310
Endovascular Treatment of Hepato- Carcinoma Using Drug Delivering Microspheres (Terumo DC Bead)
Piergiorgio Nardis, Massimiliano Allegritti, Emanuele Boatta, Paolo Rabuffi, Filippo Salvatori, Mario Bezzi, Fabrizio Fanelli, Roberto Passariello
Università La Sapienza di Roma, Dipartimento Scienze Radiologiche, Policlinico Umberto I – Roma
Purpose: To report early- and mid-term results of TACE performed with drug-eluting Beads (DC-Beads) in the treatment of unresectable HCC evaluating nodule response rate and patient response rate.
Materials and Methods: Thirty-two class A and B cirrhot- ics (21 male, 11 female; age 46–82) with unresectable HCC received segmental chemoembolization using DC-Beads (100–500μ) pre- loaded with 100 mg of Epirubicin.
Fifty-three nodules ranging between 6 and 80 mm (mean 26.1 mm) were treated. Pseudocaspule was present in 17 nodules.
Response rate was assessed by contrast-enhanced CT scan at 1, 3 and 6 months; treated nodules were classified according to the response rate: A: complete necrosis of the nodule; B: <30% of hypervascolar tissue; C: 30–50% hypervascular tissue; D: > 50% hypervascular tissue.
Patients response rate was based on EASL criteria.
Results: No major procedure-related complications were observed.
At six-months CT scan 45.5% of nodules were in class A, 16% in class B, 13.5% in class C and 25.5% in class D. If only capsulated lesions are considered, group A + B response were seen in 86.6% of cases.
Following EASL criteria, 26% of patients showed Complete Response, 37% Partial Response, 11% Stable Disease and 11% Progressive disease; Objective Response (Complete Response + Partial Response) was observed in 63% of patients.
Conclusions: As reported in the literature and from our results TACE performed with drug eluting beads seems to be a safe and promising technique in the treatment of unresectable HCC; assessment of nodules response rate suggests that best results are obtained in patients with single capsulated lesions.
311
Seven Years of Experience in Carotid Artery Stenting with Cerebral Protection Device
Emanuele Boatta, Fabrizio Fanelli, Paolo Rabuffi, Armando Pucci, Filippo Salvatori, Roberto Passariello
Università La Sapienza di Roma, Dipartimento Scienze Radiologiche, Policlinico Umberto I – Roma
Purpose: To evaluate the results and the technical aspects of seven-year experience in carotid artery stenting (CAS) performed with different cerebral protection devices in order to prevent thromboembolic complications.
Materials and Methods: From February 2000, 314 patients with internal carotid artery stenosis underwent carotid artery stenting (331 procedures were performed). They were 213 men and 101 women (age 65–87 years, mean 71,4 y.). One-hundred- twenty-one patients wee symptomatic with stenosis > 50% and 193 were asymptomatic with stenosis > 80%; 282 primary stenosis and 49 stenosis secondary to TEA were treated. Seventeen patients underwent bilateral stenting. A cerebral protection device was used in 314 cases in order to prevent cerebral embolization; 17 cases (5,1%) were performed without cerebral protection. All cases were performed using self-expandable metallic stents. A cerebral MRI examination with diffusion and perfusion sequences was olso performed before and after the procedure to evaluate neurological complication occurred during CAS.
Results: Technical success (residual stenosis < 30%) was obtained in all cases (100%). The mean follow-up was 21,5±15,8 months. Thirty-days mortality was 1/314 cases (0,3%). One year mortality was reported in 2/314 cases (6,3%). Six major complica- tion were observed (1,8%): 3 periprocedural major strokes (0,9%) and 3 post-procedural (within 3 days) major strokes (0,9%). In 21 cases (6,3%) embolic material was found inside the cerebral pro- tection. In 4 cases a moderate itra-stent restenosis was observed (1,2%) and treated with angioplasty in 2 cases an with angioplasty and re-stenting in the other two cases.
Conclusions: CAS represent a feasible procedure that can be performed in high-risk patients and it is associated with a low restenosis rate.
312
The Management of Left Subclavian Artery in The Treatment of Thoracic Aortic Disease
Fabrizio Fanelli, Emanuele Boatta, Mario Corona, Filippo Salvatori, Armando Pucci, Roberto Passariello
Università La Sapienza di Roma, Dipartimento Scienze Radiologiche, Policlinico Umberto I – Roma
Purpose: To assess clinical consequences and complications after intentional occlusion of left subclavian artery (LSA) during stent-graft deployment for thoracic aortic pathologies.
