass with. a share of more than 50% of all primary bariatric-metabolic surgery. Gastric leak, intraluminal bleeding, bleeding from the staple-line and strictures are the most common complications. Portomesenteric vein thrombosis (PMVT)after sleeve gastrectomy is. another complication that has been increasingly reported in case-series in recent.years, although it remains uncommon. In this case report is described an extended portomesenteric vein thrombosis after. sleeve gastrectomy interesting splenic vein too with a favorable course and an. uneventful follow-up. We try to search in this case for pathogenetic factors involved in. this complication. CASE REPORT A 42-year old man, with a body mass index (BMI) of 45 kg/m2, with a medical history of Obstructive Sleep Apnea Sindrome (OSAS) underwent laparoscopic sleeve gastrectomy. Early postoperative course was uneventful. Six days after discharge he complained abdominal pain and was admitted at the Emergency Department. A CT scan with intravenous contrast showed an occlusion of the portal vein, of the intrahepatic major branches and an extension to the superior mesenteric vein and the splenic vein. The patient received heparin and oral anticoagulation together with intravenous hydration and proton pump inhibitors. Considering the favourable course the patient was discharged after six days with long-term oral anticoagulation therapy. Anticoagulation with acenocumarol was continued for six months after a CT scan showed resolution of the PMVT without cavernoma. He had no recurrence of symptoms. DISCUSSION Porto-mesenteric thrombosis after sleeve gastrectomy is a rare complication but it has been increasingly reported over the last 10 years along with the extensive use of sleeve gastrectomy. Because PMVT is closely associated with sleeve gastrectomy in comparison with other bariatric procedures, we need to investigate what pathogenetic factors are involved in sleeve gastrectomy. Thrombophylic state, prolonged duration of surgery, high levels of pneumoperitoneum, thermal injury of the gastroepiploic vessels during greater curvature dissection, high intragastric pressure, inadequate antithrombotic prophylaxis and delayed mobilization of the patient after surgery have been reported as pathogenetic factors of portmesenteric vein thrombosis. Most of the cases presented in the literature such as our clinical case resolve with medical therapy, although portal vein thrombus extends into the superior mesenteric vein and the splenic vein. CONCLUSION Portomesenteric venous thrombosis is a rare but serious complication of bariatric surgery, especially associated with sleeve gastrectomy. Diagnosis is based on CT examination with intravenous contrast, and initial therapy is anticoagulation. Etiologic factors reported in the literature include a long duration of surgery, a high degree of pneumoperitoneum, high intragastric pressure after sleeve gastrectomy and thermal injury to the short gastric vessels and gastroepiploic arcade. Limited operative time, controlled values of pneumoperitoneum, careful dissection with energy device of gastric greater curvature, appropriate prophylaxis with low molecular weight heparin may be useful tools to prevent and limit this complication. Nonetheless we have to search which factors may condition the evolution of an extended PMVT as that described in this case towards resolution or to a further worsening clinical state. Early diagnosis? Correct treatment? Undiscovered patientrelated factors?
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Affiliation(s)
- F Frattini
- Department of Surgery, ASST Settelaghi, Varese, Italy.
| | - A Pino
- Division of Surgery, IRCCS Istituto Auxologico Italiano Milan, Università di Messina, Italy.
| | - A Matarese
- Division of Surgery, IRCCS Istituto Auxologico Italiano Milan, Università di Milano, Italy.
| | - F M Carrano
- Department of Surgical Sciences, University of Rome "Tor Vergata", Rome, Italy.
| | - A Gambetti
- Division of Surgery, IRCCS Istituto Auxologico Italiano Milan, Italy.
| | - L Boni
- Department of Surgery, IRCCS Fondazione Cà granda, Policlinico Hospital of Milan, University of Milan, Italy.
| | - A M Ierardi
- Operative Unit of Radiology, IRCCS Fondazione Cà Granda, Policlinico Hospital of Milan, University of Milan, Italy.
| | - G Carrafiello
- Operative Unit of Radiology, IRCCS Fondazione Cà Granda, Policlinico Hospital of Milan, University of Milan, Italy.
| | - S Rausei
- Department of Surgery, ASST Valleolona, Gallarate, Italy.
| | - S Bertoli
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Obesity Unit and Laboratory of Nutrition and Obesity Research, University of Milan, Milan, Italy.
| | - G Dionigi
- Division of Surgery, Endocrine Surgery Unit, IRCCS, Istituto Auxologico Milan, University of Milan, Italy.
