Biomedical subjects

Mario Bezzi

Publications and source records attributed to Mario Bezzi.

8 recordsLinked to original sources

PubMed2006

Techniques in cerebral protection.

Carotid angioplasty and stenting is a valid alternative option to conventional carotid endarterectomy in the treatment of carotid artery stenosis. During the stenting process, however, distal embolization can occur with neurological consequences. To avoid this, cerebral protection devices have been introduced. Three principal types of protection system have been developed: distal balloon occlusion, distal filters and proximal protection with or without reversal of flow. As protection devices became the focus of interest by manufactures and physicians, several trials are going on worldwide to analyze the characteristics of each of them and to evaluate their efficacy to reduce the rate of distal embolization.

Blood Vessel Prosthesis↗

PubMed2004

Polytetrafluoroethylene-covered nitinol stent-graft for transjugular intrahepatic portosystemic shunt creation: 3-year experience.

PURPOSE: To prospectively evaluate the use of a recently developed expanded polytetrafluoroethylene (PTFE)-covered nitinol stent-graft in preventing the need for repeated intervention after transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS: Fifty-three consecutive patients underwent TIPS procedures between January 2000 and February 2002. Minimum patient follow-up was 9 months (mean, 16.3 months). Fifty-six stent-grafts were implanted in 53 patients; eight of the devices were 8 mm in diameter and 48 were 10 mm in diameter. The stent length varied from 4 to 7 cm. Indications for the procedure included recurrence of bleeding after sclerotherapy (28 patients with cirrhosis, one patient without), refractory ascites or hydrothorax (21 patients with cirrhosis, one patient without), and Budd-Chiari syndrome (two patients). RESULTS: A technical success rate of 100% was obtained, with an early clinical success rate of 96.2%. During the follow-up period, the recurrence rate was 3.4% (one of 29 patients) for bleeding and 9.0% (two of 22 patients) for ascites. Shunt malfunction occurred in nine of 53 patients (16.9%); in one of these nine patients, shunt occlusion was evident after revision, and a parallel shunt was created. The 1-year primary and secondary patency rates were 83.8% and 98.1%, respectively. In this series, the incidence of encephalopathy (included even as a single short-lived episode) was 47.1% (25 of 53 patients). The 30-day mortality rate was 3.8% (two of 53), and the late mortality rate was 17.3% (eight of 46), excluding seven patients who underwent transplantation. CONCLUSION: The new PTFE-covered nitinol stent-graft used appears to be excellent in preventing the need for repeated interventions. A primary patency rate of 83.8% and a secondary patency rate of 98.1% were achieved.

Adolescent↗

PubMed2004

Infrarenal aortic and lower-extremity arterial disease: diagnostic performance of multi-detector row CT angiography.

PURPOSE: To compare multi-detector row spiral computed tomographic (CT) angiography with digital subtraction angiography (DSA) in evaluation of the infrarenal aorta and lower-extremity arterial system. MATERIALS AND METHODS: Fifty patients with peripheral arterial occlusive disease were evaluated with multi-detector row CT angiography and DSA. Arteries depicted at CT angiography and DSA were graded separately for degree of stenosis as 23 anatomic segments (infrarenal aorta, right and left common iliac artery, internal iliac artery, external iliac artery, common femoral artery, superficial femoral artery, deep femoral artery, popliteal artery, anterior tibial artery, tibioperoneal trunk, posterior tibial artery, and peroneal artery). Grades included the following: 1, normal patency; 2, moderate (< or =50%) stenosis; 3, focal severe (>50%) stenosis; 4, multiple severe stenoses; and 5, occlusion. Three readers independently interpreted the images, and statistical analysis was performed. The results of image interpretation were evaluated for strength of agreement by using Cohen kappa statistics. On the basis of consensus readings, sensitivity, specificity, and accuracy for detection of stenotic lesions were calculated, with findings at DSA used as the reference standard. RESULTS: Substantial to almost perfect interobserver agreement was achieved in all cases. At DSA, 349 diseased segments were found among the 1,137 segments evaluated. Sensitivity, specificity, and accuracy, based on a consensus reading of multi-detector row CT angiograms, were 96%, 93%, and 94%, respectively. A statistically significant difference (P <.05) between DSA and multi-detector row CT angiography was present only in arteries graded 1 or 2. Interobserver agreement was almost perfect among the three readers for treatment recommendations based on findings at CT angiography and DSA. CONCLUSION: Multi-detector row CT angiography appears consistent and accurate in the assessment of patients with peripheral arterial occlusive disease.

