1,720,997 research outputs found
[US-guided percutaneous management of femoral artery pseudoaneurysms by thrombin injection: personal experience and review of the literature].
No full textTreatment of femoral artery pseudoaneurysms includes US-guided compression, endovascular coil embolisation or stenting, thrombin injection and open surgical repair. Thrombin injection is currently the standard approach to all non-complicated pseudoaneurysms of the peripheral arteries. Between January 2001 and December 2004, 59 pseudoaneurysms of the femoral artery were submitted to percutaneous US-guided thrombin injection in our surgery division. Complicated pseudoaneurysms, patients in whom percutaneous treatment failed, and chronic pseudoaneurysms with large necks were excluded from this kind of treatment and underwent surgical repair. Eighteen patients were on therapeutic anticoagulation (30.5%) and none of the pseudoaneurysms had an associated arteriovenous fistula. All patients were submitted to clinical and ultrasound follow-up at 24 hours and at 1, 6 and 12 months, and thereafter at yearly intervals for evaluation of recurrences. The thrombin injection was successful in 57/59 patients (96.6%) while two patients (3.4%) were submitted to surgical treatment after failure of the procedure. In 1 patient (1.7%) an additional injection was necessary to achieve complete thrombosis of the pseudoaneurysm. No complications occurred; none of the patients reported discomfort and there was no request for sedation. No recurrences were seen at follow-up. Nowadays US-guided percutaneous thrombin injection is the treatment of choice for femoral artery pseudoaneurysms. Surgical treatment is reserved to rare selected cases. More studies are necessary to evaluate further indications for treatment of visceral or small distal artery pseudoaneurysms
Surgical treatment of abdominal aortic aneurysm with concomitant renal cell carcinoma: a single-centre experience with review of the literature.
No full textTreatment of abdominal aortic aneurysms associated with pancreatic tumors: personal experience and review of the literature (1967-2006)
No full textThe aim of the present study was to discuss the approach to a rare, but challenging, clinical situation: the coexistence of an abdominal aortic aneurysm (AAA) and a pancreatic tumor. The authors present their experience and a review of the literature of the last 40 years. From January 1988 to December 2006 the authors faced 3 cases of associated AAA and pancreatic neoplasia. Through a Medline search the authors found 15 cases of this comorbidity reported in the literature from 1967 to 2006, obtaining a total number of 18 cases. The treatment of the two diseases was in a single stage in 4 cases (22%) and in two stages in 5 cases (28%), while only one pathology was treated in 7 cases (39%) and no treatment at all was attempted in 2 cases (11%). Mortality was 0%, while morbidity was 22%, i.e. in 4 cases out of 18, although no aortic prosthesis infection was recorded. From literature analysis and their experience the authors concluded that the surgical strategy in cases of AAA and a pancreatic tumor is to be chosen depending on the pancreatic tumor prognosis, the AAA dimensions and the schedule of chemotherapy. According to the authors, AAA surgical repair is recommended in case of pancreatic cystic adenoma and neuroendocrine neoplasia, in view of their good prognosis, while endovascular repair (EVAR), when feasible, is better in patients with pancreatic adenocarcinoma
Early and Late Outcomes of Ultrasound-Guided Direct Transabdominal Embolization of Isolated Type 2 Endoleaks after Endovascular Aortic Repair
No full textBackground: The aim of this study is to report the early and late outcomes of ultrasound-guided direct transabdominal embolization (UGDTE) of isolated type 2 endoleak (T2EL) after endovascular aneurysm repair (EVAR). Methods: Forty-two consecutive T2EL patients were treated between February 2000 and September 2017 by UGDTE after previous EVAR. During the study period, UGDTE was the firs-line technique implemented for treatment of T2EL. All procedures were carried out using the same predefined technique. Aneurysm sac size change from the index treatment, freedom from recurrent endoleak after treatment, demographics, risk factors, and procedural factors were analyzed with univariate analysis. Results: During the study interval, 612 patients underwent standard EVAR for abdominal aortic aneurysm treatment and 111 (18.2%) developed an isolated T2EL. Of these, 42 (6.8%) consecutive patients were deemed suitable and treated with UDGT. Median imaging follow-up duration was 18.7 months. Median fluoroscopic and procedure times were 7 and 58 minutes, respectively. The rate of immediate technical success was 100%. Ten patients (23.8%) underwent reintervention for recurrent T2EL. Freedom from reintervention for T2EL at 1, 2, and 4 years was 81%, 78%, and 71%. No aneurysm-related mortality occurred during the follow-up period. Conclusions: The use of UGDTE for treatment of isolated T2EL after EVAR is a safe and feasible technique when performed by experienced operators, resulting in high technical success and low complication rates in selected patients. Although being effective in obtaining T2EL exclusion, up to one-third of the patients may require repeat intervention during long-term follow-up. Therefore, lifelong surveillance after the procedure is recommended
Renal cell carcinoma with invasion of the tricuspid valve apparatus
No full textA right atrial in-growth of renal carcinoma occurs in 1% of cases. A traditional approach to removal of the tumor using cardiopulmonary bypass (CPB) and deep-hypothermic circulatory arrest (DHCA) has been challenged in favor of techniques that allow tumor removal without CPB and DHCA. To the best of the present authors' knowledge, no report has yet been made of an invasion by the tumor of the tricuspid valve leaflets and subvalvular apparatus. The details of such a case are reported herein, where CPB + DHCA was used to completely remove the neoplasm, and to preserve tricuspid valve competence
Renal cell carcinoma with invasion of the tricuspid valve apparatus.
