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Semeraro V, Palmisano V, Limbucci N, Comelli S, Comelli C, Ganimede MP, Lozupone E, Barone M, Marrazzo A, Paladini A, Della Malva G, Briatico Vangosa A, Laiso A, Renieri L, Capasso F, Gandini R, Di Stasi C, Resta M, Mangiafico S, Burdi N. Woven EndoBridge Device for Unruptured Wide-Neck Bifurcation Aneurysm: A Multicenter 5-Year Follow-up. Neurosurgery 2023:00006123-990000000-00978. [PMID: 38038472 DOI: 10.1227/neu.0000000000002781] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/11/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This multicenter study aimed to assess the safety and efficacy of the Woven EndoBridge (WEB) device for treating unruptured wide-neck intracranial bifurcation aneurysms (WIBAs) with short-, mid-, and long-term follow-ups (FUPs). METHODS Consecutive patients with unruptured WIBAs treated with WEB between December 2014 and January 2018 were included. Patient, aneurysm, and device characteristics were collected and analyzed retrospectively. Morbidity and mortality rates were determined by collecting intraprocedural, periprocedural, and delayed complications. Aneurysm occlusion was assessed at 1, 3, and 5 years using a 3-grade scale: complete occlusion, neck remnant, and residual aneurysm. Complete occlusion and neck remnant were considered as adequate occlusion. Patients who received re-treatment were also evaluated. RESULTS The study included 104 consecutive patients (55.8% female, mean age 58.6 ± 11.8 years). Aneurysm maximum size, neck, and dome-to-neck mean were, respectively, 6.9 ± 2.1 mm, 4.5 ± 1.2 mm, and 1.4 ± 0.3 mm. One-year FUP was collected for 95 patients, and 3- and 5-year FUPs were collected for 83 patients. Adequate occlusion was observed at 1-year FUP in 90.5% (86/95), 91.6% (76/83) was observed at 3-year FUP, and 92.8% (77/83) at 5-year FUP. None of the aneurysms bled after treatment. During FUP, 6/83 patients (7.2%) were re-treated for residual aneurysm. Morbidity and mortality rates closely related to aneurysm occlusion were 0% (0/104). CONCLUSION The WEB device was safe and effective for treating unruptured WIBAs, both in short-term and long-term FUPs.
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Affiliation(s)
- Vittorio Semeraro
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | - Vitanio Palmisano
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | - Nicola Limbucci
- Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Simone Comelli
- Neuroradiology and Vascular Radiology Unit, Azienda di Rilievo Nazionale ed Alta Specializzazione "G. Brotzu", Cagliari, Italy
| | - Chiara Comelli
- Radiology and Neuroradiology Unit, San Giovanni Bosco Hospital, Turin, Italy
| | | | | | - Michele Barone
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | - Antonio Marrazzo
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | - Andrea Paladini
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | | | | | - Antonio Laiso
- Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Leonardo Renieri
- Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Francesco Capasso
- Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Roberto Gandini
- Department of Interventional Radiology, University Hospital "Tor Vergata", Rome, Italy
| | - Carmine Di Stasi
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | - Maurizio Resta
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
| | | | - Nicola Burdi
- Radiology and Neuroradiology Unit, "SS. Annunziata" Hospital, Taranto, Italy
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Ierardi AM, Coppola A, Renzulli M, Piacentino F, Fontana F, Paladini A, Guzzardi G, Semeraro V, Di Stasi C, Giurazza F, Niola R, Stefanini M, Contegiacomo A, Carrubba C, Discalzi A, Ciferri F, Carriero S, Lanza C, Biondetti P, Coniglio G, Fonio P, Venturini M, Carrafiello G, Del Giudice C. Correction to: Effectiveness and Safety of Different Vascular Closure Devices: Multicentre Prospective Observational Study. Cardiovasc Intervent Radiol 2023; 46:1301. [PMID: 37491524 DOI: 10.1007/s00270-023-03513-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Affiliation(s)
- Anna Maria Ierardi
- UOC Radiologia, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
| | - Andrea Coppola
- UOC Radiologia Diagnostica ed Interventistica, ASST Settelaghi, Insubria University, Varese, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCSS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Filippo Piacentino
- UOC Radiologia Diagnostica ed Interventistica, ASST Settelaghi, Insubria University, Varese, Italy
| | - Federico Fontana
- UOC Radiologia Diagnostica ed Interventistica, ASST Settelaghi, Insubria University, Varese, Italy
| | - Andrea Paladini
- U.O. Radiologia Interventistica-AOU "Maggiore della Carità", Università del Piemonte Orientale, Vercelli, Italy
| | - Giuseppe Guzzardi
- U.O. Radiologia Interventistica-AOU "Maggiore della Carità", Università del Piemonte Orientale, Vercelli, Italy
| | - Vittorio Semeraro
- SSD Radiologia Interventistica, POC SS Annunziata, ASL Taranto, Taranto, Italy
| | - Carmine Di Stasi
- SSD Radiologia Interventistica, POC SS Annunziata, ASL Taranto, Taranto, Italy
| | - Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, 80131, Naples, Italy
| | - Raffaella Niola
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, 80131, Naples, Italy
| | - Matteo Stefanini
- UO Diagnostica per Immagini e Radiologia Interventistica, Policlinico Casilino, Rome, Italy
| | - Andrea Contegiacomo
- UOSA Radiologia d'Urgenza, Fondazione Policlinico Universitario "A Gemelli", IRCCS, Rome, Italy
| | - Claudio Carrubba
- UOSA Radiologia d'Urgenza, Fondazione Policlinico Universitario "A Gemelli", IRCCS, Rome, Italy
| | - Andrea Discalzi
- Department of Surgical Sciences; Radiology Unit, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Fernanda Ciferri
- Department of Surgical Sciences; Radiology Unit, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Serena Carriero
- Post-graduate School of Radiology, Università degli Studi di Milano, Milan, Italy
| | - Carolina Lanza
- Post-graduate School of Radiology, Università degli Studi di Milano, Milan, Italy
| | - Pierpaolo Biondetti
- UOC Radiologia, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Giovanni Coniglio
- Radiologia diagnostica ed Interventistica, Azienda Ospedaliera per l'emergenza Cannizzaro-Catania, Catania, Italy
| | - Paolo Fonio
- Department of Surgical Sciences; Radiology Unit, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Massimo Venturini
- UOC Radiologia Diagnostica ed Interventistica, ASST Settelaghi, Insubria University, Varese, Italy
| | - Gianpaolo Carrafiello
- UOC Radiologia, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
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Ierardi AM, Coppola A, Renzulli M, Piacentino F, Fontana F, Paladini A, Guzzardi G, Semeraro V, Di Stasi C, Giurazza F, Niola R, Stefanini M, Contegiacomo A, Carrubba C, Discalzi A, Ciferri F, Carriero S, Lanza C, Biondetti P, Coniglio G, Fonio P, Venturini M, Carrafiello G, Del Giudice C. Effectiveness and Safety of Different Vascular Closure Devices: Multicentre Prospective Observational study. Cardiovasc Intervent Radiol 2023; 46:827-834. [PMID: 37225968 PMCID: PMC10208551 DOI: 10.1007/s00270-023-03463-5] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/29/2023] [Indexed: 05/26/2023]
Abstract
AIM The aim of this prospective, multicentre, observational study was to compare the efficacy and safety of balloon-based and non-balloon-based vascular closure devices (VCDs). MATERIALS AND METHODS From March 2021 to May 2022, 2373 participants from 10 different centres were enrolled. Among them, 1672 patients with 5-7 Fr accesses were selected. Successful haemostasis, failure and safety were evaluated. Successful haemostasis was defined as the possibility to obtain complete haemostasis with the use of VCDs, without any complication. Failure management was defined as the need of manual compression. Safety was defined as the rate of complications. Cases of haematomas/pseudoaneurysms (PSA) and artero-venous fistula (AVF) were collected. RESULTS VCDs mechanism of action is statistically significant associated with the outcome. Non-balloon-based VCDs demonstrated a statistically significant better outcome: successful haemostasis was obtained in 96.5% vs. 85.9%, of cases when compared to balloon occluders (p < 0.001). The incidence of AVF was statistically more frequent using non-balloon occluders devices (1.57% vs 0%, p: 0.007). No significant statistical difference was found in comparing haematoma and PSA occurrence. Thrombocytopenia, coagulation deficit, BMI, diabetes mellitus and anti-coagulation were demonstrated to be independent predictors of failure management. CONCLUSION Our study suggests a better outcome with the same complication rate, except that for AVF incidence for non-balloon collagen plug device if compared to balloon occluders vascular closure devices.
