Suprapubic percutaneous sclero-embolization of symptomatic female pelvic varicocele under local anesthesia.

PURPOSE: To evaluate the safety and feasibility of supra-pubic percutaneous sclero-embolization (SE) in the treatment of symptomatic female pelvic varicocele (FPV), performed under local anesthesia. MATERIALS AND METHODS: The authors selected 28 patients screened by transabdominal and transvaginal ultrasound, with venous Doppler signal. Clinicians performed SE by transfemoral catheterization, under local anesthesia, using of a mix of 2 ml of lauromacrogol 400 (Atossisclerol 3%, Chemische F. Kreussler, Wiesbaden, Germany) and 2 ml of air, in a mixed foam fashion. RESULTS: The total operative time for SE was 7.6 +/- 2.1 min. Intra-surgical blood loss was 40 +/- 14 ml. No migration of sclerosant material occurred and postoperative analgesic request during a 48 hr period occurred in 6 patients. Technical success was 100%. The Authors embolized 8 women bilaterally (28.5%), 18 on the left ovarian vein (OV) (64.2%) and 2 only in the right OV (7.1%): 7 women complained of transitory flank pain (25%), which disappeared in few minutes. The major complications in 10 days after SE were: fever (> 38 degrees C for two days) in 2 patients (7.1%) and pelvic pain for 3 days in eight patients (28.5%). After 30 days only 6 women suffered of FPV lower symptoms which disappeared in 180 days. A substantial reduction in size of pelvic varicosities was noted in all patients. CONCLUSIONS: SE is a safe and feasible procedure. It reduces significantly the mean time of scopies, the intensity of radiation emission, and it is performed under local anaesthesia. This minimally invasive procedure could be proposed to all women with supra-pubic FPV for its reproducibility and feasibility.

Salvage utilization of selective and super selective embolization in emergency by use of a-magnetic coil and nano-particles in gynecology.

INTRODUCTION: Pelvic arteries embolization (PAE) can be described as an obstetric procedure effective in emergencies, to use especially in managing uncontrollable acute uterine hemorrhage, if resistant to medical therapy. This procedure leads to immediate control of hemorrhages and restores cardiovascular status, especially in critical patients. PAE can be used as an alternative to removing organs. PURPOSE OF STUDY: To utilize the PAE in local anesthesia for management of acute uterine hemorrhage for cervical myoma in a critical patients, a fertile woman with concomitant cardiovascular stroke and in high-dosage of antithrombosis therapy, with severe anemia. MATERIAL ANDS METHODS: This procedure was used in an University affiliated Hospital, by a selective catheterization of the left hypogastric artery with an a-magnetic coil and super-selective catheterization of the right uterine artery, instilling a mixture of micro-particles and an absorbable haemostatic gelatin. RESULTS: Authors have successfully completed this procedure in 40 minutes in local anaesthesia, showed by stopping of iodated contrast fluid in vascular myoma network, with subsequent cervical myomectomy, whilst preserving uterus. CONCLUSION: PAE allows, through super-selective catheterization of both uterine arteries or selective catheterization of hypogastric arteries, to instill a mixture of micro-particles, absorbable haemostatic gelatins or endovascular coils, mixed with iodated contrast fluid and, thereby, to stop bleeding. This procedure leaded to an immediate control of hemorrhages and restores cardiovascular status, as an alternative to removing organs.

Endovenous laser therapy of the incompetent great saphenous vein.

PURPOSE: The aim of this study was the development of a new, even less invasive technique, for the treatment of varicose veins of the lower limbs than traditional surgery (ligation with stripping of the saphenous vein). MATERIALS AND METHODS: The new interventional radiological procedure uses the 810- to 980-nm endovascular laser fibre proposed by Min et al. Our technique involves the superselective catheterisation of the great saphenous vein under fluoroscopy with contralateral venous access achieved by performing iliac crossover. Retrograde and anterograde phlebographies are performed with a needle cannula positioned in the dorsum of the foot. This enables accurate venous mapping during the procedure of laser photothermolysis. We treated 52 patients between June 2003 and June 2004, with a percentage of recanalisation of 7.5% at 1 year. RESULTS AND CONCLUSIONS: The contralateral approach allows greater control over the entire procedure, with a reduction in potential risks in relation to the saphenofemoral junction given that, unlike in the technique proposed by Min et al. the tip of the laser is directed at all times towards the saphenous vein and never towards the femoral vein. This more radical procedure offers a significant reduction in the possibility of relapse of varicose disease of the saphenofemoral junction.

[Quantitative assessment of portal vein flow in subjects with active chronic hepatitis: comparison of magnetic resonance angiography with bolus tracking with color Doppler ultrasonography]. / Determinazione quantitativa del flusso nella vena porta nei soggetti con epatopatia cronica attiva: confronto tra angiografia con risonanza magnetica con bolo di protoni marcati ed eco color Doppler.