No full textA right atrial in-growth of renal carcinoma occurs in 1% of cases. A traditional approach to removal of the tumor using cardiopulmonary bypass (CPB) and deep-hypothermic circulatory arrest (DHCA) has been challenged in favor of techniques that allow tumor removal without CPB and DHCA. To the best of the present authors' knowledge, no report has yet been made of an invasion by the tumor of the tricuspid valve leaflets and subvalvular apparatus. The details of such a case are reported herein, where CPB + DHCA was used to completely remove the neoplasm, and to preserve tricuspid valve competence
Intraoperative US Staging of T in gastric cancer. Final Results of a blind prospective study.
No full textAbstract
Background
In order to improve the accuracy in the assessment of depth of tumor invasion, we performed an ultrasound examination of the resected specimen intraoperatively just after removal by the surgeon (Intraoperative Ultrasonography (IUS). This prospective blind study reports the results obtained with the IUS in the staging of T in a group of 281 patients who underwent curative gastrectomy for gastric cancer.
Methods
After the removal by the surgeon, the portion of the stomach harboring the tumor was submitted to ultrasonography with a linear 7.5 Mhz probe. An echo-free standoff pad was placed between the probe and the organ; a second echo-free standoff pad was interposed between the stomach and the support surface. The diagnosis of depth of invasion was based on the degree of disruption of the five-layer sonographic structure of the gastric wall.
Results
The IUS staging of T corresponded to the pathological diagnosis in 256 out of 281 cases (overall accuracy 91.1%). The sensitivity in the different classes of T was, respectively, 91.2 in T1m cases, 83.3 in the T1sm cases, 89.6 in the T2 cases, and 93.5% in the T3 cases.
Conclusion
The IUS on the resected specimen has a high degree of accuracy in the assessment of depth of tumor invasion and seems to be an important advance in the clinical staging of gastric cancer
Transhepatic fibrinolysis of mesenteric and portal vein thrombosis in a patient with ulcerative colitis: a case report.
No full textSheath-Anchoring for Rail Guidewire Technique to Advance and Deploy Thoracic Endograft in Hostile Anatomy
No full textBackground: To describe a bailout technique to advance and precisely deploy thoracic endograft in the ascending aorta in case of difficulty crossing the aortic arch. Case Reports: A 73-year-old man presented with a large ruptured aneurysms in the descending aorta. During the TEVAR, stent-graft passage through the aortic arch was impossible due to the severe tortuosity of the aorta. The problem has been resolved using the sheath-anchoring rail guidewire (SARG) technique. Results: Through an axillary access, a snare was used to capture the stiff wire from the femoral access. A sheath was advanced over the stiff wire to the ascending aorta and placed there. By exploiting the grip of the sheath on the stiff in the ascending aorta, it was possible to handle the tension, move the delivery system through the arch and carefully deploy the graft. Conclusion: The SARG is a simple and quick learning technique which can be useful for Physicians dealing with complex aortic arch anatomy
Usefulness of lipids, lipoprotein(a) and fibrinogen measurements in identifying subjects at risk of occlusive complications following vascular and endovascular surgery
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