Elisa Cotta

Radiofrequency ablation of intrahepatic cholangiocarcinoma: preliminary experience

The purpose of this study was to evaluate the safety and efficacy of percutaneous ultrasound (US)-guided radiofrequency ablation (RFA) in patients with intrahepatic cholangiocarcinoma (ICCA) in a small, nonrandomized series. From February 2004 to July 2008, six patients (four men and two women; mean age 69.8 years [range 48 to 83]) with ICCA underwent percutaneous US-guided RFA. Preintervetional transarterial embolization was performed in two cases to decrease heat dispersion during RFA in order to increase the area of ablation. The efficacy of RFA was evaluated using contrast-enhanced dynamic computed tomography (CT) 1 month after treatment and then every 3 months thereafter. Nine RFA sessions were performed for six solid hepatic tumors in six patients. The duration of follow-up ranged from 13 to 21 months (mean 17.5). Posttreatment CT showed total necrosis in four of six tumors after one or two RFA sessions. Residual tumor was observed in two patients with larger tumors (5 and 5.8 cm in diameter). All patients tolerated the procedure, and there with no major complications. Only 1 patient developed post-RFA syndrome (pain, fever, malaise, and leukocytosis), which resolved with oral administration of acetaminophen. Percutaneous RFA is a safe and effective treatment for patients with hepatic tumors: It is ideally suited for those who are not eligible for surgery. Long-term follow-up data regarding local and systemic recurrence and survival are still needed.

Complications of microwave and radiofrequency lung ablation: personal experience and review of the literature

PurposeComplications correlated with percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) of lung tumours were retrospectively reviewed to compare them with data from the literature and to assess risk factors related with the procedures.Materials and methodsFrom January 2003 to January 2009, 29 patients (36 lung lesions) were treated with RFA; from January 2007 to January 2009, 16 patients (17 lung lesions) were treated with MWA. Complications recorded at our institution are reported following the Society of Interventional Radiology guidelines. A systematic review of the literature was performed.ResultsAny major complication of RFA or MWA was recorded. In agreement with the literature, pneumothorax was the most frequent complication, even though the incidence in our series was lower than reported in the literature (3.5% vs. 4.3–18%). Other complications of RFA were pleural effusion and subcutaneous emphysema. No massive haemorrhages, haemoptysis, abscesses, pneumonia, infections or tumour seeding were recorded in our series. The most common complication of MWA was pneumothorax (25% vs. 39% reported in the literature). Pleural effusion was a common reaction, but therapeutic drainage was never required.ConclusionsPneumothorax is the most common complication of both techniques. RFA and MWA are both excellent choices in terms of safety and tolerance.RiassuntoObiettivoScopo del presente studio è stato analizzare retrospettivamente le complicanze registrate nel trattamento termo-ablativo con radiofrequenze (RFA) e con microonde (MWA) di tumori polmonari, confrontarli con i dati riportati in letteratura e valutare i fattori di rischio correlati alle due procedure.Materiali e metodiDa gennaio 2003 a gennaio 2009, 29 pazienti (36 lesioni polmonari) sono stati trattati con RFA; da gennaio 2007 a gennaio 2009, 16 pazienti (17 lesioni polmonari) sono stati trattati con MWA. Le complicanze da noi registrate sono state riportate seguendo le linee guida della Society of Interventional Radiology (SIR). È stata eseguita anche una revisione della letteratura.RisultatiNessuna complicanza maggiore è stata osservata. In accordo con i dati presenti in letteratura, lo pneumotorace è la complicanza più frequente anche se la sua incidenza nella nostra casistica è più bassa (5,8% versus 4,3%–18% in letteratura). Nella nostra casistica, le complicanze post-RFA includono la soffusione pleurica e l’enfisema sottocutaneo. Non è stato osservato nessun caso di emorragia massiva, emottisi, nessuna infezione polmonare, né ascesso né disseminazione tumorale. Anche, nei pazienti trattati con MWA, la complicanza più frequente è stata lo pneumotorace (25% versus 39% riportato in letteratura). La soffusione pleurica è un riscontro frequente, ma in nessun caso è stato necessario il posizionamento di un drenaggio.ConclusioniLo pneumotorace è la complicanza più frequente in entrambe le procedure. La termo-ablazione percutanea, sia RFA che MWA, rappresenta un’ottima opzione terapeutica in termini di sicurezza e tolleranza.

Percutaneous radiofrequency thermal ablation of renal cell carcinoma: Is it possible a day-hospital treatment?

