Salvatore Cuffari

Microwave tumors ablation: principles, clinical applications and review of preliminary experiences.

Local ablative techniques have been developed to enable local control of unresectable tumors. Ablation has been performed with several modalities including ethanol ablation, laser ablation, cryoablation, and radiofrequency ablation. Microwave technology is a new thermal ablation technique for different types of tumors, providing all the benefits of radiofrequency and substantial advantages. Microwave ablation has been applied to liver, lung, kidney and more rarely to bone, pancreas and adrenal glands. Preliminary works show that microwave ablation may be a viable alternative to other ablation techniques in selected patients. However further studies are necessary to confirm short- and long-term effectiveness of the methods and to compare it with other ablative techniques, especially RF.

Treatment of failed back surgery syndrome.

Objectives. To evaluate the long‐term results of different therapies for failed back surgery syndrome (FBSS).

Microwave ablation of pancreatic head cancer: safety and efficacy.

PURPOSE To evaluate the safety and efficacy of percutaneous microwave (MW) ablation treatment in locally advanced, nonresectable, nonmetastatic pancreatic head cancer. MATERIALS AND METHODS Ten patients with pancreatic head cancer treated with percutaneous (n = 5) or laparotomic (n = 5) MW ablation were retrospectively reviewed. The MW generator used (45 W at 915 MHz) was connected by coaxial cable to 14-gauge straight MW antennas with a 3.7- or 2-cm radiating section. One or two antennae were used, with an ablation time of 10 minutes. Ultrasonographic (US) and combined US/cone-beam computed tomographic (CT) guidance were used in five patients each. Follow-up was performed by CT after 1, 3, 6, and, when possible, 12 months. Tumor response was assessed per Response Evaluation Criteria In Solid Tumors (version 1.1) and Choi criteria. The feasibility, safety, and major and minor complications associated with quality of life (QOL) were recorded prospectively. RESULTS The procedure was feasible in all patients (100%). One late major complication was observed in one patient, and no visceral injury was detected. No patient had further surgery, and all minor complications resolved during the hospital stay. An improvement in QOL was observed in all patients despite a tendency to return to preoperative levels in the months following the procedure, without the influence of minor complications. No repeat treatment was performed. CONCLUSIONS Despite the small number of patients, the present results can be considered encouraging, showing that MW ablation is a feasible approach in the palliative treatment of pancreatic tumors.

Radiofrequency ablation of primary and metastatic lung tumors: preliminary experience with a single center device

BackgroundThis study aimed to assess the feasibility and short-term results for percutaneous radiofrequency ablation in the treatment of primary and secondary lung tumors.MethodsBetween May 2003 and July 2004, 15 patients (mean age, 64.9 years; range, 51–80 years) with 18 pulmonary lesions (9 primitive non–small cell lung cancers and 9 metastases) underwent the ablation procedure. All the patients had absolute contraindications to the surgery. The procedure was performed under computed tomography (CT) guidance with anesthesiologic assistance using a coaxial Le Veen needle electrode. The results were evaluated by postprocedural CT scan, and then by clinical and laboratory examination and CT scan 1, 3, 6, 9, and 12 months after the treatment.ResultsA complete ablation was obtained for 16 of 18 lesions (88.9%), and a partial ablation was achieved for the remaining 2 lesions (central tumors). In terms of complications, there were five cases of pneumothorax (2 resolved spontaneously and 3 were drained through a coaxial needle), four middle pleural reactions, and one hemothorax that required draining surgically. Follow-up evaluation was performed for 16 of 18 lesions. Stability was observed in one of two central tumors that received partial ablation. The remaining 15 tumors that received a complete ablation were followed up for a mean of 5 months (range, 1–12 months). All 15 lesions appeared to be hypodense at the CT examination. Dimension reduction with progressive fibrotic scar formation was observed in seven of seven lesions during a follow-up period of 6 months or more. A recurrence at the site of the treatment for two of three lesions was observed during a 12-month follow-up period. One of these received a second radiofrequency ablation. Five patients experienced systemic disease progression. In four of these five patients, this progression was not associated with recurrence at the site of the treatment.ConclusionRadiofrequency ablation seems to be possible for “nonsurgical” patients with primary and secondary lung tumors. Good results in terms of local tumor control were observed during short-term follow-up evaluation.

