Endovascular treatment of popliteal artery aneurysms: preliminary results.

PURPOSE: Popliteal artery aneurysms (PAAs) are a rare condition with an incidence <0.1%. The objective of this study was to evaluate the effectiveness of endovascular treatment of PAA with a covered stent-graft. MATERIALS AND METHODS: Between January 2009 and July 2010, ten patients (nine men and one woman, mean age 69 ± 12 years) with PAA were treated by endovascular placement of a heparin-coated stent-graft. All procedures were evaluated in terms of technical success, patency at 1, 6 and 12 months as assessed by colour Doppler ultrasound, complications, procedure duration and length of postoperative hospital stay. RESULTS: We obtained 100% technical success, with no peri- or postprocedural complications. Average duration of the procedure was 40 min, and mean hospital stay was 3 days. Primary and secondary patency rates at 1, 6 and 12 months were 100% and 100%, 90% and 100%, and 90% and 100%, respectively. Only one case of endoleak occurred. DISCUSSION: In keeping with the literature, our study demonstrates the effectiveness of endovascular repair of PAA, with short- and mid-term patency rates comparable to those of open surgery. Larger series and longer follow-up periods are needed to confirm these preliminary results.

Long-term efficacy of endovascular treatment of isolated iliac artery aneurysms.

PURPOSE: The aim of this study was to evaluate the efficacy of endovascular treatment of isolated iliac artery aneurysms (IIAA) and compare our data with those reported in the literature. MATERIALS AND METHODS: From May 2005 to December 2010, 32 patients (31 men and one woman; mean age 73±12 years) with a total of 40 IIAAs underwent endovascular treatment at our institute. We evaluated technical success, long-term patency, early and late complications and overall mortality. RESULTS: At a median follow-up of 36 months, we achieved a technical success of 100%, a primary patency of 95% and a secondary patency of 100%, with complete exclusion of the aneurysm in 84.6% of cases. In 12.8% of cases, there was a reduction in aneurysm sac volume, with an incidence of type II endoleak of 12.8%. Overall survival at 1, 2, 3, and 6 years was 96.8%, 84.2%, 66.6% and 64%, respectively. CONCLUSIONS: Our study documents the effectiveness of endovascular treatment of iliac aneurysms, which has become the first-choice treatment at our institute. This finding is consistent with the most recent literature and confirms the safety and long-term patency of stent-graft placement.

Endovascular treatment of transplanted renal artery stenosis with PTA/stenting.

PURPOSE: We evaluated the effectiveness of endovascular treatment with percutaneous transluminal balloon angioplasty (PTA)/stenting of transplanted renal artery stenosis (TRAS). MATERIALS AND METHODS: Between January 2005 and December 2010, 17 patients (4 women, 13 men; mean age 60.9 years) with TRAS underwent PTA/stenting. The parameters analysed were: technical success, pre- and post-treatment serum creatinine (SCr) and blood pressure (BP), average number of antihypertensive drugs administered before and after treatment and vessel patency on colour Doppler ultrasound (CDUS) at 1, 3, 6 and 12 months and once a year thereafter. RESULTS: Technical success was 100%. During a mean follow-up of 28.3±18.7 months, there was a statistically significant reduction in SCr and BP values. In 18 % of cases, moderate (<60%) restenosis was observed on CDUS without renal failure and not requiring new treatment. There was a reduction in antihypertensive drugs from an average of 3.5±0.5 to 1.5±0.5. CONCLUSIONS: Consistent with the literature data, our experience shows that endovascular treatment with PTA/stenting is a safe and effective option for managing TRAS and can thus be considered the method of choice.

[Endovascular treatment of abdominal aortic aneurysms: 6 years of experience at a single centre]. / Trattamento endovascolare di aneurismi dell'aorta addominale: esperienza monocentrica di sei anni.

