Carla Virgilio

Low-intensity body building exercise induced rhabdomyolysis: a case report

IntroductionRhabdomyolysis is a severe and debilitating condition that promotes muscle breakdown and is a relatively rare, not always diagnosed cause of acute renal failure (ARF) with an 8–20% reported incidence. Exertional rhabdomyolysis only appears in adult patients 24–48 h after strenuous activities as military basic training, weight lifting, and marathon running.Case presentationA 30-year-old man was admitted to our department because of weakness and painful swelling of the muscles as well as dark urine appearing 24 h after carrying out a body-building exercises of low intensity. The development of an acute exertional rhabdomyolysis was confirmed by the increased serum enzyme levels and myoglobinuria. The patient was treated with intravenous sodium chloride, and sodium bicarbonate. The nephrotoxicity of myoglobin was decreased by forced alkaline diuresis.ConclusionThe reported case emphasizes the occurrence of acute rhabdomyolysis even in those who underwent a low-intensity exercise. A proper treatment is mandatory to avoid a sudden worsening of clinical conditions eventually evolving to acute renal failure.

Primary balloon angioplasty of small (≤2 mm) cephalic veins improves primary patency of arteriovenous fistulae and decreases reintervention rates

PURPOSE The purpose of this study was to evaluate the effect of primary balloon angioplasty (PBA) of cephalic veins with diameter≤2 mm on patency and maturation time of autogenous radiocephalic arteriovenous fistulae (AVF) for hemodialysis. METHODS Forty patients, all candidates for distal AVF, with a cephalic vein≤2 mm, were randomized to two different surgical procedures: (1) PBA of a long segment of the cephalic vein from the wrist up to the elbow (n=19); and (2) hydrostatic dilatation (HD) of a short venous segment (5 cm) at the level of the anastomosis (n=21). PBA was performed using a standard balloon 4×150 mm. Primary end points were primary patency and reintervention rates. Secondary end points were maturation time and the rate of working AVF. Follow-up included physical and duplex ultrasound (DUS) examinations at 1,4, and 8 weeks, and every 3 months thereafter. RESULTS Risk factors were homogeneously distributed between the two groups. Mean vein diameter was 1.8±0.2 mm for the PBA group and 1.7±0.2 mm for HD. Immediate success rate was 100% for PBA and 67% for HD groups (P=.04). Causes of failure in the HD group included early vein thrombosis in seven patients (33%). Mean fistula maturation time was 32 days in the PBA group and 55 days in the HD group (P=.04). During the mean follow-up of 7 months, three patients underwent drug-eluting balloon angioplasty for failure of AVF to mature due to stenosis (1 in the PBA group and 2 in the HD group). Six-month reintervention rate was significantly lower in the PBA group (5%) compared with the HD group (43%) (P=.02). At 6 months, primary patency rates were 95% in the PBA group and 57% in the HD group (P=.01). Working AVF rate was 100% in the PBA vs 90% in the HD group. CONCLUSIONS PBA of very small cephalic veins during the creation of a distal AVF for hemodialysis is a safe and feasible procedure. This technique assures excellent primary patency, maturation time, and dramatically decreases reintervention rate.

Ultrasonographic Study of Gallbladder Wall Thickness and Emptying in Cirrhotic Patients without Gallstones

Background and Aim. Gallbladder wall thickening and impaired contractility are currently reported in cirrhotic patients and often related to portal hypertension and hepatic failure. The purpose of this work was to evaluate, by ultrasonographic method, gallbladder wall thickness and gallbladder emptying after a standard meal in normal subjects and in patients with compensated liver cirrhosis without gallstones. Methods. Twenty-three patients with Child-Pugh class A liver cirrhosis and twenty healthy controls were studied. Gallbladder wall thickness (GWT), gallbladder fasting volume (FV), residual volume (RV), and maximum percentage of emptying (%E) were calculated. Measurements of mean portal velocity, portal vein flow, and serum albumin were performed too. Statistical analysis was assessed by Students “t test” for unpaired data. Results. GWT was 0.60 ± 0.22 cm in cirrhotic patients and 0.21 ± 0.06 cm in controls (P < .0001). FV and RV were, respectively, 37.8 ± 3.7 cm3 and 21.8 ± 3 cm3 in cirrhotic patients, 21.9 ± 4.2 cm3 and 4.6 ± 2.2 cm3 in healthy volunteers (P < .0001). %E was smaller in cirrhotics (42.6 ± 7.8) as compared to controls (80.3 ± 7.2; P < .0001). Conclusions. In patients with compensated liver cirrhosis without gallstones gallbladder wall thickness is increased whereas its contractility is reduced. These early structural and functional alterations could play a role in gallstone formation in more advanced stages of the disease.

