PubMed Health⌕ Search

Biomedical subjects

F M Salvatori

Publications and source records attributed to F M Salvatori.

At least 19 recordsLinked to original sources
PubMed2006

Stent graft in TIPS: technical and procedural aspects.

Transjugular intrahepatic portosystemic shunt (TIPS) is a nonoperative therapeutic option for the management of portal hypertension, variceal bleeding, recurrent ascites, Budd-Chiari syndrome. In view of the many issues surrounding the use of TIPS, in 1994 the US National Digestive Diseases Advisory Board convened a scientific conference to review the current data available and to establish the indications and controindications for this procedure. However there are still unsolved problems especially short primary patency of the shunt due to intimal hyperplasia, which causes a reduction of the shunt lumen thus favoring a return of the portal hypertension with recurrent variceal bleeding. Several study were performed in the last years to evaluate the efficacy of covered stent in order to reduce shunt disfunction secondary to intimal hyperplasia. PTFE seems to be more efficient in the prevention of restenoses. In our experience more then 100 patients were treated with the Viatorr stent-graft. After a follow-up ranging from 1 to 50 months we reported a 1- year primary patency rate of 83.8%. However the use of the stentgraft is correlate with a high rate of hepatic hencefalopathy (46.6 %). In case of hepatic hencefalopathy refractory to the conventional medical therapy, TIPS reduction should be performed.

Ascites↗
PubMed2002

Interventional radiology techniques in the treatment of complications due to videolaparoscopic cholecystectomy.

INTRODUCTION: The development of videolaparoscopic cholecystectomy (VLC) has represented an important achievement in the search for minimally invasive surgical procedures, and especially in the surgical management of such a common and costly disease as cholelithiasis. However, the literature shows that, while VLC carries a similar mortality rate to open surgery, it has a greater incidence (2-5 times) of iatrogenic injury to the biliary tract and hepatic hilum [3, 5, 10, 25, 28]; this incidence further increases in cases of so-called "hard cholecystis" [10, 13, 25, 28, 30]. An equally minimally invasive technique is therefore needed to treat these lesions; this technique should be effective and safe, allow for shorter hospital stays and lower costs, and be made available at all the centres where VLC is performed. MATERIAL AND METHODS: We evaluated 60 patients (28 women and 22 men, age range 41-71) with 24 peritoneal collections (14 bilomas, 10 abscesses), 35 biliary stenosis (clips, chronic-developing lesions), and 2 vascular lesions as direct iatrogenic post-LC injuries. The most frequent clinical symptoms were jaundice, pain, sepsis, abdominal distension, and abdominal colic due to retained common bile duct stones. We carried out 60 percutaneous biliary reconstruction procedures, 44 biliary drainages (4 internal, 4 external), 6 combined radiological-endoscopic approaches with the Rendez-Vous technique, and 2 embolisations. RESULTS: All procedures had 100% technical success; the biliary reconstruction procedures had a 2% morbidity rate (sepsis, cholangitis). The clinical emergencies (choleperitoneum, haemoperitoneum, severe jaundice) resolved in 72 hours for 55 of the 60 patients (92%). The combined percutaneous-endoscopic procedures with the biliary Rendez-Vous technique were successfully performed in 5 out of 6 cases, allowing reconstruction of bile duct continuity and remission of symptoms, without the need to resort to surgical anastomosis. At a recent follow-up of the patients who had been managed only percutaneously, one showed patency of the bile ducts and had the stent removed after 18 months, and two showed optimal functioning of the stent that was still in place after 5 and 8 months respectively; two patients were lost to follow-up. Primary biliary patency at 60 months from biliary reconstruction was 75%. Maximum and immediate dilatation was obtained at the first attempt in most cases. Reoperation was avoided in 59 out of 60 patients. Only one patient with full transection of the common bile duct was reoperated on after insertion of a biliary drainage catheter. The overall length of hospital stays was between 1 and 4 weeks. CONCLUSIONS: Interventional radiology carried out according to indications seems to be the most natural way to treat the complications of VLC. It spares the patients, who opted for a minimally invasive technique like VLC, the need to undergo open surgery, and allows for shorter hospital stays and more efficient cost management for the hospital.

