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Biomedical subjects

Anna-Maria Belli

Publications and source records attributed to Anna-Maria Belli.

13 recordsLinked to original sources
PubMed2004

Pre-myomectomy uterine artery embolisation minimises operative blood loss.

Women with massive fibroids (extending beyond the level of the umbilicus) are conventionally offered a hysterectomy, rather than myomectomy, which is considered too technically challenging, with risks of excessive haemorrhage. Some women desire fertility, or may simply wish to preserve their uterus. Uterine artery embolisation is a relatively new treatment for fibroids, and complication rates are thought to be high with massive fibroids. We have performed uterine artery embolisation immediately prior to myomectomy, and found a reduction in blood loss. Uterine artery embolisation may be a useful adjunct to surgery in women with massive fibroids or for whom uterine artery embolisation alone is considered inadequate primary treatment, those with previous myomectomy where surgery might be complicated by extensive adhesions, in Jehovah's Witnesses and in other women who refuse blood transfusion.

Arteries↗
PubMed2003

Current treatment methods for postcatheterization pseudoaneurysms.

Pseudoaneurysms are a recognized complication of arterial catheterization. Until recently, the standard method of treatment has been surgical. The past decade has seen the introduction of several minimally invasive techniques that have largely replaced surgical treatment of pseudoaneurysms. The most commonly used methods are ultrasound-guided compression and percutaneous injection of thrombin into the pseudoaneurysm. This review article describes all the methods available for the treatment of postcatheterization pseudoaneurysms, presents results from the largest published series, and discusses the relative merits of each technique.

Aneurysm, False↗
PubMed2003

Embolization of a renal artery aneurysm using ethylene vinyl alcohol copolymer (Onyx).

PURPOSE: To report the embolization of a renal artery aneurysm using Onyx, a radiopaque nonadhesive liquid embolic agent. CASE REPORT: A 28-year-old woman with hypertension and fibromuscular dysplasia presented with a 20-mm renal artery aneurysm. In order to avoid any migration of embolic material into the parent vessel, a compliant balloon was inflated to exclude the aneurysm from the blood flow while injecting the liquid embolic agent. Complete aneurysm exclusion was achieved immediately, with no angiographic or duplex evidence of distal embolization or intra-aneurysmal flow. The Doppler ultrasound at 6 months confirmed aneurysm exclusion. CONCLUSIONS: The ease of use and nature of this material makes Onyx an effective and safe option in the treatment of wide-necked renal aneurysms.

Adult↗
PubMed2002

Endovascular repair of contained rupture of the thoracic aorta.

PURPOSE: To assess the efficacy of stent-grafts for the treatment of acute rupture of the thoracic aorta. METHODS: Four patients with acute contained ruptures of the thoracic aorta were treated by insertion of stent-grafts. The underlying aortic lesions were aneurysm, acute aortic ulcer, acute type B dissection and giant cell aortitis. The procedures were performed under general anesthesia in three patients and local anesthesia in one patient. RESULTS: All stent-grafts were successfully deployed. All patients survived the procedure and are now alive and well at follow-up (mean 6.3 months, range 44 days-16 months). One patient underwent a second stent procedure 10 days after the first procedure because of a proximal endoleak. All hemothoraces have resolved. There were no complications. CONCLUSION: Treatment of acute contained ruptures of the thoracic aorta by the insertion of stent-grafts is feasible. The technical success rates, complication rates and patient survival compare favorably with emergency surgery.

Aged↗
PubMed2002

Endovascular repair of thoracic aortic aneurysm and intramural hematoma in giant cell arteritis.

An 80-year-old woman with established giant cell arteritis presented at the authors' institution with a 6.5-cm false aneurysm of the descending thoracic aorta complicated by focal dissection and intramural hematoma after a 1-week history of acute-onset chest pain. The patient underwent uncomplicated endovascular aortic repair with a 32-mm x 15-cm TagExcluder stent-graft. After the procedure, the intramural hematoma resolved and the patient's corticosteroid and immunosuppressive therapy was repeatedly adjusted. However, the giant cell arteritis activity relapsed after 8 months with development of a similar 1.5-cm false aneurysm below the thoracic stent-graft, complicated by focal intramural hematoma. Repeat uncomplicated thoracic stent-graft implantation was performed and CT follow-up displayed resorption of the intramural hematomas with no evidence of endoleak or any new aortic pathology. This report discusses the difficult management of patients with relapsing active aortic giant cell arteritis and the potential role for endovascular thoracic aortic repair.

Aged↗
PubMed2002

Cutting balloon angioplasty for resistant renal artery in-stent restenosis.

A 76-year-old woman presented with recurrent arterial hypertension 6 months after uncomplicated primary renal artery stent placement. Diagnostic arteriography revealed severe renal artery in-stent restenosis. On repeat intervention, the lesion was resistant to attempted conventional percutaneous transluminal angioplasty (PTA) with unchanged systolic pressure gradients across the stent. Cutting balloon angioplasty (CBA) was performed with use of a 4-mm cutting balloon (IVT, San Diego, CA). CBA successfully reduced the pressure gradient to below the level of significance. Subsequent conventional PTA enhanced the lumen diameter inside the stent. The arterial hypertension reverted to normal values and duplex ultrasonography (US) at 10-month follow-up demonstrated normal renal artery hemodynamics without stenosis. CBA for potential use in renal artery in-stent restenosis and other peripheral neointimal hyperplasia is discussed.