PURPOSE The aim of this study is to evaluate the feasibility of the procedure in day-hospital and discuss prognostic factors, efficacy and complications of percutaneous radiofrequency ablation in the treatment of renal cell carcinoma. MATERIALS AND METHODS Between January 2003 and August 2008, 26 patients (mean age 79, range 70-87 years, 15 men and 11 women) affected by 27 kidney tumoral lesions, 25 RCC and two renal oncocitome (one patient was affected by two RCC), undergo 29 treatments of RFA (three patients underwent two treatments due to residual tumor at the CT performed 1 month after the first treatment). Three out of 26 patients had only one kidney due to progressed nephrectomy because of RCC; three/26 patients were carriers of oncological comorbidity while four/26 patients were carriers of medical comorbidity. The remaining 16/26 patients refused the surgical option. The lesions had a diameter between 1 and 4 cm (average diameter 2.4 cm). Seventeen of the 27 lesions were exophytic, five/27 parenchymal, three/27 was central while two/27 was mixed. All the lesions had been characterized either by CT or MRI. On the basis of the same investigation the feasibility of the radiofrequency procedure was verified. For all the procedures the RF type 3000 radiofrequency generator system was used together with the LeVeen ago-electrode. Twenty-one lesions out of 27 were treated under ultrasound guidance while six/27 lesions under the CT guide. After the procedure a US control was performed to exclude early complications and the same day the patients were discharged from hospital: the procedure was performed in day-hospital. RESULTS The technical success of the procedure was obtained in all cases (100%). After the procedure, 18 patients, without complications and comorbidity, were discharged from hospital the same day, seven patients with comorbidity were kept under observation for one night while one patient was hospitalized. The primary success of the treatment, rated with CT or MRI after 1 month, was obtained in 25/27 of the cases. In two/27 lesion, an incomplete ablation was obtained; for this reason these patients underwent a second treatment and after 6 month of a regular follow-up, no more neoplastic tissue was identified. During the follow-up there were no signs of disease in any patients. No major peri-procedural complications were recorded; only one patient had to be assisted for the appearance of a peri renal liquid (urinoma) and a thin pneumothorax layer that resolved completely in few days after the procedure. CONCLUSIONS Preliminary results with RFA of RCC are promising. Radiofrequency thermal ablation could prove to be a useful treatment for patients who are unsuitable for surgery; in this study we demonstrate the feasibility of the treatment in day-hospital for selected patients.

Initial experience with percutaneous biopsies of bone lesions using XperGuide cone-beam CT (CBCT): technical note

PurposeThis paper describes our preliminary experience with percutaneous bone biopsy under XperGuide conebeam computed tomography (CBCT) guidance.Materials and methodsSeventeen patients (11 men and 6 women; mean age 57.8; range 17–81) with 17 bone lesions underwent biopsy with XperGuide CBCT (Philips Medical System, Best, The Netherlands). The mean diameter of the lesions was 2.32 cm (range 1–8 cm). Technical success (defined as the correct positioning of the needle within the lesion), diagnostic accuracy, sensitivity and specificity were evaluated. Complication rate was also recorded.ResultsThe technical success rate was 100%. In 15 patients, a sample of adequate material for histopathological analysis to yield a definitive diagnosis was obtained; in two patients, the sample was inadequate for a definitive diagnosis. In one of these two cases, the lesion was closely followed up for 1 year, during which it remained stable in size, and as a result, it was considered a false positive; the other was considered a false negative. Diagnostic accuracy, sensitivity and specificity were 94.12%, 90.91% and 100%, respectively. No major complications were recorded; only one patient had slight bleeding, with a consequent small haematoma, which reabsorbed in about 15 days.ConclusionsBone biopsy under XperGuide CBCT guidance can be considered accurate as a result of the combination of real-time needle orientation and spatial resolution of CT fluoroscopy. Moreover, our results are encouraging in terms of complication rate, diagnostic accuracy, sensitivity, specificity and reduction of CT workload.RiassuntoObiettivoScopo del lavoro è descrivere la nostra esperienza preliminare delle biopsie ossee percutanee eseguite sotto guida XperGuide cone-beam (CBCT).Materiali e metodiDiciassette pazienti (11 maschi e 6 femmine; età media 57,8 anni, range 17–81) con 17 lesioni ossee sono stati sottoposti a biopsia percutanea con guida XperGuide CBCT. Il diametro medio delle lesioni era di 2,32 cm (range 1–8 cm). Sono stati valutati il successo tecnico (definito come il corretto posizionamento dell’ago all’interno della lesione), l’accuratezza diagnostica, la sensibilità e la specificità. è stata inoltre riportata la percentuale di complicanze.RisultatiIl successo tecnico è stato del 100%. In 15 pazienti, è stato ottenuto un campione di materiale adeguato per l’esame isto-patologico e per giungere ad una diagnosi definitiva; in 2 pazienti il campione è risultato inadeguato per giungere ad una diagnosi. In uno dei 2 casi, la lesione è stata seguita per un periodo di follow-up di 1 anno, durante il quale le sue dimensioni sono rimaste stabili; pertanto questa è stata considerata un falso positivo. L’altra è stata considerata un falso negativo. Accuratezza diagnostica, sensibilità e specificità erano rispettivamente del 94,12%, 90,91% e 100%. Non è stata registrata nessuna complicanza maggiore; solo un paziente ha presentato un lieve sanguinamento con un conseguente piccolo ematoma, assorbitosi spontaneamente in circa 15 giorni.ConclusioniLa biopsia ossea sotto guida XperGuide CBCT può essere considerata accurata grazie alla combinazione tra la possibilità di orientamento nello spazio real-time dell’ago e la risoluzione spaziale della fluoro-tomografia computerizzata (TC). Inoltre, i nostri risultati sono incoraggianti in termini di percentuale di complicanze, accuratezza diagnostica, sensibilità, specificità e non ultimo, riduzione del carico di lavoro del servizio TC.