Emergency Endovascular Treatment of Abdominal Aortic Aneurysms: Feasibility and Results

PurposeTo assess the feasibility and effectiveness of emergency endovascular treatment of abdominal aortic aneurysms (AAAs).MethodsDuring 36 months we treated, on an emergency basis, 30 AAAs with endovascular exclusion. In 21 hemodynamically stable patients preoperative CT angiography (CTA) was performed to confirm the diagnosis and to plan the treatment; 9 patients with hemorrhagic shock were evaluated with angiography performed in the operating room. Twenty-two Excluder (Gore) and 8 Zenith (Cook) stent-grafts (25 bifurcated and 5 aorto-uni-iliac) were used. The follow-up was performed by CTA at 1, 3, 6, and 12 months.ResultsTechnical success was achieved in 100% of cases with a 10% mortality rate. The total complication rate was 23% (5 increases in serum creatinine level and 2 wound infections). During the follow-up, performed in 27 patients (1–36 months, mean 15.2 months), 4 secondary endoleaks (15%) (3 type II, 2 spontaneously thrombosed and 1 under observation, and 1 type III treated by iliac extender insertion) and 1 iliac leg occlusion (treated with femoro-femoral bypass) occurred. We observed a shrinkage of the aneurysmal sac in 8 of 27 cases and stability in 19 of 27 cases; we did not observe any endotension.ConclusionsEndovascular repair is a good option for emergency treatment of AAAs. The team’s experience allows correct planning of the procedure in emergency situations also, with technical results comparable with elective repair. In our experience the bifurcated stent-graft is the device of choice in patients with suitable anatomy because the procedure is less time-consuming than aorto-uni-iliac stent-grafting with surgical crossover, allowing faster aneurysm exclusion. However, further studies are required to demonstrate the long-term efficacy of endovascular repair compared with surgical treatment.

Percutaneous sonographically guided radiofrequency ablation of medium-sized fibroids: feasibility study

OBJECTIVE The purpose of this study was to assess the feasibility and safety of percutaneous radiofrequency ablation under sonographic guidance as a unique procedure in the management of symptomatic uterine myomas. SUBJECTS AND METHODS Six premenopausal women with symptomatic submucosal or intramural uterine myomas underwent percutaneous radiofrequency ablation under suprapubic sonographic guidance. Relief of symptoms and reduction in the diameter and volume of the myomas were measured every 3 months. RESULTS The location of myomas was anterior and submucosal in one of the six patients and intramural in the other five (one posterior, one anterior, two fundal, and one on the left side). Five of the patients had pelvic pain, and four had menorrhagia. The median baseline diameter was 4.8 cm (range, 4.4-5.2 cm), and the mean volume was 58.57 cm3 (range, 44.58-73.58 cm3). The mean follow-up time was 9 months (range, 3-12 months). At follow-up, the median diameter was 2.3 cm (range, 1.20-3.2 cm), and the median volume was 8.97 cm3 (range, 0.90-18.81 cm3). The median preoperative symptom score was 47.2 (31.8-67.30), and the median health-related quality of life (QOL) score was 63.92 (37.20-86.00). The median symptom score during follow-up was 5.15 (range, 0-26), and the mean QOL score was 96.2 (range, 86.30-100). Four of six patients were symptom-free at the last follow-up visit. CONCLUSION Percutaneous sonographically guided radiofrequency ablation alone is a feasible and efficient procedure in the management of medium-sized uterine myomas.

Treatment of secondary hyperparathyroidism with ultrasonographically guided percutaneous radiofrequency thermoablation.

We present a case of a 63-year-old woman with a recurrent secondary hyperparathyroidism hyperplasia with absolute contraindication for surgery, treated in 2 sessions with percutaneous ultrasonographically guided radiofrequency tissue ablation. The complete pathologic tissue ablation was confirmed by contrast-enhanced ultrasonography performed before and after the treatment and by clinical and laboratory follow-up. Furthermore in work progress, the percutaneous ultrasonographically guided radiofrequency tissue ablation can be considered a feasible and effective nonsurgical alternative treatment for symptomatic secondary hyperparathyroidism in high-risk patients.

Endovascular treatment of steno-occlusions of the infrarenal abdominal aorta.