Nickel Allergy in a Patient with a Nitinol Stent in the Superficial Femoral Artery

nurse. An online survey was administered to participants following attendance at Imagine IR 2.0; responses were analyzed for patterns and statistical significance by using Medcalc software (Medcalc, Ostend, Belgium). A total of 14 participants completed the survey, representing 70% of symposium attendees. Overall, participants demonstrated high interest in interventional radiology and diagnostic radiology as career choices, with mean 13-point Likert scores of 10.154 and 10.385, respectively. Approximately 50% of participants had previous exposure to radiology via previous observerships (n 1⁄4 4), previous hospital employment (n 1⁄4 2), and postgraduate medical imaging training (n 1⁄4 1). Participants found great utility in demonstrations from various interventional radiology industry representatives (Likert score, 11.077). Additionally, the didactic lectures delivered by interventional radiologists scored highly (Likert score, 10.308). There was a significant increase in students’ understanding of interventional radiology’s scope of practice after the symposium compared with baseline (Likert scores, 6.385 and 9.462; P 1⁄4 .0185). In addition, students were very likely to pursue a research or elective endeavor in interventional radiology and diagnostic radiology after attending the symposium (Likert scores, 10.923 and 10.385, respectively). Participants rated hands-on workshops first (ranking, 1.615), followed by live demonstrations (ranking, 2.231), problem-based learning cases (ranking, 3.000), self-directed e-modules (ranking, 4.000), and didactic lectures (ranking, 4.154). In addition, students agreed that problem-based learning inclusion would increase their level of interest in radiology and interventional radiology as a career (Likert scores, 10.154 and 10.077, respectively). Compared with traditional didactic lectures in undergraduate radiology education, problem-based learning cases (P 1⁄4 .0114), hands-on workshops (P o .0001), and live demonstrations (P 1⁄4 .0001) were preferred by students. The main lessons participants learned from Imagine IR 2.0 included understanding the scope and practice of interventional radiology (n 1⁄4 5), radiation dosing principles (n 1⁄4 4), and the evolution of interventional radiology technology (n 1⁄4 4). Exploration of the relevance, advantages, and disadvantages of radiology-focused problem-based learning has yielded four key principles: treating learning as a constructive process, being self-directed in nature, being a sociable and collaborative environment, and aiding

Endovascular repair of bilateral common iliac artery aneurysms using GORE Excluder iliac branch endoprosthesis without aortobi-iliac stent graft conjunction: A case report

Introduction: Bilateral common iliac artery (CIA) aneurysm (CIAA) is a rare entity. In the past decade, different endovascular approaches have been adopted for patients with several comorbidities or unfit for open repair (OR). Recently, the use of iliac branch stent graft has been proposed, resulting in satisfactory patency rates and decrease in morbidity. Currently, according to instruction for use, the iliac branch stent graft is to be used with aortobi-iliac stent graft conjunction. We describe a case of a successful endovascular repair of bilateral CIAAs using the GORE Excluder iliac branch endoprosthesis (IBEs) without aortobi-iliac stent graft conjunction. Case presentation: An 83-year-old man was admitted with abdominal pain and presence of pulsatile mass in the right and left iliac fossa. Computed tomographic (CT) angiography showed the presence of large bilateral CIAAs (right CIA = 66 mm; left CIA = 38 mm), without concomitant thoracic or abdominal aorta aneurysm. Moreover, CT scan demonstrated the presence of bilateral lower accessory renal artery close to the aortic bifurcation. Due to the high operative risk, the patient was scheduled for endovascular repair with bilateral IBEs, without the aortobi-iliac stent graft conjunction to avoid the renal ischemia as a consequence of renal arteries covering. The procedure was completed without complications and duplex ultrasound demonstrated the complete exclusion of both aneurysms without any type of endoleaks at 1 month of follow-up. Conclusions: GORE IBEs without aortobi-iliac stent graft conjunction seem to be a feasible and effective procedure for the treatment of isolated CIAAs in patients with highly selected anatomical conditions.

