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1.
Br J Radiol ; 96(1145): 20221061, 2023 Apr 01.
Article in English | MEDLINE | ID: mdl-36745115

ABSTRACT

OBJECTIVES: The aim of our study is to compare the incidence of veno-venous shunts in male varicocele and evaluate the possibility to exclude them with manual compression or/and scrotal ligation in order to carry out the procedure of retrograde sclero-embolization. METHODS: In our retrospective study, all patients undergone retrograde sclerotherapy for varicocele in our Interventional Radiology Unit in the last four years were evaluated. Collaterals toward other venous shunts were identified and how many and which patients would be able to complete the procedure safely were considered. RESULTS: Of the 91 patients, as many as 22 (i.e., 24.17%) patients presented anatomical variants, consisting on shunting into left iliac vein (9 [9.89%]), lumbar left veins (3 [3.29%]), right iliac vein (1 [1.09%]), both iliac veins (1 [1.09%]), left femoral vein (1 [1.09%]) or a more proximal portion of the ISV itself without shunting (3 [3.29%]). Patients with duplication could benefit from a more distal injection in order to prevent back-flow; of the 19 left, nine successfully underwent sclerotherapy with manual compression or/and scrotal ligation, whereas in 10 flow through the collaterals could not be interrupted and patients were demanded for surgery. CONCLUSIONS: Many patients with abnormal communications between the internal spermatic vein and the iliac veins (that is, shunts towards the iliac veins) may as well undergo retrograde sclerotherapy safely if compression/ligation is applied. ADVANCES IN KNOWLEDGE: No large previous study highlighted the impact of veno-venous shunts in technical feasibility of retrograde sclerotherapy of varicocele.


Subject(s)
Varicocele , Humans , Male , Varicocele/therapy , Sclerotherapy/methods , Retrospective Studies , Incidence , Veins , Phlebography
3.
BJR Case Rep ; 8(5): 20210130, 2022 Sep 12.
Article in English | MEDLINE | ID: mdl-36211613

ABSTRACT

Gastrointestinal angiodysplasia (GIAD) represents one of the most frequent causes of recurrent lower gastrointestinal bleeding in the elder population. Clinical manifestations are highly variable, diagnosis is done with colonoscopy or CT and management consists of either endoscopic or, more conservatively, endovascular approach. Trans-arterial embolization (TAE) reduces blood flow into the lesion and may complicate with perforation, dissection, vasospasm and bowel ischaemia. To date, coils and Gelfoam represent the most employed embolizing agents, followed by PVA and onyx. We report the successful embolization of GIADs in four patients with n-butyl 2-cyanoacrylate (NBCA) and Lipiodol Ultra-Fluid (LUF): despite the reported higher risk of bowel infarction when compared with the other agents, no major complication or short-term recurrence occurred in our series.

4.
Radiol Med ; 126(6): 761-767, 2021 Jun.
Article in English | MEDLINE | ID: mdl-33715036

ABSTRACT

OBJECTIVE: Fractional extracellular space has been validated as a marker of hepatic fibrotic in cirrhotic patients at CT-scan as well as on dual-energy CT, which takes advantage from iodine uptake. Since no consensus still exists between equilibrium phases performed at 3 or 10 min, the first aim of this work is to evaluate performances at the two different time points. Moreover, correlation between fractional extracellular space and oesophageal varices, directly related to liver fibrosis, has been assessed. MATERIALS AND METHODS: Dual-Energy equilibrium phases at 3 and 10 min were performed within a follow-up CT-protocol scan in cirrhotic patients. Oesophageal varices were endoscopically assessed according to their size. At the two different time points, correlation between iodine density of the right and left liver lobes and correlation between the fractional extracellular space values were assessed. Correlation between fractional extracellular space and endoscopic grade of oesophageal varices was calculated. RESULTS: No statistical differences were found between the iodine density values from the two liver lobes at the two time points (p = 0.8 at 3'; p = 0.5 at 10'). No statistical difference about fractional extracellular space estimation was found between the two time points (p = 0.17). Correlation between fractional extracellular space values and oesophageal varices was moderate (ρ = 0.45, IC 0.08-0.71, p < 0.05). CONCLUSION: Fractional extracellular space assessed on dual-energy CT at equilibrium phases with different timing was substantially similar. The moderate correlation found between fractional extracellular space and endoscopic grade of oesophageal varices confirms that CT-scan is not currently reliable as endoscopy.


Subject(s)
Esophageal and Gastric Varices/diagnosis , Extracellular Space/diagnostic imaging , Liver Cirrhosis/complications , Liver/diagnostic imaging , Tomography, X-Ray Computed/methods , Aged , Aged, 80 and over , Esophageal and Gastric Varices/etiology , Female , Follow-Up Studies , Humans , Liver Cirrhosis/diagnosis , Male , Middle Aged , Prospective Studies , ROC Curve
5.
Indian J Radiol Imaging ; 29(3): 310-312, 2019.
Article in English | MEDLINE | ID: mdl-31741601

ABSTRACT

Biliary fistula and bile leakage are complications that can occur during hepato-biliary surgery (both open and laparoscopic) and percutaneous biliary intervention. In some cases, spontaneous resolution is documented but more often re-intervention (surgical or percutaneous) is necessary. We present the case of a male patient who underwent right hepatectomy with bilio-digestive anastomosis for a cholangiocarcinoma which developed a bilo-cutaneous fistula through the path of a previously inserted percutaneous transhepatic drainage. Sealing of bilo-cutaneous fistula was obtained using N-butil-Cyanoacrylate. This technique has already been reported in some papers as a useful tool for biliary tree obliteration; however, to our knowledge, no cases describing the use of glue to seal a sub-cutaneous route are available in literature.

6.
Surg Radiol Anat ; 41(9): 1093-1095, 2019 Sep.
Article in English | MEDLINE | ID: mdl-31123773

ABSTRACT

The portal vein derives from the vitelline veins, a component of the extraembryonic venous system, and is normally formed by the confluence of the superior mesenteric and splenic vein. The knowledge of the anatomy of the portal vein and its abnormalities is important for interventional and surgical procedures. Variant portal architecture is a common finding during imaging studies. Ultrasonography, computed tomography and magnetic resonance are non-invasive methods for studying and understanding portal vein's anatomy and abnormalities. We describe a rare case of variation in the formation and course of the portal vein. To the best of our knowledge, there is no evidence of this kind of abnormality in literature.


Subject(s)
Abdominal Pain/etiology , Anatomic Variation , Portal Vein/abnormalities , Abdominal Pain/diagnosis , Aged , Computed Tomography Angiography , Contrast Media/administration & dosage , Female , Humans , Imaging, Three-Dimensional , Portal Vein/diagnostic imaging
7.
Radiol Case Rep ; 14(3): 343-347, 2019 Mar.
Article in English | MEDLINE | ID: mdl-30581521

ABSTRACT

Purpose of this report is to describe safety and effectiveness of selective artery embolization in the treatment of bleeding angiomyolipomas (AMLs) of the kidney using a mixture of Lipiodol and Cyanoacrylate. Two patients with bleeding AMLs underwent to superselective embolization of the lesions using microcatheter and Lipiodol mixed with Cyanoacrylate in the ratio 3:1. Primary bleeding control rate was 100% with no major complications. Follow-up CT (mean time 18 months) demonstrated a significant reduction in size (about 50%) of the lesions. In conclusion, selective artery embolization with Lipiodol and Cyanoacrylate appear to be safe and effective in the treatment of bleeding AMLs.

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