F. Fontana

Percutaneous imaging-guided ablation therapies in the treatment of symptomatic bone metastases: preliminary experience

PurposeThe treatment of pain in bone metastases is currently multidisciplinary. Among the various therapies, local radiotherapy is the gold standard for pain palliation from single metastasis, even though the maximum benefit is obtained between 12 and 20 weeks from initiation. In carefully selected patients, several ablation therapies achieve this objective in 4 weeks. The purpose of this study was to assess the technical success, effectiveness and possible complications of percutaneous ablation therapies in patients with symptomatic bone metastases.Materials and methodsFrom November 2003 to May 2008, ten ablation treatments were performed in ten patients with acute pain from metastatic bone lesions. Patient selection and choice of the most appropriate ablation treatment was made based on lesion characteristics. Three patients were treated with radiofrequency, one with plasma-mediated radiofrequency, two with plasma-mediated radiofrequency and cementoplasty, three with radiofrequency and cementoplasty and one with microwave.ResultsAssessments were based not only on imaging but also on the visual analogue scale (VAS) score for determining pain and on changes in morphine-equivalent doses. In both cases, 3-month follow-up showed a statistically significant reduction of pain. In no case did local complications occur either during or after treatment. Only one patient treated with radiofrequency (1/9, 11%) developed low-grade fever and general malaise during the 6 days following the procedure, compatible with a post-radiofrequency syndrome, which was treated with acetaminophen (paracetamol) only and resolved on day 7.ConclusionsPercutaneous ablation therapies represent a safe and valuable alternative for treating localised pain from single bone metastasis, providing rapid (4-week) relief of symptoms and a significant reduction in morphine doses. This contributes to improving the quality of life of patients with metastatic disease.RiassuntoObiettiviIl trattamento del dolore nelle metastasi ossee è attualmente multidisciplinare. Tra le varie terapie, la radioterapia locale è il gold-standard nella palliazione del dolore da metastasi singola, anche se il massimo beneficio si ottiene tra le 12 e le 20 settimane dall’inizio della terapia. In pazienti accuratamente selezionati, varie terapie ablative raggiungono quest’obiettivo in 4 settimane. Scopo di questo lavoro è valutare il successo tecnico, l’efficacia e le eventuali complicanze delle terapie ablative percutanee in pazienti affetti da metastasi ossee sintomatiche.Materiali e metodiDa novembre 2003 a maggio 2008 sono stati effettuati 10 trattamenti in 10 pazienti con dolore acuto da lesioni metastatiche ossee. La selezione dei pazienti e la scelta del trattamento ablativo più idoneo è stata fatta sulla base delle caratteristiche della lesione. Tre pazienti sono stati trattati con radiofrequenza, 1 con radiofrequenza plasma-mediata, 2 con radiofrequenza plasma mediata e cementoplastica, 3 con radiofrequenza e cementoplastica, 1 con microonde.RisultatiLa valutazione è stata effettuata non solo con imaging, ma anche con una VAS score (visual analoge scale) per la determinazione del dolore e con la variazione delle dose equivalenti di morfina. In entrambi i casi la riduzione è stata statisticamente significativa. In nessun caso si sono verificate complicanze locali sia durante che dopo il trattamento. Solamente in un paziente trattato con radiofrequenza (1/9, 11%) abbiamo riscontrato nei 6 giorni successivi al trattamento insorgenza di febbricola e malessere generale compatibile con la “sindrome post-radiofrequenza”, risoltasi poi al settimo giorno e trattata solo con acetaminofene (paracetamolo).ConclusioniLe tecniche ablative percutanee rappresentano una sicura e valida alternativa al trattamento del dolore localizzato da metastasi ossee singole, apportando in breve tempo (4 settimane) un miglioramento della sintomatologia e una sensibile riduzione delle dosi di morfina. Ciò concorre a migliorare la qualità della vita in pazienti affetti da malattia metastatica.