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Affiliation(s)
- Anna Maria Ierardi
- UOC Radiologia, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
| | - Andrea Coppola
- UOC Radiologia Diagnostica ed Interventistica, ASST Settelaghi, Insubria University, Varese, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCSS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Filippo Piacentino
- UOC Radiologia Diagnostica ed Interventistica, ASST Settelaghi, Insubria University, Varese, Italy
| | - Federico Fontana
- UOC Radiologia Diagnostica ed Interventistica, ASST Settelaghi, Insubria University, Varese, Italy
| | - Andrea Paladini
- U.O. Radiologia Interventistica-AOU "Maggiore della Carità", Università del Piemonte Orientale, Vercelli, Italy
| | - Giuseppe Guzzardi
- U.O. Radiologia Interventistica-AOU "Maggiore della Carità", Università del Piemonte Orientale, Vercelli, Italy
| | - Vittorio Semeraro
- SSD Radiologia Interventistica, POC SS Annunziata, ASL Taranto, Taranto, Italy
| | - Carmine Di Stasi
- SSD Radiologia Interventistica, POC SS Annunziata, ASL Taranto, Taranto, Italy
| | - Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, 80131, Naples, Italy
| | - Raffaella Niola
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, 80131, Naples, Italy
| | - Matteo Stefanini
- UO Diagnostica per Immagini e Radiologia Interventistica, Policlinico Casilino, Rome, Italy
| | - Andrea Contegiacomo
- UOSA Radiologia d'Urgenza, Fondazione Policlinico Universitario "A Gemelli", IRCCS, Rome, Italy
| | - Claudio Carrubba
- UOSA Radiologia d'Urgenza, Fondazione Policlinico Universitario "A Gemelli", IRCCS, Rome, Italy
| | - Andrea Discalzi
- Department of Surgical Sciences; Radiology Unit, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Fernanda Ciferri
- Department of Surgical Sciences; Radiology Unit, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Serena Carriero
- Post-graduate School of Radiology, Università degli Studi di Milano, Milan, Italy
| | - Carolina Lanza
- Post-graduate School of Radiology, Università degli Studi di Milano, Milan, Italy
| | - Pierpaolo Biondetti
- UOC Radiologia, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Giovanni Coniglio
- Radiologia diagnostica ed Interventistica, Azienda Ospedaliera per l'emergenza Cannizzaro-Catania, Catania, Italy
| | - Paolo Fonio
- Department of Surgical Sciences; Radiology Unit, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Massimo Venturini
- UOC Radiologia Diagnostica ed Interventistica, ASST Settelaghi, Insubria University, Varese, Italy
| | - Gianpaolo Carrafiello
- UOC Radiologia, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
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Semeraro V, Arpesani R, Della Malva G, Gasparrini F, Vidali S, Ganimede MP, Marrazzo A, Rosella F, Biraschi F, Gandini R, Burdi N, Di Stasi C. Flow-diverter treatment for renal artery aneurysms: One-year follow-up of a multicentric preliminary experience. Diagn Interv Radiol 2022; 28:609-615. [PMID: 36550762 PMCID: PMC9885726 DOI: 10.5152/dir.2022.211015] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Renal artery aneurysms (RAAs) are rare in the general population, although the true incidence and natural history remain elusive. Conventional endovascular therapies such as coil embolization or covered stent graft may cause sidebranches occlusion, leading to organ infarction. Flow-diverters (FD) have been firstly designed to treat cerebrovascular aneurysms, but their use may be useful to treat complex RAAs presenting sidebraches arising from aneurysmal sac. To evaluate mid-term follow-up (FUP) safety and efficacy of FD during treatment of complex RAAs. METHODS Between November 2019 and April 2020, 7 RAAs were identified in 7 patients (4 men, 3 women; age range 55-82 years; median 67 years) and treated by FD. Procedural details, complications, morbidity and mortality, aneurysm occlusion and segmental artery patency were retrospectively reviewed. Twelve months computed tomography angiography (CTA) FUP was evaluated for all cases. RESULT Deployment of FD was successful in all cases. One intraprocedural technical complication was encountered with one FD felt down into aneurism sac which requiring additional telescopic stenting. One case at 3 months CTA FUP presented same complication, requiring same rescue technique. At 12 months CTA FUP 5 cases of size shrinkage and 2 cases of stable size were documented. No rescue surgery or major intraprocedural or mid-term FUP complication was seen. CONCLUSION Complex RAAs with two or more sidebranches can be safely treated by FD. FD efficacy for RAA needs a further validation at long term FUP by additional large prospective studies.
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Affiliation(s)
- Vittorio Semeraro
- Department Diagnostic Imaging and Interventional Radiology, "Santissima Annunziata" Hospital, Taranto, Italy
| | - Roberto Arpesani
- Department of Diagnostic Imaging and Interventional Radiology, "Ospedali Riuniti", Livorno, Italy
| | - Giuseppina Della Malva
- Department of Neuroscience, Imaging and Clinical Sciences - Università degli Studi di Chieti "G. D'Annunzio", Chieti, IT
| | - Fulvio Gasparrini
- Department of Integrated Assistance Processes, Complex Operative Unit of Diagnostic Imaging, Policlinico Tor Vergata, Rome, Italy
| | - Sofia Vidali
- Department of Integrated Assistance Processes, Complex Operative Unit of Diagnostic Imaging, Policlinico Tor Vergata, Rome, Italy
| | - Maria Porzia Ganimede
- Department Diagnostic Imaging and Interventional Radiology, "Santissima Annunziata" Hospital, Taranto, Italy
| | - Antonio Marrazzo
- Department Diagnostic Imaging and Interventional Radiology, "Santissima Annunziata" Hospital, Taranto, Italy
| | - Francesco Rosella
- Department of Interventional Radiology, Operative Unit of Radiology, Mater Olbia Hospital, Olbia, Italy
| | | | - Roberto Gandini
- Department of Integrated Assistance Processes, Complex Operative Unit of Diagnostic Imaging, Policlinico Tor Vergata, Rome, Italy
| | - Nicola Burdi
- Department Diagnostic Imaging and Interventional Radiology, "Santissima Annunziata" Hospital, Taranto, Italy
| | - Carmine Di Stasi
- Department Diagnostic Imaging and Interventional Radiology, "Santissima Annunziata" Hospital, Taranto, Italy
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Semeraro V, Vidali S, Borghese O, Ganimede MP, Gandini R, Di Stasi C, Burdi N. Glue Embolization in the Management of Rectus Sheath Hematomas. Vasc Endovascular Surg 2022; 56:269-276. [PMID: 35068270 DOI: 10.1177/15385744211068742] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aims to describe the results achieved in the management of rectus sheath hematoma (RSH) using glue embolization. METHOD Data about all consecutive patients presenting with RSH, between January 2005 and December 2020 were retrospectively reviewed. RSHs were classified according to the Berna CT scan Classification. Clinical and technical outcomes were evaluated during in-hospital period and 1-month follow-up. RESULTS Among 74 patients presenting with RSH, CTA revealed an active bleeding in 61 (n = 42, 69% women; median age = 68.8 y range: 47-91). 19 cases of type 1 RSH (25.7%), under anticoagulation therapy and hemodynamically stable, were successfully managed conservatively. Conversely, endovascular embolization with cyanoacrylate glue diluted with ethiodized oil (Lipiodol Ultrafluid, Guerbet, France) was needed in n = 42 (56.8%) patients, in 16 cases after failure of conservative management; a single session of percutaneous glue embolization was adequate to achieve technical and clinical success in all patients with stabilization or progressive improvement of hemoglobin values after procedure (7.1 + 1.8 g/dL pre-procedure vs 11.1 + 1.6 g/dL post-procedure). No major complications occurred. Two minor complications were reported: 1 case (2.4%) of puncture site-related complication (local self-limiting hematoma) and 1 case (2.4%) of post-embolization syndrome (abdominal pain) spontaneously regressive. The median hospital stay was 7 d. At 30-day follow-up, 2 patients (2.7%) died of multiorgan failure. CONCLUSIONS In the management of RSH, glue embolization was shown to be safe and efficacious. Glue allowed the immediate occlusion of both the "front and back doors" of bleeding without the need to reach the bleeding point, preventing potentially life-threatening recurrence.