Adult↗
PubMed1997

MR cholangiography in the examination of patients with biliary-enteric anastomoses.

OBJECTIVE: The aim of our study was to determine the role of MR cholangiography in the noninvasive examination of patients with biliary-enteric anastomoses. SUBJECTS AND METHODS: Twenty-four patients (nine men and 15 women; mean age, 68.9 years old) with biliary-enteric anastomoses underwent MR cholangiography. We used a fat-suppressed three-dimensional turbo spin-echo sequence (3000/700 [TR/TE]; echo train length, 128) with no breath-hold, optimized with a 0.5-T magnet. Imaging studies were performed because of scheduled follow-up (five patients), persistent jaundice (six patients), cholangitis and abnormal liver function (eight patients), and a combination of transient jaundice, epigastric pain, and abnormal liver function (five patients). RESULTS: Image quality was graded from optimal to good in 21 (88%) of 24 cases and poor in three (13%) of 24 cases. The degree of bile duct dilatation was correctly assessed, with complete agreement between the two observers in all cases. MR cholangiography correctly showed bile duct irregularities in six of the eight patients with cholangitis (kappa = .59), anastomotic strictures in all 19 patients with strictures (kappa = .86), and 3- to 15-mm stones in nine of 10 patients (kappa = .95). A slight overestimation of the strictures occurred in four of the 19 cases with strictures. CONCLUSION: MR cholangiography is a reliable imaging technique for the examination of patients with biliary-enteric anastomoses.

Aged↗
PubMed1996

Self-expanding stents in transjugular intrahepatic portosystemic shunt: experience with nitinol Strecker stents.

The aim of our study was to evaluate the performance and efficacy of a new self-expanding stent (nitinol Strecker stent) in the transjugular intrahepatic portosystemic shunt (TIPS) procedure. We have successfully placed 64 nitinol Strecker stents in 48 patients. The average portosystemic gradient decreased from 22 to 11 mm Hg. Balloon dilatation was necessary in 12 of 35 angiographically controlled cases at 5 days (34%), because of incomplete stent expansion, small thrombi within the stent or obstruction. At 1-6 months stent malfunctions occurred in 8 of 23 patients who underwent control angiography (34%) and at 6-24 months in 6 of 7 patients (85%). Rebleeding occurred in 2 of 39 patients (follow-up > 1 month) (5%) and temporary crises of de novo encephalopathy were observed in 11 of 48 patients (23%). Refractory ascites completely resolved in 4 of 6 patients (66%) and improved in the remaining 2 cases. Compared with other self-expanding stents, nitinol Strecker stents seem to be equally effective in TIPS; no increase in complication rate was observed, either clinical or stent-related.

Adult↗
PubMed1995

Complications after laparoscopic cholecystectomy. Coordinated radiologic, endoscopic, and surgical treatment.

The diagnostic and therapeutic approaches used for patients referred for bile duct injuries and other major complications after laparoscopic cholecystectomy (LC) were reviewed and the results of a coordinated radiologic, endoscopic, and surgical approach were assessed. From April 1991 to October 1993, 23 patients were observed. Seven patients had biliary strictures, five had biliary lesions, five presented with retained common bile duct (CBD) stones, and one had a minor cystic duct leak. Five patients had miscellaneous abdominal fluid collections; in addition, biloma or bile ascites were present in 10/23 cases. Correct definition of iatrogenic lesions was mainly made by endoscopic retrograde cholangiography (ERCP) (n = 15), associated in six cases also with percutaneous cholangiography (PTC). "Minimally invasive" treatment included the full range of endoscopic and interventional radiological procedures. Six patients with biliary strictures, one patient with a biliary lesion, all five patients with residual CBD stones, and four patients with abdominal collections were treated by "minimally invasive" techniques: Therefore, laparotomy was avoided in 70% of cases (16/23 patients). Open surgery was necessary in 7/23 patients (30%), because of ductal lesion (n = 4), ductal stricture by endoloop (n = 1), iliac artery injury (n = 1), and phlegmon of gallbladder bed (n = 1). It appears that careful assessment of complications after LC is mandatory and often requires the combined use of ERCP/PTC and cross-sectional imaging.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Nonvascular interventional radiology in the treatment of post-liver transplant complications. The clinico-radiological correlations and technical considerations].