Percutaneous Treatment of Traumatic Upper-extremity Arterial Injuries: A Single-center Experience

PURPOSEnTo assess the feasibility and effectiveness of emergency percutaneous treatment of traumatic injuries of upper-extremity arteries.nnnMATERIALS AND METHODSnBetween January 2000 and December 2007, 11 patients (mean age, 49.9 years) with traumatic injuries of upper-extremity arteries were observed: three had pseudoaneurysms, four had dissections, three had transections, and one had mural hematoma. Lesions involved the axillary (n = 6), subclavian (n = 3), or brachial artery (n = 2). Pseudoaneurysms and transections were treated with stent grafts, (n = 6) and dissections and mural hematomas were treated with bare stents (n = 2) or angioplasty (n = 3). Follow-up (mean, 45.1 months; range, 12-84 months) was performed with color Doppler ultrasonography at 1, 3, 6, and 12 months and then, yearly.nnnRESULTSnImmediate technical success was obtained in all cases. No major complications occurred; there was one asymptomatic occlusion of the interosseous artery and one case of incomplete thrombosis of the radial artery (with recanalization after 1 month with systemic medical therapy). During a mean follow-up of 45.1 months, one stent-graft occlusion occurred, which was treated with intraarterial pharmacologic thrombolysis (urokinase 60,000 IU/h for 12 hours). Overall primary clinical success rate was 95.2% and secondary clinical success rate was 100%.nnnCONCLUSIONSnPercutaneous treatment is a feasible and safe tool for injuries of upper-extremity arteries because it can provide a fast and definitive termination of bleeding or a resolution of acute ischemia. This approach, with its low invasiveness, can be proposed as first-line treatment in patients with traumatic lesions of upper-extremity arteries.

Ultrasound-Guided Radiofrequency Thermal Ablation of Uterine Fibroids: Medium-Term Follow-Up

Previous studies have shown that radiofrequency thermal ablation (RFA) of uterine fibroids through a percutaneous ultrasound (US)-guided procedure is an effective and safe minimally invasive treatment, with encouraging short-term results. The aim of this study was to assess the results in terms of volume reduction and clinical symptoms improvement in the midterm follow-up of fibroids with a diameter of up to 8xa0cm. Eleven premenopausal females affected by symptomatic fibroids underwent percutaneous US-guided RFA. Symptom severity and reduction in volume were evaluated at 1, 3, 6, 9, and 12xa0months. The mean symptom score (SSS) before the procedure was 50.30 (range 31.8–67.30), and the average quality of life (QOL) score value was 62 (range 37.20–86.00). The mean basal diameter was 5.5xa0cm (range 4.4–8) and the mean volume was 101.5xa0cm3 (range 44.58–278xa0cm3). The mean follow-up was 9xa0months (range 3–12xa0months). The mean SSS value at the end of the follow-up was 13.38 (range 0–67.1) and the QOL 90.4 (range 43.8–100). At follow-up the mean diameter was 3.0xa0cm (range 1.20–4.5xa0cm), and the mean volume was 18xa0cm3 (range 0.90–47.6xa0cm3). In 10 of 11 patients we obtained total or partial regression of symptoms. In one case the clinical manifestations persisted and it was thus considered unsuccessful. In conclusion, US-guided percutaneous RFA is a safe and effective treatment even for fibroids up to 8xa0cm.

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.

Trattamento endovascolare di aneurismi dell'aorta addominale in rottura: Endoprotesi aorto-uniliaca o biforcata?

