Dario Poretti

Percutaneous Image-Guided Cryoablation of Breast Cancer: A Systematic Review.

A systematic review of the clinical safety and efficacy of percutaneous breast cancer cryoablation was performed. Of 202 papers screened, seven matched the inclusion criteria. Cryoablation was mainly performed under ultrasound guidance, and on average two cryoprobes were used. Complete local tumor control was noted in 73% of patients (mean follow-up, 8 mo). No major complications were noted. The cosmetic outcome was satisfactory. Breast cancer cryoablation is safe, although local tumor control is suboptimal. The best results are achieved with small (<15 mm) ductal tumors treated by application of multiple cryoprobes.

Transarterial Therapies for Hepatocellular Carcinoma

Background: The treatment of hepatocellular carcinoma (HCC) is still a major health issue because of its increasing incidence and because of the complexity of its management. Transarterial embolization (TAE) and transarterial chemoembolization (TACE) are two widely used locoregional therapies in the treatment of HCC, especially for unresectable intermediate and advanced HCCs. Summary: The modern use of TAE and TACE opens new scenarios for the treatment of unresectable HCC and has yielded interesting results. The present work describes the role of transarterial therapies for HCC and focuses on the different Western and Eastern approaches to the study of response predictors. Key Messages: Recent refinements in interventional radiology techniques and in HCC patient selection have facilitated better local control of the disease. The molecular profiling of HCC to predict the response to TACE and TAE will greatly help clinicians identify the optimum therapy.

Role of interventional radiology in the management of complications after pancreatic surgery: a pictorial review.

AbstractPancreatic resections are surgical procedures associated with high incidence of complications, with relevant morbidity and mortality even at high volume centres. A multidisciplinary approach is essential in the management of these events and interventional radiology plays a crucial role in the treatment of patients developing post-surgical complications. This paper offers an overview on the interventional radiological procedures that can be performed to treat different type of complications after pancreatic resection. Procedures such as percutaneous drainage of fluid collections, percutaneous transhepatic biliary procedures, arterial embolisation, venous interventions and fistula embolisation are viable treatment options, with fewer complications compared with re-look surgery, shorter hospital stay and faster recovery. A selection of cases of complications following pancreatic surgery managed with interventional radiological procedure are presented and discussed. Teaching Points • Interventional radiology is crucial to treat complications after pancreatic surgery • Percutaneous drainage of collections can be performed under ultrasound or computed tomography guidance • Percutaneous biliary procedures can be used to treat biliary complications • Venous procedures can be performed effectively through transhepatic or transjugular access • Fistulas can be treated effectively by percutaneous embolisation

Endovascular treatment of an anastomotic iliac pseudoaneurysm after surgical aortic repair using a Cardiatis multilayer stent

The Cardiatis multilayer stent (Cardiatis, Isnes, Belgium) is a cobalt, self-expandable bare stent made of two interconnected layers without any covering that allows a pressure decrease and thrombus formation into an aneurysmal sac, while improving laminar flow in the main artery and surrounding vital branches. We report a case of an anastomotic iliac pseudoaneurysm successfully treated with the deployment of a Cardiatis multilayer stent.

Colonic Ischemia, Perforation, and Colectomy after a Complicated Endovascular Embolization for Type II Endoleak with the Use of Cyanoacrylate Glue

one case, postmortem examination revealed a catheter fragment lodged in the valve after the malpositioned catheter had been pulled back at bedside and the tip unknowingly left behind. These events did not result in immediate lethal malfunction; rather, acute alterations in cardiac output eventually progressed to unrecoverable circulatory collapse over the span of 2–5 days. Recognition of catheter or wire entanglement with the artificial valve may allow for immediate retrieval with only transient cardiovascular impairment. It is unclear what the long-term sequelae of such an event would be and whether normal flow dynamics could be restored. This event remains a significant risk that should be mentioned while obtaining informed consent from the patient and during documentation after the procedure. In the right clinical setting, similar transvenous procedures can be offered to patients with a Total Artificial Heart. We chose an A-shaped multipurpose catheter because it is easily torqued and allows directional passage of a wire. This is our standard access catheter for transvenous liver biopsies; however, any similar type of catheter would have sufficed. A stiff exchange wire