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Affiliation(s)
- Vittorio Semeraro
- Department of Interventional Radiology, 170131Santissima Annunziata Hospital,Taranto, Italy
| | - Sofia Vidali
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, 18654University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Ottavia Borghese
- Angio-cardio-thoracic Pathophysiology and Imaging, Sapienza University, Rome, Italy
| | - Maria Porzia Ganimede
- Department of Interventional Radiology, 170131Santissima Annunziata Hospital,Taranto, Italy
| | - Roberto Gandini
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, 18654University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Carmine Di Stasi
- Department of Interventional Radiology, 170131Santissima Annunziata Hospital,Taranto, Italy
| | - Nicola Burdi
- Department of Neuroradiology, Santissima Annunziata Hospital, Taranto, Italy
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Borghese O, Ganimede MP, Briatico Vangosa A, Pisani A, Vidali S, Di Stasi C, Burdi N, Semeraro V. The Minimally Invasive Treatment of Visceral Artery Pseudoaneurysms: A Retrospective Observational Single Centre Cohort Study on Glue Embolization. Vasc Endovascular Surg 2021; 55:831-837. [PMID: 34261391 DOI: 10.1177/15385744211028730] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The objective is to report a single centre experience in the embolization of visceral artery pseudoaneurysms with N-butyl-cyanoacrylate-methacryloxy sulfolane (NBCA-MS). METHODS A retrospective observational cohort study was conducted on data about all consecutive patients treated for visceral artery pseudoaneurysms in the Interventional Radiology Unit of SS Annunziata Hospital, in Taranto (Italy) between January 2016 and July 2020. Only patients treated with NBCA-MS embolization were included. Clinical and technical outcomes were evaluated during in-hospital stay and at 3-month follow-up by computed angiotomography (CTA). RESULTS Among 89 patients undergoing treatment for visceral artery pseudoaneurysm, a total of 58 (65.2%) patients (n = 32, 55.2% men; median age 45.8 years, range: 35-81) treated with NBCA-MS only were enrolled. Pseudoaneurysms were located in the renal artery (n = 18 cases, 31%), in the splenic artery (n = 27, 46.6%), in the intra-parenchymal hepatic artery (n = 3, 5.2%), in the common hepatic artery (n = 4, 6.9%) or in the pancreatic artery (n = 6, 10.3%). N-butyl-cyanoacrylate was diluted 1:1 with Lipiodol ultra-fluid, and mean volume injected was 0.6 ± 0.3 mL (range: 0.2-2.8 mL). Embolization was technically and clinically successful in all patients (n = 58, 100%) with an immediate total thrombosis of the pseudoaneurysm at the completion angiography. No systemic complications were noted in all cases. Five cases (8.6%) of non-target vessel embolization occurred without any clinical complication. No pseudoaneurysm recurrence was detected at the CTA control 1 day postoperatively. In one case (1.7%), a recurrence was detected 4 days after the initial treatment and successfully managed by a repeated NBCA-MS embolization. During the hospital stay, 56 patients recovered well but 2 (3.4%) died from multi-organ failure not related to the embolization. No recurrences were detected at the 3-month postoperative CTA in the remaining patients. CONCLUSIONS In properly selected patients affected with visceral artery pseudoaneurysms, NBCA-MS represents a definitive and safe embolization agent.
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Affiliation(s)
- Ottavia Borghese
- Department of Vascular and Endovascular Surgery, 55183Nord Laennec Hospital, Saint-Herblain, France.,9311University Sapienza of Rome, Rome, Italy
| | | | | | - Angelo Pisani
- Department of Cardiothoracic Surgery, 47165Pinata Grande Hospital, Castel Volturno, Italy
| | | | - Carmine Di Stasi
- Interventional Radiology Unit, 170131SS Annunziata Hospital, Taranto, Italy
| | - Nicola Burdi
- Interventional Radiology Unit, 170131SS Annunziata Hospital, Taranto, Italy
| | - Vittorio Semeraro
- Interventional Radiology Unit, 170131SS Annunziata Hospital, Taranto, Italy
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Contegiacomo A, Cina A, Di Stasi C, Barone M, Scrofani AR, Barbieri P, Punzi E, Manfredi R. Uterine Myomas: Endovascular Treatment. Semin Ultrasound CT MR 2021; 42:13-24. [PMID: 33541585 DOI: 10.1053/j.sult.2020.07.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Uterine fibroids embolization is a safe and effective organ sparing treatment for fibroid-related symptoms based on a broad range of published evidence including randomized-controlled trials. Indication to treatment is usually the presence of symptomatic uterine fibroids. In this review, a systematic search of journal articles relevant to the treatment of symptomatic uterine fibroids was conducted, with a special focus on the indication to treatment, technique, procedural outcomes and pain control. All clinical trials published in English language, representing original research, and reporting clinical outcomes associated with interventions for the management of symptomatic uterine fibroids were considered.
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Affiliation(s)
- Andrea Contegiacomo
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Alessandro Cina
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carmine Di Stasi
- UOC Radiodiagnostica Ospedale SS. Annunziata, Presidio Ospedaliero Centrale ASL Taranto, Taranto, Italy
| | - Michele Barone
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Università Cattolica del Sacro Cuore - Rome, Italy
| | - Anna Rita Scrofani
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Università Cattolica del Sacro Cuore - Rome, Italy
| | - Pierluigi Barbieri
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Università Cattolica del Sacro Cuore - Rome, Italy
| | - Ernesto Punzi
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Università Cattolica del Sacro Cuore - Rome, Italy
| | - Riccardo Manfredi
- Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Università Cattolica del Sacro Cuore - Rome, Italy
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Semeraro V, Valente I, Trombatore P, Ganimede MP, Briatico A, Di Stasi C, Burdi N, Boero G, Prontera MP, Gandini PR, Vidali S, Diomedi PM, Sallustio F, D'Argento F, Alexandre A, Romi A, Pedicelli A, Berardelli PA, Lozupone E. Comparison Between Three Commonly Used Large-Bore Aspiration Catheters in Terms of Successful Recanalization and First-Passage Effect. J Stroke Cerebrovasc Dis 2020; 30:105566. [PMID: 33360517 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105566] [Citation(s) in RCA: 6] [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] [Received: 10/26/2020] [Revised: 11/26/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES To compare three commonly used large-bore aspiration catheters in terms of final successful recanalization rate and first-passage successful and complete recanalization rates (the so called "first-passage effect"). MATERIALS AND METHODS it is an observational retrospective multicenter study conducted in three Italian high-volume tertiary stroke centers between January 2017 and May 2019. The study population included all consecutive patients with an ischemic stroke due to middle cerebral artery occlusion (M1 segment only) that underwent intra-arterial mechanical thrombectomy with contact aspiration as first-line strategy within 24 hours from symptoms onset. RESULTS Three hundred twenty-one patients were included in the study. Multivariable logistic regression analysis comparing the three catheters revealed no differences in terms of successful recanalization. Sofia 6 Plus catheter was associated with better first-passage successful recanalization [OR, 9.09; 95% CI, 2.66-31.03] (p<0.001) and first-passage complete recanalization [OR: 3.73; 95% CI: 1.43-9.72] (p=0.007) whereas rt-PA was associated with worse first-passage recanalization [OR: 0.52; 95% CI: 0.29-0.93] (p=0.028). CONCLUSIONS No differences between the three catheters were reported in terms of successful recanalization. Sofia 6 Plus has proven to be superior in achieving both successful and complete first-passage recanalization. Conversely, rt-PA was found to be a negative predicting factor of first-passage effect.
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Affiliation(s)
- Vittorio Semeraro
- Ospedale Santissima Annunziata, Dipartimento di Diagnostica per Immagini e Radioterapia, Taranto, Italy
| | - Iacopo Valente
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Radiologia e Neuroradiologia, Rome, Italy
| | | | - Maria Porzia Ganimede
- Ospedale Santissima Annunziata, Dipartimento di Diagnostica per Immagini e Radioterapia, Taranto, Italy
| | - Alessandra Briatico
- Ospedale Santissima Annunziata, Dipartimento di Diagnostica per Immagini e Radioterapia, Taranto, Italy
| | - Carmine Di Stasi
- Ospedale Santissima Annunziata, Dipartimento di Diagnostica per Immagini e Radioterapia, Taranto, Italy.
| | - Nicola Burdi
- Ospedale Santissima Annunziata, Neuroradiologia, Taranto, Italy.
| | - Giovanni Boero
- Ospedale Santissima Annunziata, Neurologia, Taranto, Italy
| | | | - Prof Roberto Gandini
- University Hospital of Rome "Tor Vergata", Diagnostic Imaging and Interventional Radiology, Rome, Italy.
| | - Sofia Vidali
- University Hospital of Rome "Tor Vergata", Diagnostic Imaging and Interventional Radiology, Rome, Italy
| | - Prof Marina Diomedi
- University Hospital of Rome "Tor Vergata", Stroke Unit, Departement of Neuroscience, Rome, Italy.
| | - Fabrizio Sallustio
- University Hospital of Rome "Tor Vergata", Stroke Unit, Departement of Neuroscience, Rome, Italy
| | - Francesco D'Argento
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Radiologia e Neuroradiologia, Rome, Italy.
| | - Andrea Alexandre
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Radiologia e Neuroradiologia, Rome, Italy.
| | - Andrea Romi
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Pedicelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Radiologia e Neuroradiologia, Rome, Italy.
