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Biomedical subjects

A R Cotroneo

Publications and source records attributed to A R Cotroneo.

At least 19 recordsLinked to original sources
PubMed2006

Endovascular abdominal aortic aneurysm repair: how many patients are eligible for endovascular repair?

PURPOSE: The purpose of this study was to determine how many patients with abdominal aortic aneurysm (AAA) are eligible for endovascular abdominal aortic aneurysm repair (EVAR). MATERIALS AND METHODS: We retrospectively reviewed computed tomography (CT) angiograms obtained between January 2002 and June 2003 in 182 patients with suspected AAA. Indication for surgical or endovascular treatment was based on clinical and radiological criteria. The percentage of patients eligible for EVAR was evaluated. RESULTS: Out of a total of 182 patients with suspected AAA studied by CT angiography, after combined radiological-surgical assessment, 130 were considered eligible for surgical or endovascular treatment (71.4%). EVAR was indicated in 51 patients (39.3%, group A) and surgical repair was indicated in 79 patients (60.7%, group B). The reasons for ineligibility for EVAR were the following: unfavourable anatomy of the proximal neck in 41 patients (51.9%), diameter of the aneurysm sac >7 cm in 13 patients (16.4%), markedly tortuous/dilated iliac axis in six patients (7.6%), age <65 years in 17 patients (21.5%) and patient refusal in two cases (2.5%). There were no statistically significant differences in aneurysm diameter (52.7+/-0.8 versus 49.8+/-1.2 mm, p=ns), patients' age (73.2+/-1.2 versus 70.6+/-2.02 years, p=ns) or proximal neck length (2.95+/-1 versus 3.03+/-1.2 cm, p=ns) between groups A and B. CONCLUSIONS: Endovascular repair of abdominal aortic aneurysms through the placement of aortic stent-grafts has now become a viable alternative to open surgery. In recent years, the number of patients treated with EVAR has steadily risen as a result of increased physician experience, availability of new and more versatile devices and improvements in noninvasive imaging techniques. Unfavourable neck anatomy is the primary factor for exclusion from endovascular repair.

Aged↗
PubMed2006

Computed tomography imaging of vena cava filter complications: a pictorial review.

Caval filters are widely used in the prevention of pulmonary embolism. Filters have proved to be effective, but the complication rate is not negligible. Computed tomography (CT) provides a complete evaluation of the filter, including both caval and extracaval complications. In this review, we describe the normal CT aspect of cava filters, the classification of complications and their CT findings. Technical considerations for adequate CT imaging are also highlighted.

Humans↗
PubMed2000

Color Doppler sonography in the diagnosis and monitoring of arterial complications after liver transplantation.

PURPOSE: We assessed the usefulness of color Doppler imaging in the diagnosis and monitoring of arterial complications after liver transplantation. METHODS: Subjects were 142 liver transplant recipients who underwent serial color Doppler sonographic evaluations of the hepatic arteries after surgery. Patients with abnormal sonographic findings underwent subsequent angiography. RESULTS: Eighteen subjects experienced 20 hepatic arterial complications (13 thromboses and 7 stenoses). In 7 of the 13 thrombosis incidents, hepatic arterial obstruction occurred within a month of surgery and was evident from the absence of Doppler signals; angiography confirmed the absence of hepatic arterial perfusion in these cases. In the other 6 thrombosis cases, the thrombosis developed 3 or more months after surgery and became apparent from the absence of color Doppler signals at the level of the main arterial trunk and the presence of intraparenchymal "tardus parvus" waveforms. In these cases, angiography showed obstruction of the main arterial trunk and the development of compensatory collateral vessels. In 3 of the 7 cases of stenosis, high flow velocities were recorded at the site of the narrowing, and intrahepatic tardus parvus waveforms were present. In the other 4 stenosis cases, the site of stenosis could not be identified, but intraparenchymal tardus parvus waveforms were recorded. CONCLUSION: The use of color Doppler sonography allows the early diagnosis of hepatic arterial complications after liver transplantation. Tardus parvus waveforms indicated severe impairment of hepatic arterial perfusion, from either thrombosis or severe stenosis. The presence of these waveforms enhanced the accuracy of color Doppler diagnosis (100% positive predictive value), and their detection should prompt angiography.