PURPOSE: To assess the accuracy of time-of-flight MR Angiography (MRA) with bolus tracking in evaluating mean blood velocity and flowrate in the portal vein in patients with chronic hepatitis versus healthy volunteers. MATERIAL AND METHODS: Fifteen patients with clinically-defined post-viral chronic hepatitis (viruses B and C) were examined with bolus tracking MRA and color Doppler US to evaluate portal blood flow. Both examinations were performed before and after a 1500 kcal meal. We evaluated mean blood flow velocity and flowrate in the portal vein. MRA results were compared with color Doppler findings; the results in chronic hepatitis patients were compared with those of healthy volunteers. RESULTS: The correlation between mean portal blood velocity, as measured with MRA and color Doppler US, was r = .82 before and r = .79 after the meal. There was no significant difference in mean velocity between the chronic hepatitis patients and the healthy volunteers. The correlation between portal flowrate, as measured with MRA and color Doppler US, was r = .87 before and r = .91 after the meal. There was no significant difference in mean flowrate between the chronic hepatitis patients and the healthy volunteers. In contrast, there were significant differences in mean velocity and portal flowrate, as measured with MRA before the meal, between the chronic hepatitis patients and the healthy volunteers. DISCUSSION AND CONCLUSIONS: Bolus tracking MRA is superior to color Doppler US in quantitating blood flow in the portal vein and evaluating changes after a meal. Decreased mean velocity and flowrate may indicate impaired function, as it happens in early chronic hepatitis.

Doppler sonographic assessment of functional response of the right and left portal venous branches to a meal.

PURPOSE: The aim of our study was to quantitate by Doppler sonography the blood flow in the right and left portal vein branches before and after a standard meal. We also assessed the functional response of the right and left lobes of the liver. METHODS: Portal blood flow was measured by Doppler sonography in the left and right portal vein branches and main portal trunk in 20 healthy volunteers in both fasting and postprandial states. The ratio between portal blood flow and liver volume (determined by MRI) was the portal flow index (PFI). RESULTS: Before the meal, a statistically significant difference in portal blood flow volume was observed between the right and left portal branches (p < 0.01). The right PFI (0.83 ml/minute/cm3) and left PFI (1.1 ml/minute/cm3) were also significantly different (p < 0.01). The increase in portal venous blood flow after a meal was found to be greater in the left portal branch (128%) than in the right portal branch (78%). The postprandial PFI also differed significantly (right, 1.54 ml/minute/cm3; left, 2.5 ml/minute/cm3). CONCLUSIONS: These findings suggest that the left lobe of the liver has a better postprandial compliance than the right lobe has.

Role of angiography in the evaluation of hepatic perfusion.

Angiography was the first method to be used for a morphofunctional study of hepatic perfusion. It can be performed with direct puncture of portal system or indirect opacification after contrast injection into the splenic artery or superior mesenteric artery. At present, direct angiographic procedures have only a historical value in the diagnostic approach while they have a preliminary role in interventional maneuvers on the portal system (TIPSS, embolization of portal branches or left gastric vein). Indirect angiographic procedures allow the study of arteries, parenchymas and portal system. Much of the information on arterial hepatic and portal circulation is now supplied by noninvasive procedures (US,CT,MRI); however in selected cases, angiography can be performed. Furthermore, the knowledge of angiographic findings of hepatic circulation is basic to the interpretation of "functional" information supplied by color-Doppler US, spiral CT and MR angiography.

Angiography and MR-angiography in the diagnosis of peripheral arterial occlusive disease in diabetic patients.

An invasive diagnostic procedure as angiography which involves direct arterial injection of contrast through suitable catheters, is still considered the gold standard in the evaluation of diabetic patients with peripheral arterial occlusive disease. The accuracy of anatomical details is combined on angiography with a pan view, indispensable for correct therapeutic planning. MR-angiography, with the 2D time of flight sequences in particular, supplies images of great anatomical accuracy and very sensitive in the detection of occlusive lesions which compare well with angiography and superior in the assessment of the length of occluded tracts. This noninvasive, cost-effective procedure seems bound to replace angiography in the pretreatment evaluation of diabetic patients with peripheral arterial occlusive disease.

[Quantitative evaluation of flow in the portal vein. Comparison of bolus tracking magnetic resonance and Doppler color ultrasound]. / Determinazione quantitativa del flusso nella vena porta. Confronto tra la Risonanza Magnetica con bolo di protoni marcati ed eco color Doppler.

PURPOSE: Magnetic resonance angiography (MRA) can be used to measure flow velocity in the portal vein noninvasively. Our study was aimed at measuring mean flow velocity in the portal vein and section area and overall portal flow with bolus tracking MRA versus color Doppler US. MATERIAL AND METHODS: Twenty healthy volunteers were submitted to presaturation bolus tracking MRA and color Doppler US before and after a 1500 Kcal meal. The images were acquired during breath-holding and analyzed prospectively for the following parameters: mean flow velocity, portal vein caliber and flow, before and after a meal. MRA measurements were made on both baseline images and MIP reconstructions. RESULTS: Before the meal, mean portal flow velocity was 17.07 +/- 3.01 cm/s with MRA versus 17.46 +/- 3.12 cm/s with color Doppler US (r = .85). After the meal, mean velocity was 24.52 +/- 3.8 cm/s with MRA and 24.8 +/- 4.0 cm/s with color Doppler US (r = .85). After the meal, portal velocity increased by 44% with MRA and by 42% with color Doppler US. Before the meal, the portal vein section area was 1.27 +/- .32 cm2 with MRA and 1.17 +/- .29 cm2 with color Doppler US (r = .86), versus 1.52 +/- .30 cm2 with MRA and 1.44 +/- .27 cm2 with color Doppler US (r = .85) after the meal. Portal vein flow was 1248.4 +/- 302.46 mL/min with MRA and 1202.85 +/- 316.12 mL/min with color Doppler US before the meal, versus 2252.45 +/- 523.90 mL/min with MRA and 2202 +/- 576.74 mL/min with color Doppler US (r = .91) after the meal. Portal vein flow increased by 78% with MRA versus 83% with color Doppler US after the meal. DISCUSSION AND CONCLUSIONS: Bolus tracking MRA is an accurate method to quantitate mean velocity, section area and blood flow in the portal vein.