Emergency Endovascular Repair of Two Ascending Aortic Pseudoaneurysms

1. Park KB, Do YS, Kim SS, Kim DK, Choe YH. Endovascular treatment of acute complicated aortic dissection: long-term follow-up of clinical outcomes and CT findings. J Vasc Interv Radiol 2009; 20:334–341. 2. Shimono T, Kato N, Tokui T, et al. Endovascular stent-graft repair for acute type a aortic dissection with an intimal tear in the descending aorta. J Thorac Cardiovasc Surg 1998; 116:171–173. 3. Dake MD, Kato N, Mitchell RS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med 1999; 340:1546–1552. 4. von Segesser LK, Killer I, Ziswiler M, et al. Dissection of the descending thoracic aorta extending into the ascending aorta. A therapeutic challenge. J thorac Cardiovasc Surg 1994; 108:755–761. 5. Jazayeri S, Tatou E, Gomez MC, et al. Combined treatment of aortic type A dissection: ascending aorta repair and placement of a stent in the descending aorta. Heart Surg Forum 2003; 6:387–389. 6. Kato N, Shimono T, Hirano T, Ishida M, Yada I, Takeda K. Transluminal placement of endovascular stent-grafts for the treatment of type A aortic dissection with an entry tear in the descending thoracic aorta. J Vasc Surg 2001; 34:1023–1028. 7. Noor N, Sadat U, Hayes PD, Thompson MM, Boyle JR. Management of the left subclavian artery during endovascular repair of the thoracic aorta. J Endovasc Ther 2008; 15:168–176.

Factors influencing the hemodynamic response to balloon angioplasty in the treatment of outflow anomalies of internal jugular veins

OBJECTIVE Percutaneous transluminal angioplasty (PTA) of the internal jugular veins (IJVs) has been proposed in recent years to treat chronic cerebrovascular venous insufficiency, with discordant results. Moreover, very little is known about the efficacy of PTA in restoring a normal cerebral venous outflow. The aim of this study was to investigate the anatomic factors and patient characteristics that might influence the efficacy of PTA of the IJV. METHODS There were 797 consecutive patients with venous outflow anomalies who underwent standardized, operator-independent catheter venography and PTA of the IJVs. Before and after PTA, morphologic and hemodynamic anomalies of the IJVs were documented. The primary end point of the study was to evaluate the morphologic factors influencing the efficacy of angioplasty in improving IJV outflow. RESULTS PTA resulted in an increased outflow through the IJVs in most patients. However, younger individuals with transverse endoluminal defects and higher pre-PTA flows are more likely to respond well to PTA compared with those who exhibit hypoplasia, stenosis, or longitudinal endoluminal defects. CONCLUSIONS This study identified the factors that influence and could predict the efficacy of PTA in the treatment of IJV anomalies.