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9
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Biscetti F, Nardella E, Rando MM, Cecchini AL, Bonadia N, Bruno P, Angelini F, Di Stasi C, Contegiacomo A, Santoliquido A, Pitocco D, Landolfi R, Flex A. Sortilin levels correlate with major cardiovascular events of diabetic patients with peripheral artery disease following revascularization: a prospective study. Cardiovasc Diabetol 2020; 19:147. [PMID: 32977814 PMCID: PMC7519536 DOI: 10.1186/s12933-020-01123-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/12/2020] [Indexed: 12/24/2022] Open
Abstract
Background Peripheral artery disease (PAD) represents one of the most relevant vascular complications of type 2 diabetes mellitus (T2DM). Moreover, T2DM patients suffering from PAD have an increased risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Sortilin, a protein involved in apolipoproteins trafficking, is associated with lower limb PAD in T2DM patients. Objective To evaluate the relationship between baseline serum levels of sortilin, MACE and MALE occurrence after revascularization of T2DM patients with PAD and chronic limb-threatening ischemia (CLTI). Research design and methods We performed a prospective non-randomized study including 230 statin-free T2DM patients with PAD and CLTI. Sortilin levels were measured before the endovascular intervention and incident outcomes were assessed during a 12 month follow-up. Results Sortilin levels were significantly increased in individuals with more aggressive PAD (2.25 ± 0.51 ng/mL vs 1.44 ± 0.47 ng/mL, p < 0.001). During follow-up, 83 MACE and 116 MALE occurred. In patients, who then developed MACE and MALE, sortilin was higher. In particular, 2.46 ± 0.53 ng/mL vs 1.55 ± 0.42 ng/mL, p < 0.001 for MACE and 2.10 ± 0.54 ng/mL vs 1.65 ± 0.65 ng/mL, p < 0.001 for MALE. After adjusting for traditional atherosclerosis risk factors, the association between sortilin and vascular outcomes remained significant in a multivariate analysis. In our receiver operating characteristics (ROC) curve analysis using sortilin levels the prediction of MACE incidence improved (area under the curve [AUC] = 0.94) and MALE (AUC = 0.72). Conclusions This study demonstrates that sortilin correlates with incidence of MACE and MALE after endovascular revascularization in a diabetic population with PAD and CLTI.
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Affiliation(s)
- Federico Biscetti
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia. .,Internal Medicine and Vascular Diseases Unit, Roma, Italia. .,Laboratory of Vascular Biology and Genetics, Department of Translational Medicine and Surgery, Roma, Italia.
| | | | | | | | - Nicola Bonadia
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia.,Emergency Medicine, Roma, Italia
| | - Piergiorgio Bruno
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia.,Cardiac Surgery Unit, Roma, Italia
| | - Flavia Angelini
- Laboratory of Vascular Biology and Genetics, Department of Translational Medicine and Surgery, Roma, Italia
| | | | | | - Angelo Santoliquido
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia.,Angiology Unit, Roma, Italia
| | - Dario Pitocco
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia.,Diabetology Unit, Roma, Italia
| | - Raffaele Landolfi
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia.,Internal Medicine and Vascular Diseases Unit, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Andrea Flex
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia.,Internal Medicine and Vascular Diseases Unit, Roma, Italia.,Laboratory of Vascular Biology and Genetics, Department of Translational Medicine and Surgery, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
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10
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Contegiacomo A, Amodeo EM, Cina A, Di Stasi C, Iezzi R, Coppolino D, Attempati N, Manfredi R. Renal artery embolization for iatrogenic renal vascular injuries management: 5 years' experience. Br J Radiol 2019; 93:20190256. [PMID: 31794248 DOI: 10.1259/bjr.20190256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] Open
Abstract
OBJECTIVE Evaluate the efficacy and safety of renal artery embolization (RAE) for iatrogenic renal vascular injuries (IRVI) management at Fondazione Policlinico Universitario "A. Gemelli" IRCCS, in the last 5 years. METHODS Retrospective analysis of all RAE procedures performed from January 2013 to December 2017. Patients-related (age, sex, vascular variants, hemoglobin and serum creatinine), IRVI-related (type and vascular level of IRVI, presence and extension of hematoma), management-related (temporal interval between diagnostic imaging and RAE) and procedure-related (embolic materials, technical success, clinical success and complications) parameters were evaluated. RESULTS 28 RAE procedures performed on 28 patients (21 males; 7 females) were included. 19/28 patients had pseudoaneurysm, 7/28 active bleeding and 1/28 arteriovenous fistula; 4/28 patients had a combination of 2 IRVI.The extent of perirenal hematoma showed correlation with the cause of IRVI (p = 0.028).Technical success was achieved in all patients whereas clinical success in 25/28 (89.3%), with 3 patients requiring re-treatment. Minor complications were observed during 2/28 (7.1%) endovascular procedures. No major complications occurred. A longer procedural time was observed in patients with lower pre-procedural levels of hemoglobin (p = 0.016).No differences were found in mean serum creatinine (p = 0.23) before and immediately after treatment, while values of creatinine at 1 week from the procedure were significantly lower (p = 0.04). CONCLUSION RAE is safe and effective for the management of iatrogenic IRVI showing high technical and clinical success rate and low complication rate. ADVANCES IN KNOWLEDGE Low pre-procedural hemoglobin levels increase procedural duration time. Glue alone or in combination with other materials is as safe as coils.
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Affiliation(s)
- Andrea Contegiacomo
- Department of Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Maria Amodeo
- Department of Radiological Sciences, Università Cattolica Sacro Cuore, Rome, Italy
| | - Alessandro Cina
- Department of Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Radiological Sciences, Università Cattolica Sacro Cuore, Rome, Italy
| | - Carmine Di Stasi
- Department of Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Radiological Sciences, Università Cattolica Sacro Cuore, Rome, Italy
| | - Roberto Iezzi
- Department of Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Radiological Sciences, Università Cattolica Sacro Cuore, Rome, Italy
| | - Davide Coppolino
- Department of Radiological Sciences, Università Cattolica Sacro Cuore, Rome, Italy
| | - Nico Attempati
- Department of Radiological Sciences, Università Cattolica Sacro Cuore, Rome, Italy
| | - Riccardo Manfredi
- Department of Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Radiological Sciences, Università Cattolica Sacro Cuore, Rome, Italy
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De Matthaeis N, Di Stasi C, Pizzolante F, Manfredi R, Rapaccini GL, Miele L. Multimodal sequential treatment for occluded TIPS: Case report and review of literature. Clin Mol Hepatol 2019; 26:227-230. [PMID: 31735021 PMCID: PMC7160340 DOI: 10.3350/cmh.2019.0056] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 09/05/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
- Nicoletta De Matthaeis
- Area Medicina Interna, Gastroenterologia ed Oncologia Medica. Policlinico A. Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy
| | - Carmine Di Stasi
- Area Diagnostica per Immagini. Policlinico A. Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy
| | - Fabrizio Pizzolante
- Area Medicina Interna, Gastroenterologia ed Oncologia Medica. Policlinico A. Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy
| | - Riccardo Manfredi
- Area Diagnostica per Immagini. Policlinico A. Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy
| | - Gian Ludovico Rapaccini
- Area Medicina Interna, Gastroenterologia ed Oncologia Medica. Policlinico A. Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy
| | - Luca Miele
- Area Medicina Interna, Gastroenterologia ed Oncologia Medica. Policlinico A. Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy
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12
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Annicchiarico BE, Santonocito C, Siciliano M, Scapaticci M, Guarino D, Di Stasi C, Riccioni ME, Di Stasio E, Capoluongo E, Gasbarrini A. ACE I allele is associated with more severe portal hypertension in patients with liver cirrhosis: A pilot study. Dig Liver Dis 2019; 51:293-296. [PMID: 30236768 DOI: 10.1016/j.dld.2018.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 08/03/2018] [Accepted: 08/04/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND In liver cirrhosis, the renin-angiotensin-aldosterone system is involved in the pathogenesis of portal hypertension. Its effector, angiotensin II, is generated by angiotensin-converting enzyme (ACE). Serum ACE levels are affected by I/D polymorphism of its gene, with alleles I and D being associated, respectively, with lesser and greater activity of the enzyme. In cirrhotic patients carrying the ACE I allele, an increased risk for gastro-oesophageal varices was observed. AIM The aim of our study was to evaluate whether ACE I/D polymorphism influenced portal pressure. METHODS Fifty-one consecutive cirrhotic patients were divided based on ACE genotype (DD, ID, and II). Kidney and liver function tests, upper endoscopy, and hepatic venous pressure gradient measurement (HVPG) were performed in all patients. RESULTS The presence of the ACE I allele was associated with a higher HVPG value (18.7±6.4 vs 10.3±6.3mmHg; P<.001), higher frequency of large gastrooesophageal varices (59.3% vs 25.0%; P<.05), and higher frequency of variceal bleeding (63.0% vs 29.2%; P<.05). No significant differences were found between patients with and those without the ACE I allele regarding Child-Pugh score, MELD score, ascites, and hepatic encephalopathy. CONCLUSION ACE I/D polymorphism seems to influence the severity of portal hypertension and the risk of variceal bleeding in liver cirrhosis, regardless of the severity of liver disease.