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Rossi UG, Ierardi AM, Cariati M. Aberrant right hepatic duct and cystic duct joint drainage into the common hepatic duct. Rev Gastroenterol Mex (Engl Ed) 2020; 85:354-355. [PMID: 32565044 DOI: 10.1016/j.rgmx.2019.08.010] [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] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/15/2019] [Indexed: 06/11/2023]
Affiliation(s)
- U G Rossi
- Departamento de Imagen Diagnóstica, Unidad de Radiología Intervencionista. E.O. Hospital Galliera, Génova, Italia; Departamento de Tecnología Avanzada de Diagnóstico y Terapia, Radiología y Unidad de Radiología Intervencionista, ASST Santi Paolo y Carlo, Hospital San Carlo Borromeo, Milán, Italia.
| | - A M Ierardi
- Departamento de Radiología Intervencionista y Diagnóstica, Universidad de Milán; Unidad de Radiología Intervencionista, ASST Santi Paolo y Carlo, Hospital San Paolo, Milán, Italia
| | - M Cariati
- Departamento de Tecnología Avanzada de Diagnóstico y Terapia, Radiología y Unidad de Radiología Intervencionista, ASST Santi Paolo y Carlo, Hospital San Carlo Borromeo, Milán, Italia
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Rossi UG, Ierardi AM, Cariati M. The anatomic variant of common celiacomesenteric trunk. Rev Gastroenterol Mex (Engl Ed) 2020; 85:86-87. [PMID: 31810780 DOI: 10.1016/j.rgmx.2019.04.006] [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] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/16/2019] [Indexed: 06/10/2023]
Affiliation(s)
- U G Rossi
- Departamento de Imagen Diagnóstica, Unidad de Radiología Intervencionista, E.O. Hospital Galliera, Génova, Italia; Departamento de Diagnóstico y Terapia de Tecnología Avanzada, Hospital San Carlo Borromeo, Milán, Italia.
| | - A M Ierardi
- Departamento de Radiología Diagnóstica e Intervencionista, Universidad de Milán, Milán, Italia; Unidad de Radiología y de Radiología Intervencionista, ASST Santi Paolo y Carlo, Hospital San Paolo, Milán, Italia
| | - M Cariati
- Departamento de Diagnóstico y Terapia de Tecnología Avanzada, Hospital San Carlo Borromeo, Milán, Italia
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Ierardi AM, Xhepa G, Piffaretti G, Bacuzzi A, Tozzi M, Carbone M, Barile A, Squillaci E, Fonio P, Brunese L, Carrafiello G. Clinical experience with Angiojet: a comprehensive review. INT ANGIOL 2015; 34:1-14. [PMID: 26498886] [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: 06/05/2023]
Abstract
The development of various sophisticated mechanical thrombectomy devices and the amassed experience of physicians in minimal invasive therapy produced a paradigm shift in vascular access management toward percutaneous declotting procedures, using pharmaceutical thrombolysis, mechanical thrombectomy, balloon thrombectomy, and a combination of the above techniques. In this setting, in the last years, AngioJet™ (Possis, Minneapolis, MN, USA) rheolytic thrombectomy (RT) showed an increasing use in emergency and election patients. The purpose of this review is to present the current status of percutaneous rheolytic thrombectomy in different fields of applications.