Purpose.Our aim is to report our experience in the endovascular treatment of steno-occlusions of the infrarenal abdominal aorta.Materials and methods.We selected 19 patients (mean age 66.3 years, range 45–80): five with complete occlusion of the infrarenal aorta and both common iliac arteries (CIAs), four of which were associated with occlusion of the external iliac arteries (EIAs); three with complete occlusion and three with severe stenosis of the distal aorta with occlusion or stenosis of the CIAs and EIAs; and eight with focal severe stenosis of the infrarenal aorta. All patients were treated with direct stenting.Results.Immediate technical success was 94.7% (18/19 cases). We observed two cases of distal embolism treated with thrombolysis, one case of mild renal failure and one case of transient angina abdominis. During the follow-up (mean 19.6 months; range 6–48), 2/18 (11.1%) occlusions of an iliac stent occurred 1 and 3 months after the procedure (treated with local intra-arterial thrombolysis). The primary patency rate was 88.8% and the secondary patency rate was 100%.Conclusions.Direct stenting is a feasible and safe option for the treatment of infrarenal abdominal aortic steno-occlusions, especially in patients at high surgical risk, with good early and late clinical results.

Microwave ablation therapy for treating primary and secondary lung tumours: technical note

PurposeThe purpose of our study was to retrospectively evaluate the feasibility, safety and effectiveness of microwave ablation (MWA) in nine patients with unresectable lung tumour.Materials and methodsTen lesions were treated in ten ablation sessions in nine patients. The treatments were performed with a microwave generator with 45 W and 915 MHz connected to a 14.5-gauge antenna for 10 min. Antenna placement was performed with computed tomography (CT) fluoroscopy guidance or XperGuide. All patients underwent CT follow-up at 1, 3 and 6 months from the procedure.ResultsTechnical success was obtained in all cases; mortality at 30 days was 0%.ConclusionsThis study shows that in selected patients, MWA is a valid alternative to other ablative techniques. Further studies are required to demonstrate the short- and long-term effects of this technique and to make a comparison with other available ablation systems, especially with radiofrequency.RiassuntoObiettivoLo scopo dello studio è stato quello di valutare il successo tecnico, la sicurezza, l’efficacia della metodica del trattamento ablativo mediante microonde (MW) in 9 pazienti affetti da neoplasia polmonare non trattabile chirurgicamente.Materiali e metodiSono state trattate 10 masse polmonari in 10 sessioni d’ablazione in 9 pazienti. È stato utilizzato un sistema ablativo costituito da un generatore di MW a 45 W e 915 MHz connesso ad un antenna 14,5 G, per un tempo di ablazione totale di 10 minuti. Il posizionamento dell’antenna è stato eseguito sotto guida fluoro-tomografia computerizzata (TC) o XperGuide. I pazienti sono stati sottoposti a follow-up mediante TC a 1, 3, 6 mesi dalla procedura.RisultatiSi è ottenuto un successo tecnico in tutti i casi; il tasso di mortalità a 30 giorni è stato dello 0%.ConclusioniQuesto studio dimostra che, in pazienti selezionati, la termoablazione con microonde rappresenta una valida alternativa ad altre tecniche ablative. Sono tuttavia necessari ulteriori studi per confermare a breve e lungo termine l’efficacia di questa metodologia e permettere un confronto con altri sistemi ablativi, in particolare rispetto alla radiofrequenza.

Endovascular Treatment of Anastomotic Pseudoaneurysms after Aorto-iliac Surgical Reconstruction

PurposeTo assess the effectiveness of endovascular treatment of anastomotic pseudoaneurysms (APAs) following aorto-iliac surgical reconstruction.MaterialsWe retrospectively evaluated 21 men who, between July 2000 and March 2006, were observed with 30 APAs, 13 to the proximal anastomosis and 17 to the distal anastomosis. The patients had had previous aorto-iliac reconstructive surgery with a bypass due to aneurysm (15/21) or obstructive disease (6/21). The following devices were used: 12 bifurcated endoprostheses, 2 aorto-monoiliac, 4 aortic extenders, 1 stent-graft leg, and 2 covered stents. Follow-up was performed with CT angiography at 1, 3, and 6 months after the procedure and yearly thereafter.ResultsImmediate technical success was 100%. No periprocedural complications occurred. Four patients died during follow-up from causes not related to APA, and 1 (treated for prosthetic-enteric fistula) from sepsis 3 months after the procedure. During a mean follow-up of 19.7 months (range 1–72 months), 2 of 21 occlusions of stent-graft legs occurred 3 and 24 months after the procedure (treated with thrombolysis and percutaneous transluminal angioplasty and femorofemoral bypass, respectively) and 1 type I endoleak. Primary clinical success rate was 81% and secondary clinical success was 91%.ConclusionEndovascular treatment is a valid alternative to open surgery and can be proposed as the treatment of choice for APAs, especially in patients who are a high surgical risk. Further studies with larger series and longer follow-up are necessary to confirm the long-term effectiveness of this approach.