Volumetric analysis of the aneurysmal sac with computed tomography in the follow-up of abdominal aortic aneurysms after endovascular treatment

PurposeOur aim was to assess the usefulness of volumetric analysis for the follow-up of abdominal aortic aneurysms after endovascular repair (EVAR) and operator independence of the method.Materials and methodsWe retrospectively evaluated 99 computed tomography (CT) exams of 33 patients. Two blinded operators assessed the volume before treatment and after EVAR at 1–3 and 12–24 months. Friedman’s statistical test was used to assess the reproducibility of the method. The time required for postprocessing by the two operators was compared.ResultsOne patient was excluded. Twenty-one patients showed no endoleak: 12/21 showed a volume reduction at both follow-up scans (9.7% and 19.5%, respectively); 8/21 showed an early volume increase (9.8%) with a late reduction (10.5%); 1/21 patient showed a volume increase at both follow-up scans (endotension). Eleven patients had an endoleak (one type I, nine type II and one type III); 4/9 type II endoleaks showed a volume reduction at both post-EVAR scans (8.5% and 19.5%). All other cases showed a volume increase after EVAR (type II 15.4%/16.8%, type I 24.1%/9.1%, type III 8%/10.7%). The Friedman statistical test assessed operator independence with p < 0.001. Mean difference between the two operators was 0.9% (0–4.3%).ConclusionsCT volume analysis is an accurate and reproducible modality for the follow-up of abdominal aortic aneurysms after EVAR. At early follow-up, contrast-enhanced CT remains mandatory to identify small endoleaks. For later follow-up, volumetric analysis would eliminate the need for contrast material in asymptomatic patients with stable or decreasing aneurysm volume.RiassuntoObiettivoScopo del presente lavoro è stato valutare l’utilità clinica dell’analisi volumetrica nel follow-up dei pazienti sottoposti a trattamento endovascolare per aneurisma dell’aorta addominale (EVAR) e stabilire l’indipendenza dall’operatore del metodo.Materiali e metodiSono state valutate retrospettivamente 99 tomografie computererizzate (TC) di 33 pazienti. Due operatori in cieco hanno calcolato il volume prima e dopo EVAR a 1–3 e 12–24 mesi. È stato utilizzato il test statistico di Friedman per provare la riproducibilità del metodo. È stato inoltre confrontato il tempo necessario ai due operatori per il post-processing.RisultatiUn paziente è stato escluso. In 21 pazienti non è stata osservata la presenza di endoleak: 12/21 presentavano una riduzione del volume ad entrambi i controlli (9,7%/19,5% rispettivamente); 8/21 presentavano un incremento iniziale (9,8%) con una riduzione tardiva (10,5%); in 1/21 il volume era incrementato ad entrambi i controlli (endotension). È stato osservato un endoleak in 11 pazienti (1/11 tipo I, 9/11 tipo II e 1/11 tipo III); 4/9 endoleak tipo II presentavano una riduzione volumetrica ad entrambi i controlli dopo EVAR (8,5%/19,5%). In tutti gli altri casi si è osservato un incremento volumetrico post-EVAR (tipo II 15,4%/16,8%, tipo I 24,1%/9,1%, tipo III 8%/10,7%). Il test statistico di Friedman ha dimostrato l’indipendenza dall’operatore con p<0,001. Lo scarto medio tra i due operatori è stato di 0,9% (0%–4,3%).ConclusioniIl calcolo del volume alla TC è un metodo accurato e riproducibile per il follow-up degli aneurismi dell’aorta addominale dopo EVAR. Al controllo precoce, l’impiego del mezzo di contrasto (MdC) rimane indispensabile per identificare la presenza di piccoli endoleak. Per i controlli successivi, l’analisi volumetrica consente di eliminare l’uso del MdC nei pazienti asintomatici con volume dell’aneurisma stabile o ridotto.