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Affiliation(s)
- A M Ierardi
- Department of Radiology, Insubria University, Varese, Italy -
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Ierardi AM, Xhepa G, Duka E, Laganà D, Ianniello A, Floridi C, Bacuzzi A, Reginelli A, Squillaci E, Brunese L, Carrafiello G. Ethylene-vinyl alcohol polymer trans-arterial embolization in emergency peripheral active bleeding: initial experience. INT ANGIOL 2015; 34:28-35. [PMID: 26498889] [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: 06/05/2023]
Abstract
AIM The aim of this paper was to evaluate the efficacy, safety, and clinical outcomes of superselective embolization using ethylene-vinyl alcohol copolymer (Onyx Liquid Embolic System; ev3 Neurovascular, Irvine, CA, USA) as the primary treatment in active peripheral emergency arterial bleeding. METHODS Between January 2014 and June 2014, all patients with active peripheral arterial bleeding who were treated by embolization were retrospectively analyzed. We selected 15 (age 37-91 year old) patients embolized with Onyx, chosen as embolic agent in an intention-to-treat fashion. Multidetector computed tomography was performed in all patients. RESULTS Active bleeding was detected in all cases. Digital subtraction angiography confirmed CT findings in all cases. The causes of bleeding were traumatic in 8 patients, angiodysplasia in 1 patient, duodenal ulcer in 1, chronic pancreatitis in 1 and unknown in 4 patients. Nine patients were under anticoagulant or antiplatelet therapy. Embolization was possible in all patients. The technical success rate was 100%. The immediate bleeding control rate was 100%. No rebleeding at 30 days occurred (0%). There were no major complications, or deaths attributable to the treatment. No patient needed surgery or new embolization during a mean follow-up period of 5.1 months (range, 4.5-6 months). CONCLUSION Control of massive active peripheral emergency arterial bleeding using superselective embolization with Onyx is feasible and safe.
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Affiliation(s)
- A M Ierardi
- Unit of Interventional Radiology, Department of Radiology, Insubria University, Varese, Italy -
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Ierardi AM, Xhepa G, Musazzi AM, De Chiara M, Beghi C, Carrafiello G. Endovascular treatment of a pulmonary artery pseudoaneurysm caused by Swan-Ganz catheter deployment in an anticoagulated patient. BJR Case Rep 2015; 1:20150064. [PMID: 30363577 PMCID: PMC6180823 DOI: 10.1259/bjrcr.20150064] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 06/21/2015] [Accepted: 07/06/2015] [Indexed: 11/05/2022] Open
Abstract
We present a case report of an anticoagulated 78-year old man presenting a pulmonary artery pseudoaneurysm following Swan-Ganz catheter deployment after an aortic valve and aortic root replacement. Diagnosis was established by cone beam CT angiography and catheter angiographyand embolisation was achieved via a combination of plug and glue. This case emphasises the importance of endovascular techniques in the management of iatrogenic pulmonary pseudoaneurysms and shows the benefit of using highly hemostatic polymeric agent in anticoagulated patients to obtain a rapid and effective occlusion.
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Affiliation(s)
- A M Ierardi
- Interventional Radiology, Department of Radiology, Insubria University, Varese, Italy
| | - G Xhepa
- Interventional Radiology, Department of Radiology, Insubria University, Varese, Italy
| | - A M Musazzi
- Cardiac Surgery Department, Department of Radiology, Insubria University, Varese, Italy
| | - M De Chiara
- Interventional Radiology, Department of Radiology, Insubria University, Varese, Italy
| | - C Beghi
- Cardiac Surgery Department, Department of Radiology, Insubria University, Varese, Italy
| | - G Carrafiello
- Interventional Radiology, Department of Radiology, Insubria University, Varese, Italy
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Carrafiello G, Fontana F, Mangini M, Ierardi AM, Cotta E, Floridi C, Piacentino F, Fugazzola C. Initial experience with percutaneous biopsies of bone lesions using XperGuide cone-beam CT (CBCT): technical note. Radiol Med 2012; 117:1386-97. [PMID: 22327915 DOI: 10.1007/s11547-012-0788-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 07/06/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE This paper describes our preliminary experience with percutaneous bone biopsy under XperGuide conebeam computed tomography (CBCT) guidance. MATERIALS AND METHODS Seventeen patients (11 men and 6 women; mean age 57.8; range 17-81) with 17 bone lesions underwent biopsy with XperGuide CBCT (Philips Medical System, Best, The Netherlands). The mean diameter of the lesions was 2.32 cm (range 1-8 cm). Technical success (defined as the correct positioning of the needle within the lesion), diagnostic accuracy, sensitivity and specificity were evaluated. Complication rate was also recorded. RESULTS The technical success rate was 100%. In 15 patients, a sample of adequate material for histopathological analysis to yield a definitive diagnosis was obtained; in two patients, the sample was inadequate for a definitive diagnosis. In one of these two cases, the lesion was closely followed up for 1 year, during which it remained stable in size, and as a result, it was considered a false positive; the other was considered a false negative. Diagnostic accuracy, sensitivity and specificity were 94.12%, 90.91% and 100%, respectively. No major complications were recorded; only one patient had slight bleeding, with a consequent small haematoma, which reabsorbed in about 15 days. CONCLUSIONS Bone biopsy under XperGuide CBCT guidance can be considered accurate as a result of the combination of real-time needle orientation and spatial resolution of CT fluoroscopy. Moreover, our results are encouraging in terms of complication rate, diagnostic accuracy, sensitivity, specificity and reduction of CT workload.