Aged↗
PubMed2002

Cutting balloon percutaneous transluminal angioplasty for salvage of lower limb arterial bypass grafts: feasibility.

PURPOSE: To evaluate the feasibility of cutting balloon percutaneous transluminal angioplasty (PTA) for treatment of neointimal hyperplasia in peripheral arterial bypass grafts. MATERIALS AND METHODS: Fifteen consecutive patients (six women, nine men; age range, 57-89 years; mean age, 71 years) were treated with cutting balloon PTA for 16 anastomotic stenoses after infrainguinal bypass (prosthetic grafts, seven patients; prosthetic-vein composite grafts, two; venous grafts, five; and ileofemoral stent-graft, one). Cutting balloon PTA was followed by conventional PTA to improve anastomotic diameter. Patients with stenotic vein grafts underwent cutting balloon PTA after failed conventional PTA; the other patients were treated primarily with cutting balloon PTA. Criteria for success were a lumen diameter improvement of greater than 50% or residual stenosis of 20% or less. Follow-up was performed with color duplex ultrasonographic surveillance. Patency rates and durations were calculated with Kaplan-Meier survival curves and log-rank statistics. RESULTS: Attempted conventional PTA (n = 6) prior to cutting balloon PTA was unsuccessful. Cutting balloon PTA was technically successful in 15 (94%) of 16 lesions, without clinical complications. Two local restenoses and one graft occlusion occurred between 5 and 7 months. The cumulative 6-month primary and secondary graft patency rates were 84% and 92%, respectively. At 12 and 18 months, they were 67% (95% CI: 0.34, 0.86) and 83% (95% CI: 0.48, 0.96), respectively; mean follow-up was 10.0 months. CONCLUSION: Cutting balloon PTA proved feasible for treatment of resistant peripheral arterial bypass graft stenosis, commonly caused by neointimal hyperplasia, with excellent technical success. Short-term patency with this technique appears to be superior to that with conventional PTA, and it compares well with patency of atherectomy for salvage of infrainguinal bypass grafts.

Aged↗
PubMed2002

Autologous thrombin: a new embolization treatment for traumatic intrasplenic pseudoaneurysm.

PURPOSE: To report the use of autologous thrombin for transcatheter embolization of a traumatic parenchymal splenic pseudoaneurysm. CASE REPORT: A 15-year-old boy presented with a splenic parenchymal laceration after blunt abdominal trauma. The patient was managed conservatively but developed an intrasplenic pseudoaneurysm (grade III AAST scale) with subcapsular contrast extravasation after 3 weeks. Autologous thrombin was isolated from the patient's blood and subsequently delivered to the lesion by transcatheter superselective injection into the aneurysm neck. The patient was asymptomatic after the procedure. Nine months' follow-up demonstrated a normal spleen with completely homogenous parenchyma. CONCLUSIONS: Autologous thrombin injection to induce thrombosis of intrasplenic pseudoaneurysm represents a new treatment option for traumatic abdominal organ injuries. Intrasac thrombosis can be safely induced to successfully restore the splenic parenchymal integrity without introduction of foreign material and associated risks of adverse reactions or infection that might accompany the use of commercial thrombin preparations.

Adolescent↗
PubMed2002

Using 6-mm Cutting Balloon angioplasty in patients with resistant peripheral artery stenosis: preliminary results.

OBJECTIVE: The objective of this study was to assess the efficacy of 6-mm Cutting Balloon angioplasty in patients with resistant peripheral stenoses caused by neointimal hyperplasia or irradiation-induced arteriopathy in vascular territories that are not amenable for use of the smaller Cutting Balloons that are used in cardiology. CONCLUSION: Peripheral Cutting Balloon angioplasty with the new 6-mm Cutting Balloon device proved useful in the short term for treatment of peripheral arterial stenoses resistant to conventional angioplasty.

Adult↗
PubMed2001

Percutaneous thrombectomy: a review.

Percutaneous thrombectomy (PT) is an established technique for the removal of acute thrombus in occluded arteries, veins and vascular grafts. Percutaneous thrombectomy can be used as an adjunctive treatment to other methods of thrombus removal such as thrombolysis or as sole therapy. The two main methods are percutaneous aspiration thrombectomy in which thrombus is removed by suction with the aid of wide-bore catheters, and mechanical thrombectomy using a variety of automated devices to fragment or remove thrombus. Aspiration thrombectomy is often used as an adjunct to thrombolysis in acute arterial occlusion, or as salvage therapy to remove distal emboli following iliac or femoropopliteal angioplasty. Mechanical thrombectomy is useful for the treatment of thrombosed dialysis grafts and is being increasingly used for the treatment of massive pulmonary emboli and ileofemoral or ileocaval deep venous thromboses.

Arterial Occlusive Diseases↗