MDCT evaluation of the cardiac venous system

PurposeThis study was undertaken to evaluate the usefulness of electrocardiographically (ECG)-gated multidetector-row computed tomography (MDCT) for the assessment of the coronary venous system and detection of its anatomical variants, in order to identify those suitable for lead placement in cardiac resynchronisation therapy (CRT).Materials and methodsWe retrospectively examined the coronary MDCT studies of 89 patients (73 males, 16 females, average age 62.5 years, range 31–79) referred for suspected coronary artery disease. The cardiac venous system was assessed in all patients using three-dimensional (3D) postprocessing on a dedicated Vitrea workstation (five patients were excluded from the analysis).ResultsThe coronary sinus, the great cardiac vein, the anterior interventricular vein and the middle cardiac vein were visualised in all cases. The lateral cardiac vein was visualised in 56/84 patients (67%) and the posterior cardiac vein in 63/84 patients (75%), never both missing. Along the postero-lateral wall of the left ventricle, only one branch was present in 44 cases, two branches in 21 cases and three or more branches in 19/84 cases (22%). Evaluation of the maximum diameter revealed that the lateral vein was dominant over the posterior vein in 20/40 cases. The small cardiac vein was visualised in 11/84 cases.ConclusionsMDCT provides good depiction of the cardiac venous system, enabling the study of the vessel course and the identification of anatomical variants. Hence, this imaging technique could be proposed for the preoperative planning of CRT in selected patients.RiassuntoObiettivoScopo del nostro lavoro è valutare l’utilità della tomografia computerizzata multistrato (TCMS) nell’individuazione delle varianti anatomiche del sistema venoso coronarico al fine di riconoscere quelle ritenute più idonee per l’impianto dell’elettrocatetere necessario per la terapia di resincronizzazione cardiaca (CRT).Materiali e metodiSono stati valutati retrospettivamente 89 pazienti consecutivi (73 maschi e 16 femmine, età media 62,5 anni, range di età 31–79), sottoposti ad angio—TCMS per sospetta patologia coronarica. Abbiamo valutato il sistema venoso coronarico in tutti i pazienti utilizzando una workstation dedicata Vitrea per il postprocessing 3D (5 pazienti sono stati esclusi).RisultatiIl seno coronarico, la grande vena cardiaca, la vena interventricolare anteriore e la vena cardiaca media sono state visualizzate in tutti i pazienti. La vena cardiaca laterale è stata visualizzata in 56/84 casi (67%), mentre la vena cardiaca posteriore in 63/84 casi (75%); in nessun caso mancavano entrambe. Complessivamente in prossimità della parete postero-laterale del ventricolo sinistro è stato possibile visualizzare un solo ramo in 44 casi, due rami in 21 casi, tre o più rami in 19 casi. Nei pazienti che presentavano due rami per la parete posterolaterale del ventricolo sinistro, valutando il calibro massimo della vena, la vena laterale è stata considerata dominante sulla posteriore in 20/40 casi. La piccola vena cardiaca è risultata visualizzabile in 11/84 casi.ConclusioniLa TCMS permette una buona visualizzazione delle vene coronariche, consentendo lo studio del decorso vasale e l’identificazione delle varianti anatomiche. Pertanto, questa tecnica di imaging potrebbe essere proposta nel planning dei pazienti da sottoporre alla CRT.

Intrasomatic injection of corticosteroid followed by vertebroplasty increases early pain relief rather than vertebroplasty alone in vertebral bone neoplasms: preliminary experience.