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Affiliation(s)
- Brigida E Annicchiarico
- Department of Internal Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Catholic University of the Sacred Heart, Rome, Italy
| | - Concetta Santonocito
- Laboratory of Clinical Molecular Biology, Department of Biochemistry & Clinical Biochemistry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Catholic University of the Sacred Heart, Rome, Italy.
| | - Massimo Siciliano
- Department of Internal Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Catholic University of the Sacred Heart, Rome, Italy
| | - Margherita Scapaticci
- Laboratory of Clinical Molecular Biology, Department of Biochemistry & Clinical Biochemistry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Catholic University of the Sacred Heart, Rome, Italy; Laboratory Medicine Department, San Camillo Hospital, Treviso, Italy
| | - Donatella Guarino
- Laboratory of Clinical Molecular Biology, Department of Biochemistry & Clinical Biochemistry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Catholic University of the Sacred Heart, Rome, Italy
| | - Carmine Di Stasi
- Department of Bioimaging and Radiological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Catholic University of the Sacred Heart, Rome, Italy
| | - Maria E Riccioni
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Catholic University of the Sacred Heart, Rome, Italy
| | - Enrico Di Stasio
- Laboratory of Clinical Molecular Biology, Department of Biochemistry & Clinical Biochemistry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Catholic University of the Sacred Heart, Rome, Italy
| | - Ettore Capoluongo
- Laboratory of Clinical Molecular Biology, Department of Biochemistry & Clinical Biochemistry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Gasbarrini
- Department of Internal Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Catholic University of the Sacred Heart, Rome, Italy
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Di Gennaro L, Di Stasi C, Truglia S, Snider F, Landolfi R. Retrievable filter as an unusual cause of abdominal and lower back pain: A report of an exceptional case. Thromb Haemost 2017. [DOI: 10.1160/th08-04-0267] [Citation(s) in RCA: 2] [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] [Indexed: 11/05/2022]
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14
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Cina A, Di Stasi C, Semeraro V, Marano R, Savino G, Iezzi R, Bonomo L. Comparison of CT and MR angiography in evaluation of peripheral arterial disease before endovascular intervention. Acta Radiol 2016; 57:547-56. [PMID: 26185265 DOI: 10.1177/0284185115595657] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 02/03/2015] [Accepted: 06/20/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multidetector computed tomography angiography (MDCTA) and magnetic resonance angiography (MRA) are accurate techniques for selecting patients with peripheral arterial disease for surgical and endovascular treatment. No studies in the literature have directly compared MDCTA and MRA to establish which one should be employed, in patients suitable for both techniques, before endovascular treatment. PURPOSE To compare diagnostic performance of MDCTA vs MRA before endovascular intervention. MATERIAL AND METHODS We prospectively compared MDCTA (64 slices scanner) and MRA (1.5 T scanner; 3D gadolinium-enhanced bolus-chase acquisition plus time resolved acquisition on calves) to stratify 35 patients according to the TASC II score and a runoff severity score. We also evaluated the accuracy of both techniques in each arterial segment. Selective angiography performed during the treatment was the standard of reference. RESULTS MDCTA and MRA accurately classify disease in the aorto-iliac (accuracy 0.92 for MDCTA and MRA) and femoro-popliteal (MDCTA 0.94, MRA 0.90) segments. MDCTA was more accurate in stratifying disease in the infrapopliteal segments (0.96 vs. 0.9) and in assessing the impairment of runoff arteries (0.92 vs. 0.85) at per-segment analysis. MDCTA showed a higher confidence and a shorter examination time. CONCLUSION Our results suggest that MDCTA can be considered as a first-line investigation in patients being candidates for endovascular procedures when clinical history or duplex sonographic evaluation are indicative of severe impairment of the infrapopliteal segment.
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Affiliation(s)
- Alessandro Cina
- Department of Radiological Sciences, “Agostino Gemelli” Hospital, Catholic University, Rome, Italy
| | - Carmine Di Stasi
- Department of Radiological Sciences, “Agostino Gemelli” Hospital, Catholic University, Rome, Italy
| | - Vittorio Semeraro
- Department of Radiological Sciences, “Agostino Gemelli” Hospital, Catholic University, Rome, Italy
| | - Riccardo Marano
- Department of Radiological Sciences, “Agostino Gemelli” Hospital, Catholic University, Rome, Italy
| | - Giancarlo Savino
- Department of Radiological Sciences, “Agostino Gemelli” Hospital, Catholic University, Rome, Italy
| | - Roberto Iezzi
- Department of Radiological Sciences, “Agostino Gemelli” Hospital, Catholic University, Rome, Italy
| | - Lorenzo Bonomo
- Department of Radiological Sciences, “Agostino Gemelli” Hospital, Catholic University, Rome, Italy
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15
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Nachira D, Chiappetta M, Congedo MT, Petracca-Ciavarella L, Mastromarino MG, Di Stasi C, Grossi U, Margaritora S. Successful Three-Stage Ethanol Ablation of Esophageal Mucocele. J Vasc Interv Radiol 2016; 27:152-4. [PMID: 26723929 DOI: 10.1016/j.jvir.2015.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Dania Nachira
- Department of General Thoracic Surgery, Catholic University, Via E. Perodi, Rome, Italy 00135
| | - Marco Chiappetta
- Department of General Thoracic Surgery, Catholic University, Via E. Perodi, Rome, Italy 00135
| | - Maria Teresa Congedo
- Department of General Thoracic Surgery, Catholic University, Via E. Perodi, Rome, Italy 00135
| | | | | | - Carmine Di Stasi
- Department of Bioimaging and Radiological Sciences, Institute of Radiology, Catholic University, of the Sacred Heart, Largo A. Gemelli, Rome, Italy 00135
| | - Ugo Grossi
- National Centre for Bowel Research and Surgical Innovation, Queen Mary University of London, London, United Kingdom
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Catholic University, Via E. Perodi, Rome, Italy 00135
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16
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Biolato M, Miele L, Vero V, Racco S, Stasi CD, Iezzi R, Zanché A, Pompili M, Rapaccini GL, Torre GL, Gasbarrini A, Grieco A. Hepatocellular carcinoma treated by conventional transarterial chemoembolization in field-practice: Serum sodium predicts survival. World J Gastroenterol 2014; 20:8158-8165. [PMID: 25009388 PMCID: PMC4081687 DOI: 10.3748/wjg.v20.i25.8158] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 12/10/2013] [Revised: 02/07/2014] [Accepted: 03/10/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the prognostic role of baseline clinical, biochemical and radiological characteristics of patients with hepatocellular carcinoma (HCC) treated with the first transarterial chemoembolization (TACE) procedure.
METHODS: Patients with HCC treated with conventional TACE in a tertiary care setting from 1997 to 2008 were retrospectively reviewed. Predictors of survival were identified using the Cox proportional regression model.
RESULTS: Two hundred and seventy patients were included. Median age was 66 years, 81% were male, 58% were HCV-positive, 18% hepatitis B surface antigen-positive, 64% had a Child A status, 40% patients had a largest nodule diameter ≥ 5 cm and 32% had more than 3 tumor nodules. Median overall survival of the whole cohort was 25 mo (95%CI: 21.8-28.2) and the 1-, 2- and 3-year probability of survival was 80%, 50% and 31%, respectively. Non-tumor segmental portal vein thrombosis (HR = 1.76, 95%CI: 1.22-2.54), serum sodium (HR = 1.65, 95%CI: 1.25-2.18), diameter of largest nodule (HR = 1.59, 95%CI: 1.22-2.091), number of nodules (HR = 1.41, 95%CI: 1.06-1.88), alpha-fetoprotein (HR = 1.35, 95%CI: 1.03-1.76) and alkaline phosphatase (HR = 1.33, 95%CI: 1.01-1.74) were independent prognostic factors for overall survival on multivariate analysis.
CONCLUSION: The inclusion of serum sodium alongside the already known prognostic factors may allow a better prognostic definition of patients with HCC as candidates for conventional TACE.