PURPOSE: We sought to assess the effectiveness of endovascular abdominal aortic aneurysm (AAA) repair (EVAR) through a retrospective review of 6 years' experience at a single centre. MATERIALS AND METHODS: From April 2005 to August 2011, 222 patients affected by abdominal aortic aneurysms underwent EVAR. We evaluated primary technical success, postprocedural mortality, intraprocedural and postprocedural complications with contrast-enhanced computed tomography (CT) and contrast-enhanced ultrasound (US) follow-up at 1, 6 and 12 months and annually thereafter. RESULTS: The procedures were elective in 75.7% and urgent due to symptomatic or ruptured aneurysm in 24.3%. Technical success was 98.6%; three patients (1.4%) required conversion to open surgery. Postoperative mortality rate was 24% for urgent and 2.3% for elective procedures. During a mean follow-up period of 29.6 months, no cases of stent-graft migration were observed; the overall incidence of endoleaks was 27% (60/222) and comprised four type I (1.8%) and one type III (0.45%), all treated by stent-graft extension, and 55 type 2 (24.8%), eight of which (14.5%) were treated by percutaneous injection of thrombin. In 10/222 cases (4.5%), thrombotic occlusion of the iliac extension was detected, which was successfully treated by transcatheter intra-arterial thrombolysis. One patient developed stent-graft infection requiring surgical explantation. Average hospital stay was 4 days, and average time in intensive care was 2 days. CONCLUSIONS: Consistent with the literature data, our study confirms the safety and long-term efficacy of EVAR for treating AAA.

Hepatic artery aneurysm treatment with heparin-bonded covered stent: a case report.

The hepatic artery is the second most common site for aneurysms formation within the splanchnic circulation. Most hepatic artery aneurysms (HAA) are diagnosed incidentally by a computed tomography(CT) scan or a Doppler ultrasonography. We present the case of a HAA diagnosed preoperatively in a 82-year old man, who was treated with an endovascular procedure. An abdominal ultrasonography revealed by chance the presence of a HAA. The abdominal CT scan confirmed an aneurysm of the common hepatic artery, specifically at the origin of the gastroduodenal artery. The gastroduodenal artery was embolized using coils then a heparin-bonded covered stent was deployed into the common hepatic artery to exclude the aneurysm. Final arteriogram documented the regular patency of the stent and the complete exclusion of the aneurysm. No complication occurred and the patient was discharged on the second postoperative day. Six months later, a follow-up with a Duplex scan confirmed the regular patency of the stent, and the patient was in good clinical conditions.

Comparison of cryoplasty and conventional angioplasty for treating stenotic-occlusive lesions of the femoropopliteal arteries in diabetic patients: immediate, mid-term and long-term results.

PURPOSE: The authors compared the immediate, mid-term and long-term effectiveness of cryoplasty and conventional angioplasty for treating stenotic-occlusive lesions of the femoropopliteal arteries in diabetic patients. MATERIALS AND METHODS: From October 2006 to November 2009, 48 patients with non-insulin-dependent diabetes mellitus (DM) and an indication for percutaneous revascularisation of the femoropopliteal arteries were randomly assigned to treatment with angioplasty or cryoplasty. The following parameters were analysed and compared between the two groups: immediate technical success (residual stenosis <30%) and distal run-off as assessed on postprocedural angiography, and degree of restenosis and distal run-off at 6 and 12 months, as assessed with either colour Doppler ultrasound (CDUS) or digital subtraction angiography (DSA). RESULTS: Treatment with angioplasty revealed a significant superiority in procedural technical success (p=0.04), a significant reduction in the degree of restenosis at 6 months (p=0.02) and a significant increase in the distal run-off at 6 (p=0.005) and 12 (p=0.01) months. CONCLUSIONS: Conventional angioplasty is more effective than cryoplasty for treating stenotic-occlusive lesions of the femoropopliteal arteries in diabetic patients and provides better immediate, mid-term and long-term results.

Abdominal aortic aneurysm treatment: minimally invasive fast-track surgery and endovascular technique.