PurposeIn this prospective multicenter study, we evaluate the effectiveness of corticosteroid plus vertebroplasty rather than vertebroplasty alone in the analgesic treatment of single-level vertebral neoplasms or pathological fractures.Materials and methodsFrom January 2009 to February 2011, we prospectively enrolled 20 consecutive patients (11 women, nine men; age range 46–78 years; mean age 65.1 years) with single-level vertebral neoplasm or pathological fractures totally or partially refractory to analgesic treatment, with indication to vertebroplasty. Institutional review board approval and informed consent were obtained. The inclusion criteria for the study were the presence of a single-level pathological fracture not extended to the posterior wall or symptomatic localization of primary or secondary neoplasms, visual analogue score (VAS) ≥5, and life expectancy more than 3 months. Exclusion criteria where all contraindications either to corticosteroid injection included allergy (local sepsis, bacteremia, allergy) or vertebroplasty included coagulopathy, etc. The population was randomly divided into two groups: in group A, patients underwent intrasomatic injections of 4 mg/ml of dexamethasone phosphate followed by a cement injection; patients in group B underwent standard vertebroplasty. VAS score was evaluated and compared between both groups of patients at 6 h, 24 h, 48 h, 7 days, 30 days, and 3 months after the intervention plus last available follow-up. Statistical analyses were performed by application of the t test.ResultsTechnical success was achieved in all cases. In group A, we treated six male and six female patients (age range 46–73 years, average 60.2 years). Pre-intervention VAS in group A ranged between 7 and 10 points, average 8 points. In group B, we treated three male and five female patients (age range 52–78 years, average 67.3 years). Pre-intervention VAS score in group B ranged between 7 and 9 points, with an average 8 points. Patients in group A in respect to patients in group B had a higher reduction in VAS, with a difference of 25.4% (VAS reduction average 5.5 versus 4.1) at 6 h post-intervention, 24.5% (VAS average 5.7 versus 4.3) at 24 h, 25% (VAS average 6 versus 4.5) at 48 h, 23% (VAS average 6.5 versus 5) at 7 days, 16.4% (VAS average 6.7 versus 5.6) at 30 days, 8.9% (VAS average 6.7 versus 6, .1) at 3 months. The last available follow-up ranged from 3 to 24 months in group A and from 5 to 20 months in group B.ConclusionsIn our preliminary experience, pre-vertebroplasty injection of intrasomatic corticosteroid in comparison to vertebroplasty alone is able to increase the early pain relief of the procedure.

Radiofrequency ablation for single lung tumours not suitable for surgery: seven years’ experience

PurposeThis study was done to review recurrence patterns in patients with lung cancer (primary or secondary) treated with percutaneous image-guided radiofrequency (RF) ablation.Materials and methodsFrom January 2003 to August 2010, 32 patients (24 with primary non-small-cell lung cancer and eight with metastases) with single lung cancer were treated with RF ablation. Post-treatment imaging results were available for each patient. Follow-up was performed using computed tomography (CT) scans at 1, 3, 6, 12, 18 and 24 months after the procedure and annually thereafter. Patterns of recurrence were classified as local, intrapulmonary, nodal, mixed and distant. We evaluated overall survival after RF ablation and the factors associated with recurrence.ResultsSeventeen (53.1%) patients showed no evidence of recurrence at follow-up imaging (range 12-72 months; mean, 32.5 months). Recurrence was seen in 15 (46.9 %) patients (range 6-36 months; mean 14.8 months). Local recurrence (40%) after RF ablation was the most frequent. Median disease-free survival was 20 months. Sex, tumour location, tumour size and tumour stage were not associated with a risk of recurrence. Patient age was related to the risk of recurrence (p<0.05).ConslucionsLocal recurrence is the most common pattern in our series. A more aggressive initial RF ablation might offer improvement in outcomes, but this hypothesis needs to be confirmed by larger studies involving a larger number of patients.RiassuntoObiettivoScopo del presente lavoro è stato analizzare i patterns di recidiva in pazienti con tumore polmonare (primitivo o secondario) trattato mediante termo-ablazione con radiofrequenza (RFA) per via percutanea.Materiali e metodiDa gennaio 2003 ad agosto 2010, sono stati trattati 32 pazienti [24 affetti da tumore polmonare non a piccole cellule (NSCLC) ed 8 da lesioni secondarie] con tumore polmonare singolo. I reperti di imaging post-trattamento sono disponibili per tutti i pazienti. Il follow-up è stato eseguito con la tomografia computerizzata (TC) a 1, 3, 6, 12, 18 e 24 mesi dopo la procedura, e poi annualmente. I patterns di recidiva sono stati classificati come locale, intra-polmonare, linfonodale, misto ed a distanza. Abbiamo valutato la sopravivenza globale dopo RFA ed i fattori associati con il rischio di recidiva.RisultatiDiciassette (53,1%) pazienti non hanno presentato recidiva durante il follow-up (range 12–72 mesi; media 32,5 mesi). La recidiva è stata vista in 15 (46,9%) pazienti (range 6–36 mesi; media 14,8 mesi). La recidiva locale (40%) dopo RFA è stata quella osservata più frequentemente. La sopravvivenza media libera da malattia è stata di 20 mesi. Il sesso, la localizzazione del tumore, le dimensioni e lo stadio del tumore non sono risultate associate con il rischio di recidiva. L’età del paziente è risultata essere correlata in maniera statisticamente significativa con il rischio di recidiva (p<0,05).ConclusioniLa recidiva locale è il pattern di recidiva più frequente nella nostra serie; probabilmente un trattamento iniziale con RFA più aggressivo potrebbe dare dei risultati migliori, ma in accordo con l’analisi della letteratura riportata, sono necessari un maggior numero di pazienti e di studi per confermare questa ipotesi.