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Biolato M, Miele L, Di Stasi C, Grieco A. A giant calcified hepatic mass. Ann Hepatol 2014; 12:822-3. [PMID: 24018502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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18
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Rinaldi P, Inchingolo R, Giuliani M, Di Stasi C, De Gaetano AM, Maresca G, Bonomo L. Hepatic artery stenosis in liver transplantation: imaging and interventional treatment. Eur J Radiol 2012; 81:1110-5. [PMID: 21439751 DOI: 10.1016/j.ejrad.2011.02.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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: 12/23/2010] [Accepted: 02/24/2011] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Main purpose of our study is to demonstrate the spectral and color Doppler ultrasonography (DUS) findings that would indicate hepatic artery stenosis (HAS) after liver transplantation and to report our single center results. Moreover we want to establish role and limits of the different imaging techniques in detecting HAS, proposing a non invasive diagnostic approach and to depict indications and feasibility of endovascular treatment in the single patient. MATERIALS AND METHODS Our study consisted of 222 patients who underwent liver transplantation between January 1999 and December 2009. DUS findings were correlated with multidetector computed tomography angiography (MDCTA) and angiographic results. RESULTS HAS occurred in 21 cases (9.5%). In all cases diagnosis was performed by DUS. MDCTA quantified stenosis and showed an overall picture of splanchnic vascularization. Based on DUS and MDCTA data integration, in 9 cases we adopted the "wait and see" strategy. Moreover in 12 cases treatment was considered necessary. For hepatic artery stenosis, use of DUS criteria resulted in a sensitivity of 100% (20/20), a specificity of 99.5% (201/202), a positive predictive value (PPV) of 95% (20/21), and negative predictive value (NPV) of 100% (201/201), and an overall accuracy of 99.5% (221/222). CONCLUSION Our study underline the role of DUS in early diagnosis of HAS: repeated evaluation of both direct and indirect signs increases NPV and sensitivity of DUS.
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Affiliation(s)
- Pierluigi Rinaldi
- Department of Bio-Imaging and Radiological Sciences, Catholic University - Policlinic A. Gemelli, L.go A Gemelli 8, 00168 Rome, Italy.
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Iezzi R, Santoro M, Marano R, Di Stasi C, Dattesi R, Kirchin M, Tinelli G, Snider F, Bonomo L. Low-Dose Multidetector CT Angiography in the Evaluation of Infrarenal Aorta and Peripheral Arterial Occlusive Disease. Radiology 2012; 263:287-98. [PMID: 22332067 DOI: 10.1148/radiol.11110700] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Roberto Iezzi
- Department of Bioimaging and Radiological Sciences, Institute of Radiology, A. Gemelli Hospital-Catholic University, L.go A Gemelli 8, 00168 Rome, Italy.
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Iezzi R, Di Stasi C, Dattesi R, Pirro F, Nestola M, Cina A, Codispoti FA, Snider F, Bonomo L. Proximal Aneurysmal Neck: Dynamic ECG-gated CT Angiography—Conformational Pulsatile Changes with Possible Consequences for Endograft Sizing. Radiology 2011; 260:591-8. [DOI: 10.1148/radiol.11101307] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Miele L, Vallone S, Cefalo C, La Torre G, Di Stasi C, Vecchio FM, D'Agostino M, Gabrieli ML, Vero V, Biolato M, Pompili M, Gasbarrini G, Rapaccini G, Amerio P, De Simone C, Grieco A. Prevalence, characteristics and severity of non-alcoholic fatty liver disease in patients with chronic plaque psoriasis. J Hepatol 2009; 51:778-86. [PMID: 19664838 DOI: 10.1016/j.jhep.2009.06.008] [Citation(s) in RCA: 141] [Impact Index Per Article: 9.4] [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: 03/25/2009] [Revised: 05/20/2009] [Accepted: 06/08/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIMS The association between NAFLD and psoriasis has never been explored in prospective epidemiological studies. The aim of this 2-phase study was to study the clinical features of NAFLD in patients with psoriasis. METHODS Phase 1: Investigation of prevalence and characteristics of NAFLD in an unselected cohort of 142 adult Italian outpatients with psoriasis vulgaris. Phase 2: Comparison of the psoriasis cohort subgroup with NAFLD and an age- and body mass index-matched retrospective cohort of 125 non-psoriasis patients with biopsy proven NAFLD. RESULTS Based on histories, laboratory tests, and ultrasound studies, 84 (59.2%) received clinical diagnosis of NAFLD; 30 had factors potentially associated with liver disease other than NAFLD (e.g., viral hepatitis, significant ethanol, methotrexate use); and 28 (19.7%) had normal livers. Comparison of the normal-liver and NAFLD subgroups revealed that NAFLD in psoriasis patients (Ps-NAFLD) was significantly correlated with metabolic syndrome (p<0.05); obesity (p=0.043); hypercholesterolemia (p=0.029); hypertriglyceridemia (p<0.001); AST/ALT ratio >1 (p=0.019), and psoriatic arthritis (PsA) (p=0.036). The association with PsA remained significant after logistic regression analysis (OR=3.94 [CI, 1.07-14.46]). Compared with the retrospective non-psoriatic NAFLD cohort (controls), Ps-NAFLD patients (cases) were likely to have severe NAFLD reflected by non-invasive NAFLD Fibrosis Scores and AST/ALT >1. CONCLUSIONS NAFLD is highly prevalent among psoriasis patients, where it is closely associated with obesity (overall and abdominal), metabolic syndrome, and PsA, and more likely to cause severe liver fibrosis (compared with nonPs-NAFLD). Routine work-up for NAFLD may be warranted in patients with psoriasis, especially when potentially hepatotoxic drug therapy is being considered.
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Affiliation(s)
- Luca Miele
- Institute of Internal Medicine, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy
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Di Gennaro L, Di Stasi C, Truglia S, Snider F, Landolfi R. Retrievable filter as an unusual cause of abdominal and lower back pain: a report of an exceptional case. Thromb Haemost 2008; 100:1193-1195. [PMID: 19132248] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Leonardo Di Gennaro
- Institute of Internal Medicine and Geriatrics, Haemostasis Research Center, Catholic University School of Medicine, Rome, Italy
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23
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Nuzzo G, Giuliante F, Giovannini I, Murazio M, D'Acapito F, Ardito F, Vellone M, Gauzolino R, Costamagna G, Di Stasi C. Advantages of multidisciplinary management of bile duct injuries occurring during cholecystectomy. Am J Surg 2008; 195:763-9. [PMID: 18367147 DOI: 10.1016/j.amjsurg.2007.05.046] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2006] [Revised: 05/10/2007] [Accepted: 05/10/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of the present study was to highlight the advantages of treatment of bile duct injury (BDI) occurring during cholecystectomy on the basis of a multidisciplinary cooperation of expert surgeons, radiologists, and endoscopists. METHODS Sixty-six patients had major BDIs or short- or long-term failures of repair. BDI was diagnosed intraoperatively in 27 patients (40.9%) and postoperatively in 39 (59.1%) patients. Among referred patients, 30 had complications from bile leak, 15 from obstructive jaundice, and 20 from recurrent cholangitis. Two patients died from sepsis after delayed referral before repair was attempted. Eleven additional patients had minor BDIs with bile leak both with and without choleperitoneum. RESULTS Of patients with major BDI, surgical repair was performed in 41 (64.1%). Postsurgical morbidity rate was 15.8%, and there was no mortality. The rate of excellent or good results after surgical repair was 78.0% (32 of 41 patients), and this increased to 87.8% (36 of 41 patients) by continuing treatment with stenting in postsurgical strictures. Biliary stenting alone was performed in 23 patients (35.9%), with excellent or good results in 17 (73.9%). More than 200 endoscopic and percutaneous procedures were performed for initial assessment, treatment of sepsis, nonsurgical repair, contribution to repair, and follow-up. Patients with minor BDIs underwent various combinations of surgical and endoscopic or percutaneous treatments, always with good results. CONCLUSIONS A multidisciplinary approach was of paramount importance in many phases of treatment of BDI: initial assessment, treatment of secondary complications, resolution of sepsis, percutaneous stenting before surgical repair, dilatation of strictures after repair, final treatment in patients not repaired surgically, and follow-up.
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Affiliation(s)
- Gennaro Nuzzo
- Department of Surgery, Hepatobiliary Surgery Unit, Catholic University of the Sacred Heart School of Medicine, Rome, Italy.
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24
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De Gaetano AM, Rinaldi P, Barbaro B, Mirk P, Di Stasi C, Gui B, Maresca G, Bonomo L. Intrahepatic portosystemic venous shunts: Color Doppler sonography. ACTA ACUST UNITED AC 2008; 32:463-9. [PMID: 17334878 DOI: 10.1007/s00261-006-9068-1] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of the study was to evaluate intrahepatic portosystemic venous shunts (IPSVS) patterns and to determine the role of Color Doppler sonography in the diagnosis and evaluation of related hemodynamic changes in portal perfusion. METHODS Sonography and Color Doppler imaging were performed in nine patients with IPSVS. Type and Doppler waveform of the shunt were determined; velocity measurements in the portal trunk and portal branches were studied to evaluate the effects of the shunt on intrahepatic circulation. Computed tomography was performed in six patients, magnetic resonance imaging in three patients, and angiography in two patients. RESULTS The shunt between the portal and hepatic veins was aneurismal in six patients, while localized peripheral shunt with multiple tortuous vessels in one hepatic segment was observed in three patients. The shunts showed continuous low velocity spectral tracings and in the aneurismal shunts a low velocity bi-directional or helicoidal flow was detected. The feeding portal branches and the draining hepatic veins showed anomalous Doppler tracings and alterations of intrahepatic portal perfusion were observed in three cases. CONCLUSION Color Doppler is essential for proper diagnosis of IPSVS and for evaluation of related hemodynamic changes in portal perfusion.