In our department we started a program in order to offer a mini-invasive approach to all patients affected by abdominal aortic aneurysms (AAAs), trying to offer this option also to patients not eligible for endovascular aneurysm repair (EVAR) due to unfavorable anatomy, age under 65 years and aorto-iliac occlusive disease, considering nowadays EVAR is the gold-standard for the mini-invasive treatment of AAAs. The aim of this study was to compare endovascular versus fast-track surgical treatment in patients undergoing elective surgery for AAAs. We wanted to verify if it was possible to be totally mini-invasive in the treatment of AAAs. A total of 128 patients were chosen for the study. Ninety-four patients were enrolled in the OPEN group and 34 were enrolled in the EVAR group. This study demonstrates that minimally invasive treatment with the fast-track protocol may be a valid alternative to EVAR.

Moyamoya disease and arteriovenous fistula of the epiaortic vessels.

The association of Moyamoya disease (MD) with other cerebrovascular disease has been reported in literature but not the occurrence of MD and arteriovenous fistula of the epiaortic vessels. A 61-year old Italian woman was admitted to our Department because of the sudden onset of Broca's aphasia. At general examination she presented a murmur above the right clavicle. Brain magnetic resonance imaging (MRI) showed an ischemic lesion involving left frontal and temporal lobes. Cerebral digital subtraction angiography (DSA) showed moyamoya vessels and an arteriovenous fistula between vertebral artery and internal giugular vein in right laterocervical region. This is the first report of the association of MD with arteriovenous fistula of the epiaortic vessels.

Contrast-bolus MR angiography of the transplanted kidney with a low-field (0.5-T) scanner: diagnostic accuracy, sensitivity and specificity of images and reconstructions in the evaluation of vascular complications.

PURPOSE: This study was performed to assess the feasibility, interobserver variability, sensitivity, specificity and diagnostic accuracy of raw data and postprocessed images from a low-field (0.5-T) magnetic resonance (MR) unit in evaluating vascular complications of kidney grafts. MATERIALS AND METHODS: We enrolled 49 patients undergoing MR angiography (MRA) for a clinical suspicion of renal artery stenosis. The raw data, maximum intensity projections (MIP) and multiplanar reconstruction (MPR) image sets were evaluated independently. We calculated the number and degree of stenosis, and sensitivity, specificity and accuracy for MIP, MPR and raw data image sets, together with interobserver variability. RESULTS: Interobserver agreement was substantial. There were no differences among the MIP and MPR algorithms and raw data images for the detection of stenosis. Raw data images were more accurate in quantifying the severity of stenosis, with higher sensitivity (75% vs. 62.5%), equal specificity and higher diagnostic accuracy (75% vs. 71.43%). CONCLUSIONS: Contrast-enhanced MRA, even with a low-field (0.5-T) unit, is a feasible, sensitive and accurate technique for the study of the renal arteries of the transplanted kidney.

MRI post-vertebroplasty.

PURPOSE: Percutaneous vertebroplasty (PVP), first described by Hervè Deramond in 1984, is an interventional procedure for the treatment of aggressive vertebral angioma. The aim of this study was to evaluate magnetic resonance imaging (MRI) patterns in the affected vertebrae before and after vertebroplasty by determining changes in signal intensity and size and distribution of bone cement within the vertebra at follow-up carried out at 1 week, 6 months and 12 months. MATERIALS AND METHODS: Fourteen patients were examined using MRI, for a total of 41 treated vertebrae; MRI was performed with a 0.5-Tesla (T) superconductive magnet (SIGNA GE). RESULTS: MRI patterns following vertebroplasty are mainly characterised by the signal produced by the areas surrounding the cement and by the cement itself. There is little effect on the size of the treated vertebra. Acrylic cement appears as an intraspongy focal area of T1 and T2 hypointensity that is mostly oval (34%) or rounded (26.8%); this appearance tends to become stable 6 months after treatment. The area surrounding the cement appears hypointense on T1 and hyperintense on T2, a likely expression of bone marrow oedema; this signal alteration tends to disappear gradually. CONCLUSIONS: In pre- and post-vertebroplasty imaging, MRI is regarded as the reference standard for correct evaluation of both container and content. Awareness of cement changes over time and of the reaction of the surrounding bone tissue is crucial for correct assessment of post-vertebroplasty images.