Methods and Materials: From December 2000, 43 type B dissections and 20 thoracic aneurysms (TAA) underwent endo-
vascular treatment. A short proximal neck (<2 cm) was present in 23/43 dissections and in 6/20 TAA. Pre-treatment evaluation of carotid and vertebral arteries was done in all cases. Dissection: all LSAs were covered by the stent-graft. TAA: LSA origin was cov- ered in five cases.
Results: After LSA exclusion, blood pressure in the left arm significantly decreased. TAA: 5/5 patients were asymptomatic; two endoleaks (40%) originating from the LSA were evident. Dissection: 1/23 patient (4.3%) required a surgical transposi- tion of the LSA for visual impairment eight months after. In eight patients (34.8%), revascularization of the false lumen occurred from the LSA. Endoleak sealed spontaneously in one case (12.5%). LSA origin and false lumen were occluded with coils (N=1), glue (N=4) and coils+glue (N=2).
Conclusions: Prophylactic LSA transposition is not nec- essary prior to stent-graft placement. For the high incidence of endoleaks, occlusion of the LSA during stent-graft deployment is highly recommended.
313
The Rule of Viabil in Malignant Biliary Obstruction
Paolo Rabuffi, Fabrizio Fanelli, Emanuele Boatta, Massimiliano Allegritti, Antonio Bruni, Mario Corona, Roberto Passariello
Università La Sapienza di Roma, Dipartimento Scienze Radiologiche, Policlinico Umberto I – Roma
Purpose: To compare clinical effectiveness of ePTFE covered metallic stents with uncovered stents for palliative treatment of malignant jaundice due to cholangiocarcinoma.
Materials and Methods: Fifty patients with inoperable cholangiocarcinoma Bismuth types I-II and no hepatic metastasis were admitted for palliation. They were 28 men and 22 women (age 39–86, mean 62,3). Stricture was located in upper CHD (without infiltrating the duct confluence) in four patients, lower CHD in13, upper CBD in 22 and lower CBD in 11.There was no infiltration of the cystic duct. We used 36 Wallstents (Boston Scientific) 6–9 cm long and 10 mm wide in 30 patients (group A) and 21 Viabil (W.L. Gore) covered stents with and without side holes in 20 patients (group B). All patients were followed –up until death.
Results: Technical success was 100% in both groups. Early stent occlusion was noted in one group B patient due to sludge for- mation and was treated by dilation. Complication rate was 13,3% in group A and 10% in group B. One year primary patency was 54% for group A and 77,2% in group B.
Conclusion: Viabil stents offer a significantly better 12-month primary patency than mesh stents in the palliation of malignant strictures due to cholangiocarcinoma without hepatic metastasis.
314
Endovascular Revascularization for Limb Salvage in Diabetic Patients
R. Gandini, E. Pampana, L. Di Vito, M. Di Primio, C.A. Reale, A. Spinelli, S. Fabiano, G. Simonetti
Department of Diagnostic Imaging, University Polyclinic of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
Purpose: To evaluate short- and long-term results in dia- betic Patients who underwent endovascular revascularization for limb salvage.
Material/Methods: From 2001 to 2007 635 diabetic Patients, were treated with different endovascular techniques to obtain a direct flow to the foot and to avoid major amputation. All the lesions were staged with Texas classification: 65 Patients (10.25%) stage IIB, 80 (12.6%) IIC, 109(17.16%) IID, 16 (2.52%) IIIA, 115 (18.11%) IIIB, 129 (20.31%) IIIC and 121 (19.05%) IIID. The only contraindication is the lack of visualization of the plantar arch and/or the pedal artery. All Patients were previously assessed with clinical evaluation, TcPO2/TcPCO2 measurement and stud- ied with angiographic-MRI or angiographic-CT. The Patients had several comorbidities (coronary arteries disease, hypertension, nephropathy).
Results: Post-intervention evaluation included measurement of TcPO2/TcPCO2, clinical evaluation and ultrasound. Technical success was 95.6%. The 1.9% of Patients despite technical success underwent to amputation for ostheomielitis and microangiopa- thy. 68(10.7%) Patients underwent re-intervention, for not healed wounds or decrease of TcPO2. The success rate was achieved in 53(8.34%). Mean follow-up time was 24 months. The rate of limb salvage and major amputation was 91.34% and 8.66% respec- tively.
Conclusion: Endovascular revascularization shows an high technical success rate with an elevated success rate of re-interven- tion and should be considered as the primary preferred therapeu- tic option in lower limb salvage for diabetic Patients.
315
Trans-Caval Endoleak Embolization (TCEE) for Type I and/or Type II Endoleak
R. Gandini, E. Pampana, S. Fabiano, M. Di Primio, L. Boi, L. Di Vito, G. Simonetti
Department of Diagnostic Imaging, University Polyclinic of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
Purpose: To investigate the feasibility, efficacy of an alter- native technique for treatment of type I or/and II endoleak after endovascular repair, through transfemoral-caval approach of abdominal aortic aneurysm (AAA) with adhesion to vena cava.