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Affiliation(s)
- G Carrafiello
- Department of Radiology, Insubria University, Viale Borri 57, 21100, Varese, Italy.
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Carrafiello G, D'Ambrosio A, Mangini M, Petullà M, Dionigi GL, Ierardi AM, Piacentino F, Fontana F, Fugazzola C. Percutaneous cholecystostomy as the sole treatment in critically ill and elderly patients. Radiol Med 2012; 117:772-9. [PMID: 22327921 DOI: 10.1007/s11547-012-0794-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 10/27/2010] [Indexed: 10/14/2022]
Abstract
PURPOSE This study was done to investigate the effectiveness and clinical outcome of percutaneous cholecystostomy (PC) of treating acute cholecystitis in critical ill and elderly patients. MATERIALS AND METHODS In the last 3 years, PC was performed on 30 elderly and critically ill patients (17 men, 13 women; mean age 78.6, range 57-97 years) with acute cholecystitis and comorbid diseases. RESULTS Technical success was 30/30 (100%). Clinical effectiveness was 30/30 (100%), with statistically significant reductions in while blood cell (WBC) count, C-reactive protein (CRP) and fever. Mean WBC upon admission (19.87×10(3)±1.61×10(3) /μl), axillary temperature (38.2±0.11 °C), and CRP (248.7±4.76 mg/l) values were significantly decreased in the 72 h following PC [12.9×10(3) ± 1.05×10(3)/μl (p≤0.0001), 37 ± 0.04 °C (p≤0.0001), 113.5 ± 3 mg/l (p≤0.0001), respectively]. Clinical and ultrasonographic (US) signs of acute cholecystitis decreased in all patients. There were no major complications or procedure-related deaths, and the morbidity rate was low (3/30; 10%). CONCLUSIONS PC appears to be a fast, easy and effective treatment for the acute phase of cholecystitis in elderly and critically ill patients. Procedure-related morbidity and mortality rates are very low compared with surgery. Conservative treatment for patients who are not eligible for surgery is acceptable.
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Affiliation(s)
- G Carrafiello
- Department of Radiology, Università dell'Insubria, Viale Borri 57, 21100, Varese, Italy.
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Carrafiello G, Fontana F, Mangini M, Ierardi AM, Cotta E, Piacentino F, De Chiara M, Floridi C, Di Massa A, Marconi AM, Fugazzola C. Upper urinary tract biopsy: an old device for a new approach. Radiol Med 2012; 117:1152-60. [DOI: 10.1007/s11547-012-0799-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 07/14/2011] [Indexed: 11/28/2022]
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Carrafiello G, Mangini M, Fontana F, Di Massa A, Ierardi AM, Cotta E, Piacentino F, Nocchi Cardim L, Pellegrino C, Fugazzola C. Complications of microwave and radiofrequency lung ablation: personal experience and review of the literature. Radiol Med 2011; 117:201-13. [PMID: 22020434 DOI: 10.1007/s11547-011-0741-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Accepted: 02/08/2011] [Indexed: 01/04/2023]
Abstract
PURPOSE Complications correlated with percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) of lung tumours were retrospectively reviewed to compare them with data from the literature and to assess risk factors related with the procedures. MATERIALS AND METHODS From January 2003 to January 2009, 29 patients (36 lung lesions) were treated with RFA; from January 2007 to January 2009, 16 patients (17 lung lesions) were treated with MWA. Complications recorded at our institution are reported following the Society of Interventional Radiology guidelines. A systematic review of the literature was performed. RESULTS Any major complication of RFA or MWA was recorded. In agreement with the literature, pneumothorax was the most frequent complication, even though the incidence in our series was lower than reported in the literature (3.5% vs. 4.3-18%). Other complications of RFA were pleural effusion and subcutaneous emphysema. No massive haemorrhages, haemoptysis, abscesses, pneumonia, infections or tumour seeding were recorded in our series. The most common complication of MWA was pneumothorax (25% vs. 39% reported in the literature). Pleural effusion was a common reaction, but therapeutic drainage was never required. CONCLUSIONS Pneumothorax is the most common complication of both techniques. RFA and MWA are both excellent choices in terms of safety and tolerance.