Adult↗
PubMed1999

Delayed MR imaging of hepatocellular carcinoma enhanced by gadobenate dimeglumine (Gd-BOPTA).

The purpose of this study was to determine the efficacy of gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance (MR) imaging for evaluation of hepatocellular carcinoma HCC. MR images were obtained in 14 patients with 31 HCC nodules as a part of a phase III clinical trial. T1- and T2-weighted images were obtained before and after iv administration of 0.1 mmol/kg of Gd-BOPTA. Two blinded readers evaluated pre- and delayed postcontrast images separately for detection of tumor nodules. Quantitative measurements of signal-to-noise (SNR) and tumor/liver contrast-to-noise (CNR) ratios were also performed. A signal/intensity ratio was calculated. Tumor enhancement was correlated with histologic findings. Consensus agreement of precontrast T1- and T2-weighted images revealed 23/31 HCC nodules in 14 patients; postcontrast T1-weighted images demonstrated 24/31 HCC nodules in the same number of patients. Combining both pre- and postcontrast images, 27/31 lesions were detected. Four patients had four well-differentiated HCC nodules detected only on postcontrast images, while three well-differentiated lesions in two patients were only seen on precontrast images. Quantitative evaluation showed an SNR ratio increase in both liver parenchyma and HCC nodules, as well as a significant increase in the absolute CNR ratio on postcontrast T1-weighted gradient-recalled images (P < 0.05). Well-differentiated HCC lesions showed a greater enhancement than poorly differentiated HCC lesions.

Aged↗
PubMed1998

[Percutaneous retrieval of intravascular foreign bodies].

INTRODUCTION: The spreading of interventional procedures and the frequent use and replacement of central venous catheters have contributed to a relative increase in the occurrence of intravascular foreign bodies (FBs). Their retrieval is justified by potential complications related to their characteristics, location and permanence. The high morbidity related to surgical retrieval, especially in case of intravenous FBs (often located in the right cardiac chambers or the pulmonary artery) has contributed to the spreading of interventional retrieval procedures. The purpose of percutaneous retrieval is: 1) to hook the FB to stop its migration to more critical districts; 2) to extract it through the percutaneous access route or, if the latter is unfeasible, 3) to simplify surgical retrieval. MATERIAL AND METHODS: We report our experience with 15 patients presenting an FB [intravenous (i.v.) in 11 cases and intra-arterial (i.a.), in 4]. Retrieval was performed mainly with snare-loop catheters (13 cases, together with a pig-tail catheter in 3 patients) and also with Dormia baskets (3 cases, together with a snare loop in 1 case). To ensure the percutaneous retrieval, we used introductors with a greater caliber than that of the FB, the latter generally being a 6-7 F intravenous catheter. The percutaneous approach was mostly transfemoral (right femoral in 9 cases and bilateral femoral, left femoral, axillary and left jugular in 1 case each). RESULTS: Percutaneous retrieval was successful in all the i.v. cases and in 1 ia case. The other 3 ia cases required surgical removal under local anesthesia after percutaneous hooking and displacement of the FB to a more accessible site. No major complications were observed during retrievals. CONCLUSIONS: Based on our personal results and in agreement with the major international reports, we believe that percutaneous retrieval should be considered the treatment of choice for FBs. The procedure success depends on an accurate diagnostic approach, good knowledge of materials and techniques and the operator's experience, as well as the possibility of an interdisciplinary collaboration of the interventional radiologist with the surgeon and anesthesist.

Adult↗
PubMed1997

Spontaneous intrahepatic portosystemic venous shunt in a patient with cirrhosis: diagnosis by combined color Doppler and pulsed Doppler ultrasonography.

Large spontaneous intrahepatic portosystemic venous shunts are occasionally found and their diagnosis by Doppler sonography is rarely reported. The authors describe a case of spontaneous intrahepatic porto-systemic venous shunt in liver cirrhosis diagnosed by color Doppler and characterized by an unusual pulsed Doppler spectrum: a continuous flat portal-like pattern of flow in the portal branch, and in both the shunt and the hepatic vein.