Methods and Materials: Twelve-years single centre expe- rience in treatment of endoleaks was reviewed. In the last year, 23 patients (13 with type II, 9 with type I and 1 with type I and II endoleak) were treated with transfemoral-caval puncture and
embolization inside the aneurysm sac. This was performed using a combination of coils, N-butyl-cyanoAcrylate (Glubran 2) and thrombin. Coils in number from 10 to 21/patient and mean size of 9x60 mm and maximum 1 ml of glue, thrombin was enough to achieved occlusion of endoleak.
Results: Population of study is 23 patients (14 men, 9 women; mean age 77.2 years). The mean time of follow-up was 16 months. Technical success after endoleak treatment using TCEE technique was achieved in all cases (100%). During the follow-up time any aneurysm-related death or diameter increase of aneurysmal sac was shown and endoleak recurrence was observed in one case.
Conclusion: TCEE represents an original technique of type I and/or II endoleak treatment which seems to be safe, feasible and can offer new possibilities for the treatment of this complication.
316
An Up to Eight-Year Follow-Up of
Endovascular Treatment of Internal Carotid Artery Stenosis: Our Results
Roberto Gandini, Francesco Versaci, Enrico Pampana, Sebastiano Fabiano, Matteo Stefanini, Alessio Spinelli, Carlo Andrea Reale, Massimiliano Di Primio,
Eleonora Gaspari, Giovanni Simonetti
Department of Diagnostic Imaging, University Polyclinic of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
Objective: Carotid artery stenting (CAS) may be an alter- native to endoarterectomy not only in high-risk patients. Few data are available on the long-term clinical efficacy of CAS and on the incidence of restenosis. Our experience demonstrates that if requirements are fulfilled CAS can be considered an effective treatment with short and long-term high success rates.
Methods: April 1999–March 2008 we treated 1050 patients (1160 arteries) affected by internal carotid artery stenosis. 603 (52%) were symptomatic lesions, and 557 (48%) asymptomatic. The preprocedural evaluation was performed with DopplerUS, Angio-MR/Angio-CT and a neurologic evaluation. Antiplatelet therapy was administered before and after the procedure.
Results: Technical success was achieved in 1155 cases (99.6%) and a cerebral protection device successfully used in 1078 proce- dures (92.9%). The 30-day TIA/stroke/death rate was 2.16%: death (0.18%) major stroke (0.45%) and minor stroke-TIA (1.53%).
During an up-to-8-year follow-up restenoses occured in 39 cases(3.36%), of which 28 were post-CAS(2.41%) and 11 after a CAS due to post-TEA(0.95%) restenosis. Only 5 symptomatic restenoses >80% were retreated with an endovascular treatment.
Conclusions: CAS is an effective treatment with better results compared to endarterectomy.In our follow-up CAS seems to be effective in the prevention of stroke with a low restenosis rate.
317
Male Varicocele: Transcatheter Foam Sclerotherapy with Sodium Tetradecyl Sulfate – Outcome in 512 Patients
R. Gandini, E. Pampana, D. Konda, M. Di Primio, L. Boi, L. Di Vito, A. Spinelli, G. Simonetti
Department of Diagnostic Imaging, University Polyclinic of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
Purpose: Retrospectively evaluate the recurrence rate, reso- lution of pain, improvement of semen parameters, and achieve- ment of pregnancy after transcatheter foam sclerotherapy (TCFS) in varicocele by using sodium tetradecyl sulfate (STS) foam.
Methods: We conducted a retrospective study in 512 consec- utive male patients (mean age, 27.6 years; range, 16–42 years) with 694 varicoceles treated with TCFS between January 2000 & March 2008. The gonadal vein was then selectively catheterized; a foam of 3% STS and air was injected. Follow-up was performed with physical and Doppler ultrasonographic examinations; by using a questionnaire-based assessment of pain and pregnancy and semen analysis was performed.
Results: Technical success was 97.5% (677 varicoceles). Complete follow-up results (mean, 91.6 months) in 568 varico- celes (81.8%) revealed 19 (3.3%) grade II-III recurrent varicoce- les and resolution of pain in 337 (96.8%) of 348 cases. Significant improvement of semen parameters was achieved in infertile patients. Of 145 patients with pretreatment sperm alterations who desired pregnancy, 65 (44.8%) achieved pregnancy.
Conclusion: TCFS in male varicocele with STS foam was associated with a low recurrence rate, pain resolution, and an improvement of pretreatment sperm parameter alterations; a substantial increase in pregnancy achievement was obtained for patients who desired pregnancy.