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1.
Radiol Med ; 113(3): 395-413, 2008 Apr.
Article in English, Italian | MEDLINE | ID: mdl-18493776

ABSTRACT

PURPOSE: The aim of our study was to illustrate the benefits of percutaneous treatment by embolisation of high-flow pulmonary arteriovenous malformations (PAVM) in patients suffering from hereditary haemorrhagic telangiectasia (HHT; Rendu-Osler-Weber disease). MATERIALS AND METHODS: From December 2001 to February 2007, we embolised 60 PAVMS in 35 procedures performed on 30 patients, all referred by the HHT centre in Crema, and enrolled in a screening programme of HHT families. All patients underwent clinical evaluation, contrast-enhanced ultrasound (CEUS) and spiral computed tomography (CT). Embolisation was made with nonmagnetic metallic coils via femoral venous access; an endovascular Amplatzer device was used in one patient only. RESULTS: All embolisations were performed without difficulty. One patient only developed partial temporary aphasia, which resolved in 72 H. At spiral-CT follow-up, we generally demonstrated exclusion from circulation of treated PAVMS and regression of clinical symptoms. In the case of new lesions or recanalisation, further embolisation was possible: CONCLUSIONS: Percutaneous embolisation has recently become the initial treatment option in PAVM owing to its good results and minimal invasiveness compared with thoracotomy. Our experience is in agreement with the literature: the procedure has a low complication rate, provides very good technical and clinical results and avoids resection of healthy pulmonary parenchyma.


Subject(s)
Arteriovenous Fistula/therapy , Arteriovenous Malformations/therapy , Embolization, Therapeutic/methods , Pulmonary Artery/abnormalities , Pulmonary Veins/abnormalities , Telangiectasia, Hereditary Hemorrhagic/complications , Adult , Aged , Arteriovenous Fistula/etiology , Arteriovenous Malformations/diagnostic imaging , Arteriovenous Malformations/etiology , Arteriovenous Malformations/pathology , Embolization, Therapeutic/instrumentation , Female , Humans , Male , Middle Aged , Retrospective Studies , Telangiectasia, Hereditary Hemorrhagic/diagnostic imaging , Tomography, Spiral Computed , Treatment Outcome , Ultrasonography
2.
J Exp Clin Cancer Res ; 22(4 Suppl): 171-5, 2003 Dec.
Article in English | MEDLINE | ID: mdl-16767926

ABSTRACT

In the past, intrahepatic arterial locoregional chemotherapy was performed by surgical approach via gastroduodenal artery; early use of percutaneously placed arterial port was complicated by clotting and bleeding in 50% of pts. More recently, permanent catheters were positioned percutaneously in GDA by Japanese group and fixed to the artery by means of bucrylate in order to reduce dislocation. We present the technique and the preliminary results of percutaneous implantation of intraarterial catheters connected to a subcutaneous infusion reservoir for prolonged regional chemotherapy of hepatic tumors. Two hundred patients underwent to percutaneous arterial port implant, for loco-regional chemotherapy for liver primary or metastatic tumors. Catheter dislodgments were observed in 14,5%, but in 90% the catheters could be reinserted. No case of catheter related mortality was registered. Percutaneous positioning of arterial port is a safe and effective technique to deliver loco-regional treatment for hepatic tumors. Complication rates are similar to the surgical series and to other percutaneous interventional radiological reports. This percutaneous approach in the hands of a skilled team allows intra-arterial infusion in a wide percentage of pts, improving the accuracy of clinical trials by a faster and optimal balanced comparison between systemic and arterial arm.


Subject(s)
Catheters, Indwelling/adverse effects , Chemotherapy, Cancer, Regional Perfusion/methods , Liver Neoplasms/drug therapy , Antineoplastic Agents/administration & dosage , Chemotherapy, Cancer, Regional Perfusion/adverse effects , Chemotherapy, Cancer, Regional Perfusion/instrumentation , Hepatic Artery/surgery , Humans , Infusions, Intra-Arterial
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