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Affiliation(s)
- G Carrafiello
- Department of Radiology, Research Centre in Interventional Radiology, University of Insubria, Viale Borri 57, 21100, Varese, Italy.
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Baggiani A, Ierardi AM, Caspani B, Motta F, Toniolo D, Belloni P, Setola E, Campagnoli E, Tempini S, Crocchiolo R, Bregni M, Belli L. Hypoxic liver perfusion with mitomycin-C for treating multifocal metastases and unresectable primary tumours: a single-centre series of 42 patients. Radiol Med 2011; 116:1239-49. [DOI: 10.1007/s11547-011-0724-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 12/15/2010] [Indexed: 01/02/2023]
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Carrafiello G, Piffaretti G, Laganà D, Fontana F, Mangini M, Ierardi AM, Piacentino F, Canì A, Mariscalco G, Di Massa A, Cuffari S, Castelli P, Fugazzola C. Endovascular treatment of ruptured abdominal aortic aneurysms: aorto-uni-iliac or bifurcated endograft? Radiol Med 2011; 117:410-25. [PMID: 21892717 DOI: 10.1007/s11547-011-0717-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 02/21/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE This study evaluated the safety and technical and clinical success rates of positioning endovascular endografts (EG) in ruptured abdominal aneurysms. MATERIALS AND METHODS Patients with a ruptured abdominal aortic aneurysm confirmed by contrast-enhanced computed tomography angiography (CTA) were eligible for the analysis. Of 67 patients, 42 (62.7%) were treated with EG. Thirteen patients (30.9%) received an aorto-uni-iliac EG (group A) and 29 a bifurcated EG (group B). Patients were divided for comparative analysis according to the configuration of the EG implanted. RESULTS The primary technical success rate was 100%; the primary clinical success rate was 95% (40/42). There were two intraoperative deaths (4.7%) related to intractable shock. No patient required conversion to open repair. Overall, 12 patients (28.5%) died within 30 days. The in-hospital death rate was 30.9% (13/42). Hospital mortality rate was statistically higher in group A; the type of EG and intensive care unit admission were the only independent predictors of hospital mortality. CONCLUSIONS In our experience, a higher mortality rate was observed for the aorto-uni-iliac configuration; shock at admission was confirmed as the most important factor for postoperative survival.
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Affiliation(s)
- G Carrafiello
- Interventional Radiology, Department of Radiology, University of Insubria, Viale Borri 57, 21100, Varese, Italy.
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Mancarella L, De Santis M, Magarelli N, Ierardi AM, Bonomo L, Ferraccioli G. Septic sacroiliitis: an uncommon septic arthritis. Clin Exp Rheumatol 2009; 27:1004-1008. [PMID: 20149323] [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: 05/28/2023]
Abstract
Septic sacroiliitis is an uncommon joint infection and the diagnosis is often delayed. We present the first case of a septic arthritis of the shoulder and of the sacroiliac joint in a woman affected by systemic sclerosis, and we reviewed the medical literature since 1997 to 2008 on septic sacroiliitis with a specific microbiological diagnosis other than Mycobacteria and Brucella species.Evidence shows that antibiotic therapy should be continued until full clinical and radiological resolution is achieved.
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Affiliation(s)
- L Mancarella
- Department of Rheumatology, Catholic University, Rome, Catholic University, Rome, Italy
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