Eleven patients, included in a series of 105 orthotopic liver transplant recipients, underwent interventional radiologic procedures for post-operative complications. Seven patients had obstructive jaundice, three patients had sepsis, and one patient was bleeding from the T-tube. Cholangiography, performed in 9/11 patients, demonstrated stenosis of the anastomosis in six cases, stenosis of the intrahepatic biliary tree in one case, and stenosis of both tracts in the remaining two cases. Four patients were treated with bilioplasty (from 1 to 5 sessions), using balloon catheters (8-10 mm) followed by stones removal in one case, and by the placement of a metallic stent in another case. The follow-up ranged from one to three years: no biliary stasis occurred, during that period, in these patients. Another patient with recurrent cholangiocarcinoma of the biliary anastomosis, treated with Carey-Coons endoprosthesis and brachytherapy, died four months later without jaundice. In the three patients with sepsis and in the patient with bleeding from the T-tube, intra- or extra-hepatic (in one case) multiple abscesses were demonstrated. The conservative treatment with the placement of percutaneous drainage catheters, associated with internal biliary drainage in two cases, allowed complete symptoms resolution. The technical success obtained in all patients confirmed the effectiveness of interventional radiology in the treatment of biliary complications after liver transplant, thus avoiding the need of surgical reintervention.

Cholangiography↗
PubMed1994

[Carbon dioxide as an intra-arterial contrast agent in echography: a technic for its preparation and the preliminary results in assessing hepatocarcinoma vascularization].

This paper reports on an original method to prepare a contrast agent consisting of CO2 microbubbles to be injected i.a. during ultrasound examinations (ultrasound angiography-USA), whose value was investigated in the study of tumor neovascularity in HCC patients. Thirty-five HCC patients underwent USA. CO2 was drawn out from a gas container under pressure and, through a sublimation process, made available in predetermined quantities in test tubes. USA was performed during angiography in 9 cases and immediately before arterial chemoembolization in the other 26 cases. In 51 lesions vascularity was evaluated with conventional angiography, USA and lipiodol CT. USA demonstrated lesion hypervascularity in 91% of cases, as confirmed by lipiodol CT (88%), versus 72.4% of angiography. In 3 of 35 patients USA demonstrated 6 more lesions undetected by other modalities: two of them were proved to be HCC and adenomatous hyperplasia at percutaneous biopsy. USA is a cost-effective procedure, which is easy to perform during conventional angiography: it is more sensitive than conventional angiography in the study of lesion neovascularity and can help plan lesion management, anticipating the results of chemoembolization. The role of USA in the diagnosis and treatment of HCC is, however, still to be defined.

Aged↗
PubMed1994

[Transjugular intrahepatic portosystemic shunt (TIPS): indications and results after 22 months of experience].

December 1991 through November 1993, fifty-five patients underwent TIPS with the following indications: failed sclerotherapy or surgery (25 patients), bleeding from gastric varices (3 patients), patients waiting for liver transplantation (11 patients) and refractory ascites (9 patients). Seven patients were included in a randomized TIPS vs sclerotherapy trial. The average follow-up of living patients is 4.6 months (range: 1-16 months). The technical success rate was 100%. The portosystemic gradient decreased from 22 mmHg to 10.7 mmHg. After TIPS all patients were followed-up with endoscopic, angiographic and color Doppler examinations and underwent periodic clinical checks. Early (5-day) angiographic follow-up exams showed partial stent thrombosis in 5/32 cases (15.5%) and complete stent thrombosis in 3 cases (9.3%). Late angiographic follow-up exams (1-9 months) showed complete stent occlusion in 2 cases, stent stenosis in 8 cases and hepatic vein stenosis in 5 cases. At present, 37 patients are alive (67%); 5 patients have undergone liver transplantation (9%), and 13 patients died (24%)--3 within 48-72 hours after the procedure and 10 in 1-8 months. Five patients had recurrent bleeding (9%). Ascites was reduced or disappeared in 8/9 cases. Early clinical complications occurred in 12% of cases and were treated with medical therapy. Within one year, signs of encephalopathy developed in 13 patients (23%) and were successfully treated with medical therapy.