Pulmonary veins: magnetic resonance angiography anatomy.

OBJECTIVE: to optimize magnetic resonance angiography technique for the selective study of the anatomy of pulmonary veins. MATERIALS AND METHODS: twenty consecutive patients (13 males and seven females; mean age 30.5 years) prospectively studied were enrolled. Magnetic resonance angiography was performed using a 1 T superconductive magnet and three dimensional time of flight technique (3D TOF). Imaging with steady-state free precession sequence during intravenous infusion of contrast medium (Gd DTPA 0.2 mmol kg(-1)) administration was employed using the following parameters: FA 20 degrees, TR 58 ms, TE 6 ms, MA 192 x 256, NEX 1, slice thickness 4 mm and slice orientation on the Z and Y planes. RESULTS: in the right lung magnetic resonance angiography well visualized 124 venous vessels on the coronal plane versus 106 venous vessels on the sagittal plane, whereas in the left lung magnetic resonance angiography visualized 96 vessels on the coronal plane versus 44 visualized on the sagittal plane. Our data suggest that 3D time of flight with contrast medium is a promising evaluation technique for pulmonary veins, and that combined evaluation of acquisitions on coronal and sagittal planes allows the visualization of a higher number of venous vessels. CONCLUSION: 3D time of flight with contrast medium and without breath-hold permits to visualize a venous vascular map of the lungs.

Vasodilating in MR-angiography: a comparison of techniques.

PURPOSE: To verify the hypothesis that a drug that causes vasodilation can contribute to improvement in MRA spatial resolution. To test this hypothesis, a comparison was made between the images obtained using the high resolution time-of-flight (TOF HR 3D) technique and the TOF 3D MTC TONE technique. METHODS: From November 1993 to December 1994, we studied 40 patients, of which 20 patients (16 males and 4 females; average age of 10 years; range from 3 to 20 years) we examined after they had inhaled Isoflurane (experimental group), and 20 patients (16 males and 4 females; average age 9.7 years; range from 3 to 12 years) were examined with standard MRA (control group). RESULTS: The vasodilator in both HR MRA and MTC TONE MRA permits a better spatial visualization with respect to the clinical routine MRA. On the other hand, it is true that MTC TONE gives better visualization of the small vessels. DISCUSSION: In our experience, this preliminary study indicates that with respect to routine MR, the spatial resolution is notably increased when Isoflurane is used. The signal-to-noise ratio is increased but, moreover, the ability to visualize small vessels is increased. CONCLUSION: The preliminary results obtained in this study indicate that a pharmacological drugs is capable of increasing the vascular detail of MRA images of the intracranial vessels and that continued research this direction is called for.

[Angiography with magnetic resonance of the body with contrast media. Experience with a 0.5 tesla device]. / Angiografia con Risonanza Magnetica del corpo con mezzo di contrasto. Esperienza con apparecchio da 0,5 tesla.

INTRODUCTION: We optimized the technique of contrast-enhanced Magnetic Resonance Angiography (MRA) with a .5 T superconductive magnet. MATERIAL AND METHODS: Forty patients with normal blood pressure and heart rate gave their informed consent to MRA studies with contrast agent administration. The carotid arteries were studied in 10 patients, the pulmonary arteries in 10, the thoracic aorta in 10 and the abdominal aorta and renal arteries in 10. All the examinations were performed with a .5 T superconductive magnet (Philips T5) acquiring 3D T1-weighted GE sequences with contrast agent administration. The parameters were: TR/TE/FA 13 ms/4 ms/60 degrees; 256 x 256 MA; 2 mm slice thickness; 1 NEX. The contrast agent was administered with an automatic injector (.2 mmol/kg at 1.5 flowrate) after a bolus test to evaluate circulation time. The images were studied by a radiologist rating artery visualization as "good" or "poor" on a multiple choice card. The signal-to-noise ratio was evaluated using regions of interest positioned on the examined vessels (signal) and muscles (noise). RESULTS: The mean start delay was 12.2 s for the abdominal aorta, 10.3 s and 8.7 s for the thoracic aorta and pulmonary arteries, and 10.3 for the carotid arteries. Fifty-eight of 70 vessels were well visualized and 12 were poorly visualized. The signal-to-noise ratio exceeded 1 in all districts. CONCLUSIONS: Our experience shows that enhanced MRA provides diagnostic images of body arteries even at .5 T.