Isolated Common Iliac Artery Aneurysms Treated Solely With Iliac Branch Stent-Grafts: Midterm Results of a Multicenter Registry

Purpose: To assess early and midterm outcomes of iliac branch device (IBD) implantation without an aortic stent-graft for the treatment of isolated common iliac artery aneurysm (CIAA). Methods: From December 2006 to June 2016, 49 isolated CIAAs in 46 patients were treated solely with an IBD at 7 vascular centers. Five patients were lost to follow-up, leaving 41 male patients (mean age 72.5±7.8 years) for analysis. Mean CIAA diameter was 39.1±10.5 mm (range 25–65). Thirty-two patients (2 with bilateral CIAAs) were treated with a Cook Zenith iliac branch device; 9 patients (1 bilateral) received a Gore Excluder iliac branch endoprosthesis. Primary endpoints were technical success, survival, aneurysm exclusion, device patency, and freedom from reintervention at 1 and 5 years. Freedom from major adverse events and aneurysm shrinkage at 1 year were also assessed. Results: Thirty-day mortality and the IBD occlusion rate were 2.4% and 2.3%, respectively. At a mean follow-up of 40.2±33.9 months, no patient presented buttock claudication, erectile dysfunction, or bowel or spinal cord ischemia. Three patients died within 6 months after the procedure. Estimates of cumulative survival, device patency, and freedom from reintervention were 90.2%, 95.2%, and 95.7%, respectively, at 1 and 5 years. At 1 year, CIAA shrinkage ≥5 mm was recorded in 21 of 38 survivors. No evidence of endoleak, device migration, or disconnection was found on imaging follow-up. Conclusion: The use of IBDs without an aortic stent-graft for isolated CIAAs resulted in excellent patency, with low morbidity and mortality. This, in conjunction with no endoleak or migration and a low reintervention rate, supports the use of isolated IBDs as a stable and durable means of endovascular reconstruction in cases with suitable anatomy. Longer follow-up and a larger cohort are needed to validate these results.

Novel Compliant Scaffold with Specific Design for Venous System: Results of a Porcine Model Study

Background Stenting has become the first-line treatment of obstructive venous disease because of poor results of balloon angioplasty. This preclinical study aimed to investigate the safety and efficacy profile of a novel compliant venous scaffold (CVS) denominated Petalo CVS, specifically designed for venous diseases. Materials and Methods Twelve healthy pigs weighing 90 kg were used to test Petalo CVS. The devices were implanted into the internal jugular veins (IJVs) using a femoral vein percutaneous approach. The safety profile including the success rate of device releasing, anchoring, and positioning was evaluated immediately. Fracture, migration, primary patency, and endothelial response were assessed at 1, 2, 3, and 6 months after the study procedure. Results A total of 32 devices were successfully released in both IJVs. No procedure- or device-related complications were reported, and all pigs successfully completed the different scheduled follow-up periods. The primary patency rate was 100%, and no fracture or migration of the device into the brachiocephalic trunk was reported. Histological examination revealed only minimal lesions with minimal or absent inflammatory reaction surrounding the incorporated metallic rods. Conclusions This porcine model study showed a promising safety and efficacy profile of Petalo CVS, a novel endovenous device based on specific concepts.

Endovascular Treatment of Chronic Occluded Popliteal Artery Aneurysm

Critical limb ischemia may be the consequence of chronic occlusion of an aneurysm of popliteal artery. Endovascular repairs have the potential to be less invasive than open surgery and to allow the treatment, during the same procedure, of occlusive infrapopliteal diseases achieving a better distal outflow. Eleven patients with occluded popliteal artery aneurysm (PAA) underwent an endovascular repair of PAA using a new technique, by positioning of a Viabahn graft inside a bare nitinol stent, deployed at the level of aneurysm with the intent to avoid distal embolization and to assure an external scaffold for the Viabahn graft. Immediate success rate was 100%. A peroneal artery embolization occurred in 1 patient (9%) and was successfully treated by stent implantation. Four (36.4%) patients needed a below-the-knee revascularization to achieve at least 1 vessel line to the foot. Mean postoperative hospital stay was 2.6 days. At 24-month follow-up, primary patency, target lesion revascularization, and major amputation rates were 82%, 9%, and 0%, respectively. All patients are still alive at last follow-up visit. The endovascular repair with the combined use of a bare metal stent and Viabahn graft resulted in a low incidence of distal embolization and major amputation rate, with an excellent 24-month patency rate, and may offer a safe alternative to open surgery for the treatment of occluded PAAs.