Aged↗
PubMed1995

[Congenital anomalies of the inferior vena cava: role of imaging].

In recent years, clinics and radiology of congenital anomalies of the inferior vena cava have increased in importance in planning abdominal surgery, liver or kidney transplantation, or new interventional or diagnostic procedures such as the positioning of inferior vena cava filters to prevent pulmonary embolism, varicocel sclerotherapy and renal venous sampling. In the past, the radiologic assessment of these rare anomalies was performed only with angiography, which remains the most accurate diagnostic method. Today, besides angiography, less invasive examinations can be performed, e.g., US, CT and MRI, with MRA. In the last two years, 5 patients with inferior vena cava anomalies were examined: 3 had double inferior vena cava and 2 azygos continuation. All of them were submitted to US, CT, MRI and MRA and 3 patients underwent also angiography, two of them with double puncture. US can suggest the diagnosis but may be limited by technical factors and in the assessment of the whole inferior vena cava. Enhanced CT can depict anomaly extent, but uses contrast agents and ionizing radiations. Angiography better depicts craniocaudal spread and collateral networks but is an invasive procedure and sometimes needs a double puncture (double inferior vena cava). MRI, with MRA, yields the same information as the other modalities, but without contrast agents or ionizing radiations. The development of velocity encoded sequences will probably make this technique the method of choice in the study of inferior vena cava anomalies. Our study was aimed at reviewing the embryo-genesis of inferior vena cava anomalies and to assess the relative importance of different diagnostic procedures in the diagnosis and staging of these anomalies.

Aged↗
PubMed1994

Treatment of intraosseous arteriovenous fistulas of the extremities.

Intraosseous arteriovenous fistulas of the extremities are rare malformations frequently associated with severe systemic hemodynamic alterations. In many cases, it is quite difficult to eliminate these anomalous vascular structures, but the possibilities for successful treatment are much greater when surgery is combined with interventional radiology. Selective embolization of the malformed vessels can be produced with a variety of agents that are injected into afferent arteries, via percutaneous puncture or through direct surgical access. The intraosseous portion of the fistula should be resected at the time of embolization or later. The authors describe the successful treatment of three patients having intraosseous arteriovenous fistulas of the upper extremities, who have had follow-up for 2 to 10 years.

Adolescent↗
PubMed1994

[Doppler ultrasonography assessment of the inferior mesenteric artery. Feasibility study and definition of morphologic and flowmetric characteristics].

The conventional and Doppler US assessment of the inferior mesenteric artery has not been reported in the literature to date. In the present study, the feasibility of Doppler US of the inferior mesenteric artery was prospectively investigated in 112 consecutive nonselected patients; the corresponding morphological features (size and vessel course) and Doppler flowmetry (peak systolic, peak diastolic and mean velocities; pulsatility index) were defined. In 32 patients (29%) neither conventional nor color-Doppler nor duplex imaging was possible. Of the extant 80 patients, in 65 (81%) all the three methods allowed the correct assessment of the inferior mesenteric artery; in 15 patients (19%) the results were suboptimal (poor US visualization, or inadequate Doppler flowmetry). In 33/80 patients, arterial blood flow was quantitatively assessed in 1/min. As for the patients who underwent further diagnostic procedures--e.g., CT and angiography--a close correlation was demonstrated between the morphological and functional data obtained by Doppler US and the corresponding CT and angiographic features. The possibility of analyzing the inferior mesenteric artery with conventional and Doppler US, besides the celiac trunk and the superior mesenteric artery, should allow splanchnic circulation to be more completely assessed, thanks to information about normal hemodynamics (after a meal or in response to pharmacological treatments) as well as about the diseases known to affect intestinal perfusion--e.g., mesenteric ischemia.

Adult↗
PubMed1993

[Echo-Doppler in the study of pre- and post-hepatic portal hypertension].