Adult↗

PubMed2003

Intrahepatic aneurysmal portohepatic venous shunt: embolization with a tissue adhesive solution.

PURPOSE: To report the endovascular treatment of an intrahepatic portosystemic venous shunt (IPSVS) using a tissue adhesive solution. CASE REPORT: A 40-year-old woman without diagnosed liver disease presented for evaluation of vague abdominal pains. A latent portosystemic encephalopathy was diagnosed only during hospitalization, when ultrasound examination disclosed a venous-venous right hepatic communication. The patient was treated with selective percutaneous embolization using a tissue adhesive after blocking the lesion's venous inflow and outflow tracts. The result was excellent, and the patient recovered completely in a few days. After 5 months, the patient is asymptomatic and event-free. CONCLUSIONS: Large IPSVS may be successfully treated percutaneously using a tissue adhesive solution, avoiding a more invasive procedure.

Adult↗

PubMed2003

Type A aortic dissection developing during endovascular repair of an acute type B dissection.

PURPOSE: To describe an extension of type B dissection into type A during endoluminal treatment of acute type B dissection. CASE REPORT: A 57-year-old man with acute type B dissection underwent endovascular repair using 2 Excluder stent-grafts. Before releasing the second stent-graft, the patient complained of mild central chest pain, headache, and visual flashes, but no hemodynamic changes were noticed. An angiogram, performed soon afterwards, showed a retrograde extension of the dissection through the aortic arch involving both the left carotid artery and the ascending aorta. The procedure was completed, and the patient was transported to the operating room where the proximal ascending aorta was replaced. Spiral computed tomographic angiography performed 2 weeks after the procedure showed complete exclusion of the primary entry tear. At 6-month follow-up, the patient was asymptomatic; the left carotid artery dissection had disappeared. CONCLUSIONS: Endovascular repair of acute type B dissection is technically feasible, but longer experience will help prevent technical complications.

Aortic Dissection↗

PubMed2002

New ePTFE/FEP-covered stent in the palliative treatment of malignant biliary obstruction.

PURPOSE: To determine the technical efficacy and safety of an expanded polytetrafluoroethylene and fluorinated ethylene propylene (ePTFE/FEP)-covered metallic stent in the management of malignant biliary obstruction and to evaluate its clinical efficacy by estimating stent patency and patient survival rates. MATERIALS AND METHODS: Twenty-six patients with common bile duct stricture caused by malignant disease were treated by placement of 29 stents. The stent consists of an inner ePTFE/FEP lining and an outer supporting structure of nitinol wire. Multiple wire sections elevated from the external surface provide anchoring. Stents are available in two versions, with or without holes in the proximal stent lining. Holes should provide drainage of the cystic duct or biliary side branches when covered by the proximal stent end. Clinical evaluation and assessment of serum bilirubin and liver enzyme levels were done before stent placement and at 1, 3, 6, and 9 months. Average follow-up duration was 5.4 months (range, 5 d to 12.5 mo). RESULTS: Placement was successful in all cases. The 30-day mortality rate was 11.5%. The survival rates were 40% and 15% at 6 and 12 months, respectively. Eighty-four percent of patients had adequate palliative drainage during their lifetime. The stent patency rates were 91%, 77%, and 77% at 3, 6, and 12 months, respectively. Four patients (16%) presented with stent occlusion and needed repeat intervention. No migration occurred. Complications other than stent occlusion occurred in five patients (19%); among these, acute cholecystitis was observed in three patients (12%). CONCLUSION: Preliminary results suggest that placement of this ePTFE/FEP-covered stent is feasible and effective in achieving biliary drainage. The percentage of patients undergoing lifetime palliation and the midterm patency are promising. However, the incidence of acute cholecystitis is high. Treatment of a larger group of patients is mandatory to validate these long-term results.