Adult↗
PubMed1993

[Metallic stents in benign biliary stenosis. A four-year follow-up].

From October 1988 to September 1989, 29 self-expanding biliary metallic stents were positioned in 18 patients with recurrent benign biliary strictures, who were no longer candidates to surgical repair and did not respond to percutaneous balloon dilatation. "Z" stent were used in 17 patients and a Wallstent in one case. At four years' follow-up (range: 39-50, average: 46 months), 10 patients remain asymptomatic, without signs of bile stasis (55.5%), five patients had recurrence of symptoms and were subsequently retreated (27.7%) and three patients died from severe underlying diseases, two of them with stent obstruction, one without signs of bile stasis. Recurrences were caused by stent obstruction in three cases. At four years' follow-up the overall patency rate is 68.7%. According to the type of stricture treated, patency is 100% in the group of patients with single CBD stenosis and in the patients with single anastomotic strictures, whereas in all patients with multiple or complicated strictures the stents completely occluded within 4-22 months.

Adult↗
PubMed1993

[Percutaneous treatment of symptomatic renal cysts: effects of the combination of sclerotherapy with alcohol and fibrin glue (tissucol)].

The percutaneous treatment of symptomatic renal cysts has grown in therapeutic importance over the last years. The international literature includes many reports on the sclerotherapy of renal cysts with different sclerosing agents. The authors report their experience with the percutaneous treatment of renal cysts by combining pure alcohol and fibrin glue. The glue serves the purpose to seal the walls of the cyst already damaged by alcohol. The results of the combined treatment show that relief of symptoms was obtained in all patients, with no major or minor complications. Complete cyst ablation was obtained only in 16% of cases, while a partial recurrence was seen in 80% of patients, with an average regrowth < 35% of the initial cyst volume. None of these patients presented further symptoms. At present, the follow-up time ranges 3 to 34 months.

Adolescent↗
PubMed1992

[Ultrasound and color Doppler control of percutaneous angioplasty (PTA) of the renal artery].

The Authors report their experience about fifty patients affected with renovascular hypertension, treated by percutaneous transluminal angioplasty (PTA) for stenosis of main renal artery and now studied by Duplex-Scan and Color-doppler. Results, compared with arterial pressure measurements, renography and laboratory renal function evaluation, showed a sensibility of 84%, specificity of 90% and an accuracy of 87.5%. Advantages and limits of Duplex-scan in patients treated by PTA are briefly discussed.

Angioplasty, Balloon↗
PubMed1990

Recurrent benign biliary strictures: management with self-expanding metallic stents.

Self-expanding metallic stents of a modified Gianturco design were used to treat benign strictures of the biliary tree in 17 patients. Thirteen patients had undergone several unsuccessful surgical repairs, and four had not undergone surgery because of their clinical status. All patients had already undergone multiple percutaneous balloon dilations without success. Stents were placed percutaneously, through a transhepatic approach, without complications. Adequate caliber of the strictured segment, stable relief of symptoms, and normalization of liver function tests were achieved in 14 patients (82.4%). Partial primary success was obtained in one patient; initial success was achieved in two patients, but strictures recurred after 5 months. The average follow-up period was 8 months. Results suggest that placement of these stents might represent a permanent therapeutic solution for intractable recurrences. Extended follow-up and experimental studies to clarify long-term patency and biotolerance are needed.

Adult↗
PubMed1989

[Percutaneous treatment of benign biliary stenosis: bilioplasty and stenting].

We reviewed our personal experience in 46 patients with biliary strictures, who underwent percutaneous balloon dilatation between 1983 and 1988. The strictures were iatrogenic in 24% of the cases, anastomotic in 52%, inflammatory in 17%, and associated with sclerosing cholangitis in 7%. The treatment consisted in dilating the bile ducts with balloon catheters of different kinds and sizes ("bilioplasty") and placing an internal drainage catheter for a varying period of time ("stenting"). In 22 patients the catheter was removed after an average time of 7.7 months. The rate of stricture recurrence was 13.5% (average follow-up: 20 months). In the remaining 24 patients the stents are still in situ, waiting for removing. Major complication rate was 6.4% (2 pleural effusions and 1 hepatic artery bleeding). We also report our initial experience with metallic self-expanding stents which appear as a promising tool in the management of recurring strictures.