Magnetic resonance angiography of the origins of the supraaortic arteries: comparison of single and double volume acquisition 3D time of flight.

PURPOSE: The authors have optimized the technique of Magnetic Resonance Angiography (MR-angio) in the study of the origins of the supraaortic arteries. METHODS: Twenty healthy volunteers, mean age 21.5, were studied with MR-angio of the origins of the supraaortic arteries; a 1 T superconductive magnet (Impact) with body coil was used. All the volunteers were studied using Time of flight (TOF), and two acquisition techniques: single volume FISP (fast imaging with steady-state precession) 3D TONE (titled optimized non-saturating excitation) and double volume FISP 3D TONE with 30% overlapping. The images were acquired on the axial plane following the positioning of three pre-saturation pulses. RESULTS: Regarding the visualization of the different components of the origins of the supraaortic arteries, a statistical analysis was worked out using the Mann Whitney test (p < 0.05); there was no statistically significant difference between two techniques. Regarding the visualization of the various segments (origin, 1/3 proximal, 1/3 middle, 1/3 distal), although the double volume did on the one hand allow a better visualization of the more distal vascular components (statiscally significant difference), on the other it induced the presence of artefacts with decreased the quality of the image as a whole. DISCUSSION: In our experience TOF 3D technique with TONE and single volume has well identified the origin of the vertebral arteries, while, in several cases, TOF 3D technique with TONE and double volume did not permit the visualization of the origin of the vertebral arteries due to the presence of the artefacts from overlapping. CONCLUSION: From our experience we have established that the TOF 3D technique with TONE and single volume makes it possible to obtain MR-angio of a high diagnostic quality in a short time (10-15 mn).

[Primary non-Hodgkin's lymphomas of the colon: apropos of a case with double localization]. / I linfomi primitivi non-Hodgkin del colon: a proposito di un caso a duplice localizzazione.

A case of non-Hodgkin's lymphoma involving the caecum and the rectum was resected. The disease occurs in 1-4% of gastrointestinal neoplasms and comprises 0.2-0.65% of colorectal tumours. The caecum is frequently involved while primary malignant lymphoma localized to the caecum and the rectum is more uncommon. The most representative histological types are histiocytic or lymphocytic tumours. The disease commonly presents as a painful abdominal mass and is associated with weight loss and diarrhoea. Barium enema and pancolonoscopy are sufficient for diagnosis, but echotomography and Tc scan are useful for staging. Surgery is the treatment of choice and overall 5-years survival is 30-40%. The role of adjuvant therapy has not yet been clearly defined, although data from some studies indicate increased survival in those patients given adjuvant therapy compared with patients treated with surgical resection alone.

[Intraoperative ultrasonic evaluation of the residual thyroid weight in thyroidectomy in diffuse toxic goiter]. / Valutazione ecografica intra-operatoria del peso tiroideo residuo nelle tiroidectomie per gozzo tossico diffuso.

The amount of thyroid tissue to be ablated in unresponsive Basedow disease has mainly, until now, been empirically evaluated. An attempt has been made, using intraoperative ultrasonography, to evaluate the residual tissue. This method allows weight calculation of the thyroid lobe to be ablated through two sonographic measurements of the superior pole axes. This technique provides a precise codification of the intervention and reduces the incidence of recurrence. The results six months after operation prove just two cases of latent hypothyroidism (10%).