Portal hypertension is due to a number of pathologic processes; these conditions cause hypertension mostly by hindering the portal flow. The obstacle to portal flow may be located at three different levels--i.e., subhepatic, intrahepatic and suprahepatic. The intrahepatic obstacle is observed in 95% of patients with portal hypertension, while the extra-hepatic causes are rare. This paper is aimed at assessing the diagnostic capabilities of color-Doppler US in the evaluation of pre- and posthepatic portal hypertension. This technique, combining morphologic and Doppler data, allows hypertension to be demonstrated and its degree to be assessed. Color-Doppler US can also define the intra/extrahepatic cause and the level of the obstacle to portal flow. In the diagnosis of the involved processes, the role of color-Doppler US is discussed and compared to the roles of other techniques.

Budd-Chiari Syndrome↗
PubMed1992

[Biliodigestive anastomoses on echography. The normal and pathological aspects].

The normal and pathological US features of different types of bilioenterostomy (hepaticojejunostomy, choledochoduodenostomy, polyductal bilioenteric anastomosis) are described, as observed in a prospective study of 27 patients, for a total number of 35 (18 normal and 17 abnormal) examinations. For 20 patients with hepaticojejunostomy, the bilioenteric anastomosis was identified on 13/13 normal examinations and 10/12 pathological examinations. For 2 patients with choledochoduodenostomy, the bilioenteric anastomosis was identified on 2/2 examinations. For 5 patients with polyductal bilioenteric anastomosis (each patient having 2 or 3 anastomoses), all surgical anastomoses were separately identified on 6/8 examinations; as for the remaining 2 patients, 2/3 and 1/3 anastomoses were seen. An abnormal condition was correctly recognized in all the 11 patients with local disease (lithiasis and benign biliary stricture, 2 patients; benign biliary stricture, 5 patients; primary cholangiocarcinoma, 1 patient; recurrent malignancy, 3 patients); in 1 patient, parenchymal and biliary abnormalities due to vascular obstruction were misinterpreted as a result of benign stricture. US can demonstrate the surgical anastomoses between the resected common bile duct or second order intrahepatic ducts and the jejunal loop, with typical features according to the type of surgery performed. Knowledge of such normal appearances after bilioenteric surgery is mandatory in order to detect and correctly evaluate such possible abnormalities at this site as lithiasis and benign or malignant strictures.

Adult↗
PubMed1990

Transvenous sclerotherapy of the gonadal veins for treatment of varicocele: long-term results.

Percutaneous occlusion of the spermatic vein has been performed on 136 consecutive patients with varicocele scroti during the last six years. The authors report their long-term results on the first 119 cases to have a follow-up of at least six months. Occlusion of the insufficient gonadal vein is induced by the selective transcatheter injection of sclerosing agent with local anesthesia. Their patients are always evaluated before and after the procedure by Doppler examination. A spermiogram is done before the procedure and after six months. In this series they registered only 4 recurrences with no major complications.

Follow-Up Studies↗
PubMed1988

[Embolization of the splenic artery in cirrhotic patients with portal hypertension. Ultrasound results and follow-up].

Over the last four years the authors performed transcatheter embolization of the splenic artery by Gianturco coils in 32 consecutive cirrhotic patients with portal hypertension, splenomegaly, cytopenia and gastro-esophageal varices endoscopically proved. This procedure was especially useful for treatment of splenomegaly and cytopenia because a constant reduction of spleen dimensions and increase in platelet count were registered. The effectiveness of transcatheter embolization and follow-up are based on clinic, hematologic and sonographic findings. We believe sonographic monitoring to be very useful both to evaluate splenomegaly and signs of portal hypertension and to reveal splenic complications (abscesses). We never registered severe complications.

Adult↗
PubMed1987

Therapeutic embolization of renal artery to control severe hypertension due to renal trauma.

In a young patient with a post-traumatic renal hematoma, severe systemic hypertension, secondary to the activation of the renin-angiotensin axis, developed. Because of persistent hypertension, after 3 months of drug therapy, selective percutaneous embolization of the damaged vessels was performed. One year after procedure, the patient is normotensive without drugs.

Adult↗