Adult↗
PubMedDate not supplied

Percutaneous management of benign biliary strictures with balloon dilation and self-expanding metallic stents.

Seventy patients with benign biliary strictures were treated by means of percutaneous balloon dilation and stenting. Patients with stenoses relapsing during catheter stenting (18/70) were treated with self-expanding metallic stents. Results were evaluated in 56 patients; in patients without sclerosing cholangitis (n = 47) the patency rate with both modalities of treatment was 96%, while in the patients with secondary sclerosing cholangitis (n = 9), it was 33%, for a total success rate of 86%. The average follow-up was 23 months (range 3-72 months). Major complications included one death for septic shock (1%), three severe hemorrhages (4%), two of which required arterial embolization, two pleural effusions (3%), and one liver abscess following arterial embolization. Moderate fever for 1-2 days was a common finding after percutaneous puncture and balloon dilation. Percutaneous management of benign biliary strictures so far has been attempted only in surgical failures or in complicated cases. In view of our midterm results it may well become the initial treatment in many patients.

Adult↗
PubMedDate not supplied

Metallic stents in benign biliary strictures: three-year follow-up.

Eighteen patients with recurrent benign biliary strictures (BBS) were selected for metallic stents placement because they failed to respond to percutaneous balloon dilatation. None were candidates for surgical corrections. We used "Z" single or double stents in 17 cases and a Wallstent in 1 case. After more than 3 years of follow-up (average period 37 months, range 30-41 months), 10 patients (55.5%) were asymptomatic without signs of bile stasis; 5 patients (27.7%) had recurrence of symptoms and were eventually retreated; and 3 patients (16.6%) died, 2 of obstructive jaundice and liver failure and 1 of metastatic gastric cancer. Recurrence was due to stent occlusion by tissue ingrowth in 3 cases, stent migration in 1 case, and an inflammatory lesion of the papilla of Vater in another case, with patency of the metallic stent. The overall patency rate, at 3-year follow-up was 68.7%. In our series, the main factor determining long-term patency of metallic stents has been reactive tissue ingrowth. Nevertheless, long-term results obtained with metallic stents in recurrent benign biliary strictures should be considered satisfactory. In selected patients, metallic stents may represent the only long-term treatment available for maintaining bile flow.

Adult↗
PubMedDate not supplied

Clinical experience with covered wallstents for biliary malignancies: 23-month follow-Up.

PURPOSE: To evaluate the effectiveness of partially covered metallic Wallstents to prevent tumoral ingrowth in patients with neoplastic obstruction of the biliary tract. METHODS: Twenty-one patients with malignant obstructive jaundice have been treated with Wallstents partially covered with a polyurethane polymer. In total, 36 covered stents (8 and 10 mm in diameter, 70 and 90 mm long) were deployed. All the stents were free from covering at both ends. RESULTS: Jaundice was successfully treated in 100% of cases. There were no problems related to the releasing system during stent positioning, no major complications, and no incompatibility reactions to the materials composing the endoprostheses. At 23-month follow-up, 6 patients are still alive and 15 are dead; of these 15 patients, 11 died in the first 6 months and the last 4 died between 6 and 23 months. Seven patients had an obstructed stent; in four of these, cholangioscopy showed the presence of tumoral ingrowth and in one it showed necrotic tissue with biliary pigments and inflammatory cells. No biopsy specimen was obtained in the remaining two patients with stent obstruction. The follow-up, ranging from 7 to 23 months, showed a primary patency of 46.8% and 24.6% and an assisted patency of 66.3% and 59% at 6 months and 23 months, respectively. CONCLUSIONS: Covered metallic stents are effective and may produce improved survival in patients with malignant biliary obstruction (27. 8% at 23 months). Stent patency, however, is similar to that of uncovered stents. Modifications in the design of the covering membrane may reduce stent obstruction resulting from disruption of the plastic covering.

Aged↗