PurposeThis study evaluated the safety and technical and clinical success rates of positioning endovascular endografts (EG) in ruptured abdominal aneurysms.Materials and methodsPatients with a ruptured abdominal aortic aneurysm confirmed by contrastenhanced computed tomography angiography (CTA) were eligible for the analysis. Of 67 patients, 42 (62.7%) were treated with EG. Thirteen patients (30.9%) received an aorto-uni-iliac EG (group A) and 29 a bifurcated EG (group B). Patients were divided for comparative analysis according to the configuration of the EG implanted.ResultsThe primary technical success rate was 100%; the primary clinical success rate was 95% (40/42). There were two intraoperative deaths (4.7%) related to intractable shock. No patient required conversion to open repair. Overall, 12 patients (28.5%) died within 30 days. The inhospital death rate was 30.9% (13/42). Hospital mortality rate was statistically higher in group A; the type of EG and intensive care unit admission were the only independent predictors of hospital mortality.ConclusionsIn our experience, a higher mortality rate was observed for the aorto-uni-iliac configuration; shock at admission was confirmed as the most important factor for postoperative survival.RiassuntoObiettivoScopo del nostro lavoro è stato valutare sicurezza, successo tecnico e successo clinico nel posizionamento di endoprotesi (EP) con approccio endovascolare in pazienti con aneurisma dell’aorta addominale in rottura.Materiali e metodiSono stati valutati 67 pazienti con aneurisma dell’aorta addominale in rottura, confermato mediante esame angio-tomografia computerizzata (TC). In 42 casi (62,7%) è stata posizionata endoprotesi: aorto-uniiliaca in 13 pazienti (30,9%) (gruppo A), e biforcata in 29 (gruppo B).RisultatiNel 95% dei casi (40/42) è stato ottenuto il successo tecnico. Le morti intra-operatorie sono state 2 (4,7%). In nessun paziente l’intervento è stato convertito in open. Dodici pazienti (28,5%) sono morti entro 30 giorni. La percentuale di morti durante il ricovero è stata del 30,9% (13/42). Mediante una analisi uni- e multivariata, i due gruppi sono risultati ben ponderati; lo shock è risultato statisticamente più frequente nel gruppo A. La percentuale di morte intra-ospedaliera è risultata statisticamente più alta nel gruppo A e questa era correlata al tipo di endoprotesi e all’accesso nella unità di terapia intensiva.ConclusioniNella nostra esperienza, si è osservata una più alta mortalità nel gruppo in cui è stata posizionata una EP aorto-uni-iliaca; lo shock all’ingresso è risultato essere il fattore più importante da correlare con la sopravvivenza post-operatoria.

Usefulness and safety of biliary percutaneous transluminal forceps biopsy (PTFB): our experience.

Abstract Aim: To evaluate the usefulness and safety of percutaneous transluminal forceps biopsy in patients suspected of having a malignant biliary obstruction. Material and methods: Forty consecutive patients (21 men and 19 women; mean age, 71.9 years) underwent forceps biopsy through percutaneous transhepatic biliary access performed to drain bile. Lesions involved the common bile duct (n 8), common hepatic duct (n 18), hilum (n 6), ampullary segment of the common bile duct (n 8) and were biopsied with 7-F biopsy forceps. Final diagnosis was confirmed with pathologic findings at surgery, or clinical and radiologic follow-up. Results: Twenty-one of 40 biopsies resulted in correct diagnosis of malignancy. Thirteen biopsy diagnosis were proved to be true-negative. There were six false-negative and no false-positive diagnoses. Sensitivity, specificity and accuracy in aspecific biliary obstructions were 85%, 100% and 88,7% respectively. Sensitivity of biopsy in malignancies was higher than in benign obstructions (100% vs 68,4%, CI = 95%). Sensitivity was lower in the hilum tract and in the common bile duct than in other sites (CI = 95%). No major complications related to biopsy procedures occurred. Conclusions:Percutaneous transluminal forceps biopsy is a safe procedure, easy to perform through a transhepatic biliary drainage tract, providing high accuracy in the diagnosis of malignant biliary obstructions.