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Affiliation(s)
- Anna Maria De Gaetano
- Department of Radiology, A. Gemelli University Hospital, 8, Largo F. Vito, Rome 00168, Italy.
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25
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De Carolis MP, Costa S, Polimeni V, Di Stasi C, Papacci P, Romagnoli C. Successful removal of catheter fragment from right atrium in a premature infant. Eur J Pediatr 2007; 166:617-8. [PMID: 17063348 DOI: 10.1007/s00431-006-0275-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Accepted: 07/25/2006] [Indexed: 10/24/2022]
Abstract
A premature infant with rupture of percutaneous central catheter and subsequent migration of the fragment in the right atrium was reported. Umbilical venous catheterization was safely used to remove the fragment.
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Affiliation(s)
- Maria Pia De Carolis
- Division of Neonatology, Department of Pediatrics, Catholic University Sacred Heart, Rome, Italy.
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26
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Costa S, De Carolis MP, Di Stasi C, Papacci P, Fusco F, Romagnoli C. Transumbilical embolization of hepatic arteriovenous malformation in a neonate with heart failure. Eur J Pediatr 2006; 165:807-9. [PMID: 16738868 DOI: 10.1007/s00431-006-0168-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 03/02/2006] [Accepted: 04/20/2006] [Indexed: 10/24/2022]
Abstract
A newborn infant presented with severe heart failure due to a large hepatic arteriovenous malformation (AVM). Umbilical artery (UA) access was safely used for immediate diagnosis and for embolization.
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Affiliation(s)
- Simonetta Costa
- Division of Neonatology, Department of Pediatrics, Catholic University Sacred Heart, Rome, Italy.
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Affiliation(s)
- Vincenzo Tondolo
- Department of Surgery, Division of Transplantation, Catholic University, Largo A Gemelli 8, 00168 Rome, Italy.
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28
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Annicchiarico BE, Siciliano M, Di Stasi C, Bombardieri G. Proximal splenic artery embolization allows pegylated interferon and ribavirin combination therapy in chronic hepatitis C virus-infected patients with severe cytopenia. Eur J Gastroenterol Hepatol 2006; 18:119-21. [PMID: 16357632 DOI: 10.1097/00042737-200601000-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Ferrante A, Di Stasi C, Pierconti F, Snider F. Incidental finding of right renal venous aneurysm in a patient with symptomatic ipsilateral renal carcinoma: a case report. Cardiovasc Pathol 2005; 14:327-30. [PMID: 16286043 DOI: 10.1016/j.carpath.2005.06.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND True venous aneurysms of the renal veins are very uncommon lesions. Diagnosis is incidental, and thrombosed aneurysms may simulate solid renal masses. METHODS AND RESULTS A case of right renal vein aneurysm incidentally found in a patient with a ispilateral renal carcinoma and abdominal aortic aneurysm is reported. While CT examination suggested a high-flow arteriovenous (A-V) malformation, a selective angiographic study identified two separate and independent pathologic conditions (venous aneurysm and intratumoral, acquired A-V fistulae). Successful preoperative embolization of the renal tumor was obtained and surgical treatment (nephrectomy+aneurysmectomy) was uneventful. CONCLUSIONS Although uncommon, venous renal aneurysms require an accurate preoperative diagnosis; this case is interesting because the coexistence of renal tumor with acquired A-V fistulae raised the prospect of a large, high-flow A-V communication with secondary venous enlargement. The integrated imaging studies were basic to differentiate acquired, tumor-induced A-V fistulae found in the lower renal pole from the true venous aneurysm located in the upper pole. To our knowledge, this is the first report of such a condition.
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Affiliation(s)
- Angela Ferrante
- Vascular Surgery Unit, Department of Cardiovascular Medicine, A. Gemelli University Hospital, Catholic University School of Medicine, Rome, Italy.
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30
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Pompili M, Riccardi L, Covino M, Barbaro B, Di Stasi C, Orefice R, Gasbarrini G, Rapaccini GL. Contrast-enhanced gray-scale harmonic ultrasound in the efficacy assessment of ablation treatments for hepatocellular carcinoma. Liver Int 2005; 25:954-61. [PMID: 16162152 DOI: 10.1111/j.1478-3231.2005.01135.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of this study was to compare contrast-enhanced gray-scale harmonic ultrasound with multiphasic spiral computed tomography in the assessment of treatment efficacy of non-surgically treated HCC. METHODS We studied 56 HCCs treated by percutaneous ethanol injection (31 cases), radiofrequency ablation (three cases), trans-arterial chemoembolization (12 cases), and combined treatment (10 cases). The efficacy of therapies was blindly assessed by multiphasic computed tomography and gray-scale harmonic ultrasound with a second-generation contrast agent (sulfur hexafluoride). RESULTS On computed tomography 30 tumors (53.6%) showed complete necrosis, while 26 lesions (45.4%) were still viable. On contrast-enhanced ultrasound examination 33/56 nodules (58.9%) had no contrast enhancement in the arterial phase, while 23/56 lesions (41.1%) were still vascularized. All the nodules assessed as completely necrotic on computed tomography did not show arterial enhancement on contrast-enhanced ultrasound and diagnostic agreement was found in 53/56 cases (94.6%) (P<0.001). Contrast-enhanced ultrasound demonstrated relative sensitivity and specificity of 87.0% and 98.4%. CONCLUSIONS Contrast-enhanced harmonic ultrasound is promising in the efficacy evaluation of ablation treatments for HCC. Nodules vascularized in the arterial phase on contrast harmonic ultrasound should be considered still viable and addressed to additional treatment without further evaluation.
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Affiliation(s)
- Maurizio Pompili
- Istituto di Medicina Interna e Geriatria, Universita Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy.
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Cina A, Pedicelli A, Di Stasi C, Porcelli A, Fiorentino A, Cina G, Rulli F, Bonomo L. Color-Doppler sonography in chronic venous insufficiency: what the radiologist should know. Curr Probl Diagn Radiol 2005; 34:51-62. [PMID: 15753879 DOI: 10.1067/j.cpradiol.2004.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [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: 11/22/2022]
Abstract
Chronic venous insufficiency (CVI) is a pathologic condition caused by valvular incompetence, with or without associated venous outflow obstruction, which may affect both the superficial and the deep venous system, causing venous hypertension and stasis. The most common form of CVI is primary varicose veins due to the insufficiency of the saphenous system. Color-Doppler sonography (CDS) is actually the main diagnostic technique of imaging for CVI. In this article, we describe the anatomy, the technique, and the information necessary to the radiologist to perform CDS in chronic venous insufficiency. The knowledge of the venous anatomy is the cornerstone for an adequate sonographic examination. The venous network in the lower extremities is divided into three systems: superficial, deep, and perforating veins. Deep veins are "comitantes" to the corresponding arteries and run under the muscular fascia. Superficial veins course into the subcutaneous fat, superficially to the deep muscular fascia; the main superficial veins are the greater and lesser saphenous and their tributaries. Connection between the saphenous veins are defined as communicating veins. Superficial and deep veins are connected by perforating veins, with flow directed, under normal circumstances, from the superficial to the deep system. The main perforating are the Hunter in the mid thigh, the Dodd in the lower thigh, the Boyd in the upper calf, and the Cockett's in the middle and lower calf. Sonographic examination must be performed in the upright and supine position. Compression sonography and color and PW Doppler are systematically employed to assess the absence of deep venous thrombosis. Femoro-popliteal veins are evaluated with color and PW Doppler for valvular insufficiency with reflux by performing Valsalva maneuver and calf compression. The sapheno-femoral and sapheno-popliteal junctions are examined to identify type of junction, continence, accessory saphenous, and incompetent collaterals. Perforating veins are usually identified at the medial aspect of the thigh and at the medial, lateral, and posterior aspects of the leg. Outward flow (lasting more than 500 ms) in the perforating veins should be considered a sign of their incompetence. Several surgical and interventional procedures are now available for the treatment of the CVI, as follows: vein ligation and stripping, stab avulsion, endoluminal occlusion of the saphenous trunks, subfascial endoscopic perforator surgery, and valvuloplasty.