Upper urinary tract biopsy: an old device for a new approach

PurposeThe authors sought to evaluate the feasibility, diagnostic accuracy and safety of urological biopsy performed using a flexible alligator forceps.Materials and methodsTwenty-seven patients with suspected urothelial malignancy underwent retrograde biopsy using a 7-F biopsy forceps (Cordis, Miami, FL, USA). Mild sedation was guaranteed by an anaesthesiologist. The final diagnosis was confirmed by cytohistological data and subsequently by pathology findings at surgery. Lesions with benign histopathology were closely monitored for at least 12 months.ResultsThe technical success rate was 92.6%. The high diagnostic accuracy was related to the positive correspondence between histological outcomes and surgical results or follow-up observations. As regards sample site, the procedure was less successful in calyceal lesions than in lesions located in the upper urinary tract, with a technical success of 71.43%. Twenty patients had asymptomatic haematuria in the early hours after the procedure; ten of them had mild dysuria. No one require medication, and no major complications occurred.ConclusionsUrological forceps biopsy is a safe and easy procedure. It provides a relatively high level of accuracy in the diagnosis of lesions of the upper urinary tract.RiassuntoObiettivoScopo del nostro lavoro è stato valutare fattibilità, accuratezza diagnostica e sicurezza della biopsia urologica eseguita con un biotomo flessibile tipo alligator.Materiali e metodiVentisette pazienti con il sospetto di patologia uroteliale maligna, sono stati sottoposti a biopsia per via retrograda, utilizzando il biotomo da 7 F (Cordis, Miami, FL, USA). L’anestesista ha eseguito una blanda sedazione. La diagnosi finale è stata confermata dai reperti patologici chirurgici e precedentemente dai risultati citoistologici. Le lesioni con risultato isto-patologico benigno sono state tenute sotto stretto follow-up per almeno 12 mesi.RisultatiIl successo tecnico è risultato del 92,6%. L’alta accuratezza diagnostica era dovuta alla corrispondenza positiva tra esame isto-patologico eseguito sul prelievo bioptico ed i reperti patologici chirurgici o la stazionarietà/ riduzione dimensionale della alterazione durante il periodo di follow-up. Considerando la sede dei prelievi, la performance della procedura è risultata più bassa per le lesioni localizzate nei calici che non per quelle localizzate in altre sedi dell’apparato urinario superiore (AUS), con un successo tecnico, pari al 71,43%. Venti pazienti hanno presentato ematuria asintomatica nelle prime ore dopo la procedura; dieci hanno presentato lieve disuria. Nessuno ha avuto bisogno di specifica terapia. Non è stata osservata nessuna complicanza maggiore.ConclusioniLa biopsia eseguita con il biotomo è una procedura sicura e facile da eseguire. L’accuratezza diagnostica per le lesioni dell’AUS è risultata alta.

Vascular Emergencies of the Retroperitoneum

In this chapter we review the major vascular emergencies of the retroperitoneum, including traumatic injuries of the big vessels of the retroperitoneum. We also give a brief overview of endovascular treatment in this field, with particular attention to the advantage of endovascular treatment compared to open surgical repair.