Endovascular treatment of isolated iliac artery aneurysms: 2-year follow-up

PurposeThe aim of this study was to assess the effectiveness of endovascular treatment of isolated iliac artery aneurysms (IAAs).Materials and methodsBetween March 1999 and March 2004, 15 isolated IAAs in 13 patients (mean age: 71.8 years) were selected for endovascular repair by means of a covered stent or stent-graft: 12 were in the common iliac artery (2 with the proximal end 12 mm from the aortic bifurcation and 2 involving the distal hypogastric artery), and three were in the external iliac artery. The preoperative study and the follow-up (at 3, 6 and 12 months and yearly thereafter) were performed by computed tomography (CT) angiography.ResultsPrimary technical success was obtained in all cases, without periprocedural complications. Two patients died within 3 months and were not considered for follow-up. Follow-up (mean duration: 25 months, range: 6–60 months) in the remaining 11 patients, affected by 13 aneurysms, showed aneurysm exclusion in nine cases and progressive shrinkage of the aneurysmal sac in four cases, whereas in the other five, the size of the aneurysm remained unchanged. In a patient with bilateral IAA, bilateral proximal endoleaks were observed after 2 years, and the patient was treated with a bifurcated aortic stent-graft. In another patient with a large aneurysm, a left aortofemoral bypass became necessary after 2 months because of stent-graft dislodgement. In another patient, an endoleak from the hypogastric artery occurred after 2 years but was not treated.ConclusionsEndovascular treatment of isolated IAA is a feasible procedure that is less invasive than surgery and yields excellent short-and midterm results. However, a longer follow-up and larger patient series are needed to verify the long-term efficacy of this form of treatment.RiassuntoObiettivoVerificare l’efficacia del trattamento endovascolare degli aneurismi isolati dell’asse arterioso iliaco (AAI).Materiali e metodiTra marzo 1999 e marzo 2004 sono stati selezionati per l’esclusione endovascolare mediante stent ricoperto o endoprotesi 15 aneurismi isolati dell’AAI in 13 pazienti (età media 71,8 anni): 12 dell’arteria iliaca comune (di cui 2 con estremo prossimale distante 12 mm dalla biforcazione aortica e 2 coinvolgenti distalmente l’arteria ipogastrica) e 3 dell’arteria iliaca esterna. Lo studio pre-operatorio e il follow-up (controlli a 3, 6, 12 mesi e in seguito annualmente) sono stati espletati mediante angio-TC spirale.RisultatiÈ stato documentato il successo tecnico immediato in tutti i pazienti, senza complicanze peri-procedurali. Due pazienti sono deceduti entro 3 mesi e non sono stati considerati ai fini del followup. Il follow-up (durata media 25 mesi, range 6–60 mesi), disponibile nei restanti 11 pazienti, portatori di 13 aneurismi, ha dimostrato l’esclusione dell’aneurisma in 9 casi, con la progressiva riduzione volumetrica della sacca in 4, mentre negli altri 5 la sacca è rimasta immodificata. In un paziente portatore di aneurismi isolati dell’AAI bilaterale si è osservato un endoleak prossimale di entrambi gli aneurismi a 2 anni, trattato pertanto con endoprotesi aortica biforcata; in una paziente con un voluminoso aneurisma si è resa necessaria la conversione in by-pass aorto-femorale sinistro a due mesi di distanza per dislocazione di più endoprotesi embricate; in un paziente, infine, a due anni si è rilevato un endoleak rifornito dall’arteria ipogastrica, che non è stato trattato.ConclusioniL’esclusione endovascolare degli aneurismi isolati dell’AAI è una procedura fattibile, meno invasiva dell’intervento chirurgico, con ottimi risultati a breve e medio termine. È tuttavia necessario un follow-up più protratto e una casistica più numerosa per verificare l’efficacia a lungo termine di questo tipo di trattamento.