Adult↗

PubMed2002

Malignant biliary obstruction: treatment with ePTFE-FEP- covered endoprostheses initial technical and clinical experiences in a multicenter trial.

PURPOSE: To determine and present the initial technical and clinical results of using an expanded polytetrafluoroethylene-fluorinated ethylene propylene (ePTFE-FEP)-covered biliary endoprosthesis to treat malignant biliary obstruction. MATERIALS AND METHODS: This prospective nonrandomized study included 42 patients with malignant obstruction of the common bile duct, common hepatic duct, and hilar confluence. Unilateral (n = 38) or bilateral (n = 4) bile duct drainage was performed by using fully covered endoprostheses with anchoring fins. To avoid branch duct blockage, endoprostheses with drainage holes at the proximal end were available. Procedure- and device-related complications were recorded. Patient survival and stent patency rates were calculated with Kaplan-Meier survival analysis. Mean follow-up bilirubin and alkaline phosphatase levels were calculated, and differences in means were evaluated with a paired t test. RESULTS: Successful deployment, correct positioning, and patency of the device were achieved in all patients. Procedure-related complications occurred in two (5%) patients. Thirty-day mortality rate was 20% (eight of 41 patients), and median survival time was 146 days. Laboratory values decreased significantly after the procedure (P <.001). Recurrent obstructive jaundice occurred in six (15%) patients. Primary patency rates at 3, 6, and 12 months were 90%, 76%, and 76%, respectively. Calculation of the composite end point of death or obstruction revealed a median patency duration of 138 days. No endoprosthesis migration was observed. Branch duct obstruction was observed in four (10%) patients. Postmortem examination of one stent revealed a widely patent endoprosthesis with intact covering. CONCLUSION: Initial results of percutaneous treatment of malignant biliary obstructions with fully covered ePTFE-FEP endoprostheses suggest that they are safe and potentially clinically effective.

Abdominal Neoplasms↗

PubMedDate not supplied

Hepatic arterial continuous infusion (HACI) of oxaliplatin in patients with unresectable liver metastases from colorectal cancer.

BACKGROUND: Oxaliplatin, a new DACH-platinum compound, has provided high response rates both in untreated and 5-FU-resistant patients. AIM: To define the feasibility and toxicity profile of Oxaliplatin administered as a continuous hepatic aterial infusion. PATIENTS AND METHODS: Seventeen patients with pretreated metastatic liver colorectal cancer were treated with Oxaliplatin 20 mg/m2/day by HACI x 5 days every 3 weeks. RESULTS: Toxicity grade 3 included pain (4 out of 17), asthenia (1 out of 17) and nausea (1 out of 17). Abdominal pain grade 4 (WHO) was noted in only one patient. Overall, severe abdominal pain (main dose-limiting toxicity) was observed in 41% of patients and no chemical hepatitis and sclerosing cholangitis pain-related was proven by an endoscopic retrograde cholangiography. The response rate was not a primary end-point; nonetheless among 15 evaluable patients we observed partial responses (PR) in 7 patients (46%) and stable disease (SD) in 21% of cases for an overall tumor growth control of 67%. Progression to disease (PD) was 33%. Following chemotherapy, one patient underwent surgical removal of residual metastases, with curative intent. The 1-year survival rate was 64%. The median duration of survival was 19 months. The median delay to hepatic progression was 10 months. CONCLUSION: Further studies are required to define the role of HACI Oxaliplatin, the schedule of administration (bolus vs continuous infusion) and the combination, also in this setting, with fluoropyrimidines.

Aged↗