Iatrogenic Pulmonary Pseudoaneurysm Treated with Percutaneous Coil and Glue Embolization

A 76-year-old female patient experienced recurrent hemoptysis in the first 48 hours after thoracotomy for mitral valve replacement. On multidetector computed tomography (CT), a large lung pseudoaneurysm of the right middle lobe was detected (Fig 1), which showed contrast enhancement similar to that of the aorta. The patient was, therefore, referred to the interventional radiology service to undergo endovascular embolization. Despite selective angiography of multiple bronchial arteries, no feeding vessels were detected. Pulmonary angiography (Fig 2) ruled out supply from the pulmonary arteries. Therefore, the pseudoaneurysm was directly punctured with a Chiba needle under fluoroscopic guidance, and a small amount (0.5 mL) of n-butyl cyanoacrylate (NBCA; Glubran 2; GEM, Viareggio, Italy) was injected in the pseudoaneurysm sac. However,

Role of US-guided Percutaneous Drainage in Management of Lower Limb Spontaneous IntraMuscular Hematoma

To the Editor, We read with great interest the article by Popov et al. [1] about the management of spontaneous intramuscular hematomas (SIMH) through transarterial embolization (TAE); as in previous papers [2, 3], authors focused on abdomen and pelvis, the mainly interested areas in SIMH development. However, SIMH can occur in different locations, and cases are expected to increase due to the extensive use of anticoagulation therapy in elderly highly comorbid patients. Furthermore, in this clinical scenario, the endovascular approach appears difficult [2], and its role in the therapeutic algorithm results more troublesome [4, 5]. An 84-years-old man suffering from post-ischemic cardiomyopathy, hypertension, chronic kidney failure, and anemia, treated with acetylsalicylic acid (ASA), was admitted to our Emergency Department for worsening of lower extremities swelling. Blood specimen showed serum Creatinine of 3.05 mg/dL, Hb of 7.9 g/dL, and D-dimer of 7.030 mg/dL; US-Doppler scan found deep vein thrombosis in the right thigh. Immediately, ASA was suspended, and treatment with subcutaneously Calcic Nadroparin was started. In the following hours, the patient developed diffuse ecchymosis at upper and lower limbs associated with shock signs and Hb of 4 g/dL; emergency CT-angiography (Fig. 1) showed an extensive hematoma in the right thigh with contrast-medium active extravasation. The patient was immediately transferred to angiographic suite for arteriography, which revealed no active blood loss from deep and/or superficial femoral artery (SFA) branches (Fig. 2A). To depict the bleeding, it was decided to drain the blood collection through US-guided 12 Fr pigtail drainage catheter; around 3000 mL of blood was drained. Once removed the hematoma, contrast-medium extravasation was depicted at the level of Hunter’s canal from a narrow SFA muscular branch, originating close to an atherosclerotic plaque (Fig. 2B). Although a 2.4 Fr microcatheter was used, catheterization was not possible, and empirical embolization was unfeasible. Therefore, a compressive dressing was applied to the thigh, and different compression degrees were evaluated until arteriography revealed no active hematoma supply (Figs. 2C and D); finally, the drainage catheter was removed. The patient remained stable and removed the compressive dressing after 5 days; nevertheless, renal and cardiac functions deterioration and septic status due to CVC infection led patient to death 7 weeks later. SIMH in the thigh have similar risk factors and clinical presentation compared with other locations, but for the low incidence, the management is actually poor defined, especially in unstable patients; considering common recurrence, difficult vascular pedicle identification, and high infection risk, TAE represents a reasonable therapeutic alternative to the surgical options [2, 4, 5]. However, the bleeding source can be hard to find due to the hematoma compressive effect; otherwise, when the bleeding vessel is well& Felice D’Antuono felixdant@hotmail.it

Inferior vena cava septic thrombosis due to gut perforation after accidental toothpick ingestion

A 57-year-old male patient was referred to our emergency department complaining of irremediable abdominal pain associated with mild fever. Abdominal CT scan revealed the presence of a small bowel perforation caused by an ingested toothpick, in association with a subsequent inferior vena cava thrombosis.