Percutaneous cholecystostomy as the sole treatment in critically ill and elderly patients

PurposeThis study was done to investigate the effectiveness and clinical outcome of percutaneous cholecystostomy (PC) of treating acute cholecystitis in critical ill and elderly patients.Materials and methodsIn the last 3 years, PC was performed on 30 elderly and critically ill patients (17 men, 13 women; mean age 78.6, range 57–97 years) with acute cholecystitis and comorbid diseases.ResultsTechnical success was 30/30 (100%). Clinical effectiveness was 30/30 (100%), with statistically significant reductions in while blood cell (WBC) count, C-reactive protein (CRP) and fever. Mean WBC upon admission (19.87×103±1.61×103 /μl), axillary temperature (38.2±0.11 °C), and CRP (248.7±4.76 mg/l) values were significantly decreased in the 72 h following PC [12.9×103 ± 1.05×103/μl (p≤0.0001), 37 ± 0.04 °C (p≤0.0001), 113.5 ± 3 mg/l (p≤0.0001), respectively]. Clinical and ultrasonographic (US) signs of acute cholecystitis decreased in all patients. There were no major complications or procedure-related deaths, and the morbidity rate was low (3/30; 10%).ConclusionsPC appears to be a fast, easy and effective treatment for the acute phase of cholecystitis in elderly and critically ill patients. Procedure-related morbidity and mortality rates are very low compared with surgery. Conservative treatment for patients who are not eligible for surgery is acceptable.RiassuntoObiettivoL’obiettivo del nostro lavoro è stato quello di dimostrare l’efficacia della colecistostomia percutanea nel trattamento della colecistite acuta nei malati critici e nei pazienti anziani non candidabili al trattamento chirurgico.Materiali e metodiNegli ultimi 3 anni abbiamo effettuato 30 colecistostomie percutanee in malati critici e pazienti anziani (17 uomini, 13 donne, età media 78 anni, range 57–97 anni) con colecistite acuta e associate comorbilità.RisultatiIl successo tecnico è stato ottenuto nel 100% dei casi (30 su 30). L’efficacia clinica si è avuta in 30 casi su 30 (100%) con una riduzione statisticamente significativa della leucocitosi (WBC),proteina C reattiva (CPR) e febbre. Il valore medio dei globuli bianchi al ricovero (19,87×103±1,61×103/μl), della febbre (38,2±0,11°C) e della CRP (248,7±4,76 mg/l) si sono significativamente ridotti nelle 72 ore successive al trattamento di colecistostomia percutanea [12,9×103±1,05×103/ μl (p≤0,0001), 37±0,04°C (p≤0,0001), 113,5±3 mg/l (p≤0,0001), rispettivamente]. I segni clinici ed ecografici di colecistite acuta sono migliorati in tutti i pazienti. Non ci sono stati complicanze maggiori o casi di morte periprocedurale. La morbilità collegata alla procedura è stata bassa 3/30 (10%).ConclusioniIn conclusione si dimostra che la colecistostomia percutanea, nonostante il numero limitato di pazienti del nostro campione, è un metodo di trattamento veloce, semplice ed efficace per la cura della colecistite acuta nei malati critici e nei pazienti anziani. La morbilità relativa alla procedura e la mortalità sono molto basse se comparate alla chirurgia tradizionale. Il trattamento conservativo per i pazienti per i quali è controindicato il trattamento chirurgico è ben tollerato.

Gross hematuria caused by a congenital intrarenal arteriovenous malformation: a case report.

IntroductionWe report the case of a woman who presented with gross hematuria and was treated with a percutaneous embolization.Case presentationA 48-year-old Caucasian woman presented with gross hematuria, left flank pain, and clot retention. The patient had no history of renal trauma, hypertension, urolithiasis, or recent medical intervention with percutaneous instrumentation. The patient did not report any bleeding disorder and was not taking any medication. Her systolic and diastolic blood pressure values were normal at presentation. The patient had anemia (8 mg/dL) and tachycardia (110 bpm). She underwent color and spectral Doppler sonography, multi-slice computed tomography, and angiography of the kidneys, which showed a renal arteriovenous malformation pole on top of the left kidney.ConclusionsThe feeding artery of the arteriovenous malformation was selectively embolized with a microcatheter introduced using a right transfemoral approach. By using this technique, we stopped the bleeding, preserved renal parenchymal function, and relieved the patients symptoms. The hemodynamic effects associated with the abnormality were also corrected.