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Affiliation(s)
- Alessandro Cina
- Department of Radiology, Università Cattolica del Sacro Cuore, Policlinico "Agostino Gemelli," Rome, Italy
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Tropeano G, Di Stasi C, Litwicka K, Romano D, Draisci G, Mancuso S. Uterine artery embolization for fibroids does not have adverse effects on ovarian reserve in regularly cycling women younger than 40 years. Fertil Steril 2004; 81:1055-61. [PMID: 15066463 DOI: 10.1016/j.fertnstert.2003.09.046] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [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: 04/23/2003] [Revised: 09/02/2003] [Accepted: 09/02/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the impact of uterine artery embolization (UAE) for fibroids on ovarian reserve in women younger than 40 years. DESIGN Prospective study. SETTING University-based reproductive endocrinology unit. PATIENT(S) Twenty regularly cycling women aged 33-39 years undergoing UAE for fibroids. All had cycle day 3 FSH levels <10 mIU/mL. INTERVENTION(S) Measurements of serum FSH and E2 levels and of the total ovarian volume and antral follicle number by transvaginal ultrasonography on day 3 of the menstrual cycle preceding UAE and on day 3 of the cycles occurring in months 3, 6, and 12 after UAE. MAIN OUTCOME MEASURE(S) Preprocedural and postprocedural hormone levels, ovarian volumes, and antral follicle numbers. RESULT(S) There were no significant changes from baseline in the mean day 3 FSH and E2 levels, ovarian volume measurements, and antral follicle numbers measured at 3, 6, and 12 months after UAE. CONCLUSION(S) Although this study might be not sensitive enough to conclude that UAE for fibroids does not interfere with a woman's ovarian status, these data indicate that in this series of reproductive-aged women UAE did not have short- or mid-term effects on ovarian reserve as assessed by hormonal and sonographic parameters.
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Colli R, Di Stasi C, Modugno P, Orlando G, Cavallaro A. Intravascular ultrasound in the endovascular management of atherosclerotic peripheral occlusive disease. Chir Ital 2004; 56:229-38. [PMID: 15152515] [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: 04/29/2023]
Abstract
This study is a retrospective analysis of the impact of intravascular ultrasound in addiction to conventional angiography in 36 patients with 55 stenotic peripheral arterial lesions treated with angioplasty and/or stenting. Before treatment, intravascular ultrasound imaging showed that the vessel diameter was underestimated with angiography in 6 cases. The correlation index between angiography and intravascular ultrasound measurements, however, was significant in 27 arterial lesions. After endovascular treatment, angiography showed 3 vessel dissections and no incomplete stent deployment, whereas intravascular ultrasound showed 15 dissections and 5 instances of stent underdeployment. If we consider the intravascular ultrasound data as the gold standard, the specificity of angiography is 100%, while its sensitivity is 56% for vessel dissection and 75% for stent deployment. In the follow up of the 16 patients treated for iliac lesions with intravascular ultrasound control, re-stenosis occurred in 5% (primary patency 94.7%); in a control group of 15 patients treated in the same period without intravascular ultrasound control, re-stenosis occurred in 15.8% (primary patency 83.4%, difference not statistically significant). In conclusion, in the peripheral arteries intravascular ultrasound is more accurate than arteriography in evaluating dissection and stent deployment, but the routine use of intravascular ultrasound in every case of iliac PTA or stenting would not appear justified.
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Affiliation(s)
- Rosa Colli
- Institute of Surgical Semeiotics, Catholic University, Rome
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Canadè A, Mancini AP, Di Stasi C, Brizi MG, Mutignani M. Combined diagnostic and therapeutic imaging of hemosuccus pancreaticus. Rays 2003; 28:197-207. [PMID: 14509195] [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: 04/27/2023]
Abstract
The justification of a request of ERCP in a patient with hematobilia, was evaluated, based on the medical history and negative endoscopy findings for gastrocolic bleeding. The diagnostic examination was performed: it confirmed the release of blood from the papilla of Vater, however the definitive diagnosis could not be established; CT, as the examination of first choice was performed. It provided additional information and the diagnosis of aneurysm of the splenic vein apparently non communicating with the main pancreatic duct, was established. Angiography of the splenic artery was performed as the examination of second choice to definitely ascertain the source of bleeding. During the examination, the aneurysm embolization excluded the affected vessel from the circulation and allowed immediate benefit to the patient.
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Affiliation(s)
- Adolfo Canadè
- Istituto di Radiologia, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
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35
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Gui B, Missere M, Di Stasi C, Manfredi R, Lafuenti G, Spagnolo AG. Diagnostic and therapeutic imaging in a case of cervical pregnancy. Clinical aspects and ethical implications. Rays 2003; 28:167-74. [PMID: 14509191] [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: 04/27/2023]
Abstract
A case of a 37-year-old, 8 week pregnant woman come to the emergency service with the diagnosis of cervical pregnancy an metrorrhagia, is reported. Uterine artery embolization was performed to arrest the bleeding. BCF monitoring documented its disappearance after approximately 15 days with progressive decrease in serum beta-hCG levels. Once the death of the fetus was ascertained, placental detachment was facilitated with the administration of methotrexate therapy. In view of the curettage of the uterine cavity a second uterine artery embolization was performed. Twenty days after the diagnosis of abortion, curettage was performed and the patient could be discharged. The combined action of embolization, methotrexate therapy and curettage allowed to preserve the potential fertility of the woman.
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Affiliation(s)
- Benedetta Gui
- Istituto di Radiologia, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
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Tropeano G, Litwicka K, Di Stasi C, Romano D, Mancuso S. Permanent amenorrhea associated with endometrial atrophy after uterine artery embolization for symptomatic uterine fibroids. Fertil Steril 2003; 79:132-5. [PMID: 12524076 DOI: 10.1016/s0015-0282(02)04400-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [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: 10/27/2022]
Abstract
OBJECTIVE To report a case of permanent amenorrhea associated with endometrial atrophy after uterine artery embolization for symptomatic uterine fibroids. DESIGN Case report. SETTING Gynecologic clinic of a university hospital. PATIENT(S) A 44-year-old woman with menorrhagia and anemia caused by multiple fibroids. INTERVENTION(S) Transcatheter bilateral uterine artery embolization with polyvinyl alcohol particles, with hormonal, sonographic, and hysteroscopic follow-up procedures. MAIN OUTCOME MEASURE(S) Serum follicle-stimulating hormone (FSH) and estradiol levels were measured, and sonographic appearance of the ovaries and the endometrium at baseline and 1, 3, 6, and 12 months after treatment were recorded. Hysteroscopy was performed with endometrial biopsy at baseline and 6 months after embolization. RESULT(S) The patient remained amenorrheic from the procedure. Serial posttreatment measurements of FSH and estradiol levels and repeated ovarian imaging showed no change in ovarian function as compared with baseline. A reduction in endometrial thickness (<or=5 mm), as compared with the endometrial thickness measured at baseline (7.2 mm), was sonographically documented 1, 3, 6, and 12 months after treatment. Postprocedure hysteroscopy showed an atrophic endometrium, and endometrial biopsy confirmed endometrial atrophy. CONCLUSION(S) Permanent amenorrhea associated with endometrial atrophy may occur following uterine artery embolization for fibroids and, to the best of our knowledge, this is the first time this complication has been reported. Patients should be appropriately counseled about the risk of reduced fertility after embolization.
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Affiliation(s)
- Giovanna Tropeano
- Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy.
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Cotroneo AR, Di Stasi C, Cina A, De Gaetano AM, Evangelisti R, Paloni F, Marano G. Stent placement in four patients with hepatic artery stenosis or thrombosis after liver transplantation. J Vasc Interv Radiol 2002; 13:619-23. [PMID: 12050303 DOI: 10.1016/s1051-0443(07)61657-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [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: 12/16/2022] Open
Abstract
Hepatic artery stenosis and thrombosis represent dangerous complications of liver transplantation because the associated mortality and morbidity rates are high. In the past, repeat transplantation was considered the first-choice therapy; however, new surgical and interventional revascularization techniques have been suggested recently. Although extensive experience has been acquired with percutaneous transluminal angioplasty (PTA) and fibrinolysis techniques, only sporadic cases of stent placement in the hepatic artery of a transplanted liver have been reported, and no long-term results of this technique are available. In this study, seven stents (five Wallstents and two Palmaz stents) were positioned in four patients (two with stenoses and two with thromboses). Stent placement was performed in three cases after PTA and fibrinolysis, whereas primary stent placement was performed in the fourth. In all cases, technical success was achieved. During 18-25 months of follow-up, all stents proved patent and no patient required another transplantation. Although experience is still limited, the authors' experience indicates that placement of a stent in the hepatic artery in cases of stenosis or thrombosis yields good medium-term success, improving the results obtained by fibrinolysis and PTA and consequently enabling the graft to survive and avoiding the need for repeat transplantation.
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Affiliation(s)
- Antonio Raffaele Cotroneo
- Department of Diagnostic and Interventional Radiology, Policlinico "Agostino Gemelli," Catholic University, Rome, Italy
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