[Show abstract][Hide abstract] ABSTRACT: Purpose
To evaluate retrospectively the safety and efficacy of anterograde embolization of the periprostatic venous plexus (AEPV) via percutaneous access of the deep dorsal vein of the penis for erectile dysfunction (ED) resulting from veno-occlusive dysfunction (VOD).
Materials and Methods
From September 2009 through December 2012, 18 patients with moderate to severe ED secondary to insufficiency of physiologic venous occlusion as diagnosed by color Doppler evaluation of the penis after direct pharmacologic stimulation were treated. Preliminary diagnoses were also confirmed with dynamic cavernosography. Selective AEPV was achieved using a combination of N-butyl cyanoacrylate and endovascular coils. Follow-up consisted of collecting International Index of Erectile Function questionnaire (IIEF-6) scores and repeated color Doppler evaluation.
Immediate technical success was achieved in 16 of 18 patients (88.8%). Follow-up data were obtained at a mean of 13.3 months ± 7.5. In 12 of the patients with technical success, the mean IIEF-6 score improved from 10.5 ± 5.2 to 20.6 ± 8.4 after the procedure (P = .0069). At 3-month short-term follow-up, clinical success defined by an end-diastolic velocity of < 5 cm/s on color Doppler was noted in 81% (13 of 16 patients). Of these 13 patients, 7 patients had continued erectile function at the end of follow-up, and the other 6 patients reported progressive diminishment in the benefit over time. No major complications and two minor complications were encountered.
AEPV for ED secondary to VOD is a safe alternative to surgical treatment that demonstrates promising short-term and midterm efficacy.
Journal of vascular and interventional radiology: JVIR 06/2014; 25(6). DOI:10.1016/j.jvir.2014.01.015 · 2.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: PURPOSE
To value the safety , the efficacy of the periprostatic-bladder venous plexus anterograde embolization (PVAE) in erectile dysfunction (ED) due to venous leakage.
METHOD AND MATERIALS
from January 2009 until November 2011 we treated a total of 14 patients suffering from severe to moderate vascular ED due to veno-occlusive insufficiency not related to trauma, not responsive to any oral therapy (phosphodiesterase type 5 inhibitors). The diagnosis was previously obtained with a penile color doppler flow evaluation after direct pharmacologic stimulation with intracavernosal injections of prostaglandin E1 (end-diastolic velocity > 5cm/s) and confirmed with dynamic cavernography. All the patients underwent selective anterograde embolization of the perirpostatic-bladder plexus using US guided access of the deep dorsal penile vein(DDV). Once the periprostatic venous plexus catheterization was obtained, a selective embolization with surgical glue (N-butyl cyanoacrylate) diluted with lipiodol and coils as required was performed. The follow up ranged from 3 to 24 months and was obtained giving out the international index of erectile function questionnaire (IIEF) and the penile color doppler evaluation after direct pharmacologic stimulation.
The technical success, defined as complete periprostatic venous plexus occlusion, was obtained in 13 of the 14 patients .9 patients were evaluated before and post procedure using the IIEF .The initial mean IIEF score was 10 which reached up to 20,25 (p value 0,0271) after the embolization.11 of the 13 patients perceived a benefit with an improvement in the erection with a recovery of the sexual activity . In 6 patients the duration of the benefit was constant, in 5 patients there was a reduction of the initial benefit; of these 3 have begun to use phosphodiesterase type 5 inhibitors. No major nor minor complications were reported.Two patients developed a mild curvature of the penis.One patient developed a silent pulmonary embolism of glue/lipiodol. One patient had a partial reflux of the glue/lipiodol in the Dartos soon after the introducer removal with pain in the shaft in the following 3 weeks treated with analgesics and most likely due to nerve irritation.
The PVAE in erectile dysfunction due to venous leakage represents an innovative, safe and effective alternative to the surgical treatment.
This is the first report on the PVAE in ED due to venous leakage.
Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
[Show abstract][Hide abstract] ABSTRACT: Hepatic arterial chemotherapy (HAC) is an effective treatment of liver metastases from colorectal cancer (CRC). Phase I and II studies have already shown the feasibility and efficacy of intra-arterial oxaliplatin (OXA).
Twenty-one pre-treated patients with liver metastases who received HAC with OXA/folinic acid (FA)/5-fluorouracil (5-FU) at our Division between March 2000 and November 2003, were clinically examined. Most patients were heavily pre-treated with two or more systemic chemotherapeutic regimes. All patients received a percutaneously implanted catheter into the hepatic artery through femoral or transaxillary access. Treatment was administered every 14 days: OXA 100 mg/m2 as a 12-hour infusion on day 1; FA 100 mg/m2 as a 2-hour infusion on days 2 and 3; 5-FU 2600 mg/m2 as a continuous infusion on days 2 and 3.
Grade 3-4 toxicities were: asthenia (2 out of 21), transaminase elevation (2 out of 21) and pain (2 out of 21), nausea and vomiting (1 out of 21), neutropenia (1 out of 21), thrombocytopenia (1 out of 21) and neurotoxicity (1 out of 21). Main dose limiting toxicity was right upper quadrant pain. Response rates were: 5% complete response, 19% partial response, 28% stable disease and 48% progressive disease. Two patients became operable and underwent complete resection of liver disease. The median overall survival was 36.1 months. Two-year and 3-year survival rates were 62% and 52%, respectively.
This regimen is feasible with low toxicity and with an encouraging overall tumor growth control (52%) in a subset of heavily pre-treated patients. Intra-arterial OXA/FA/5-FU should be considered for the treatment of patients pre-treated with systemic chemotherapies with liver metastases from CRC.
In vivo (Athens, Greece) 11/2006; 20(6A):743-6. · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The feasibility, toxicity and local response rates of intra-arterial chemotherapy with 5-fluorouracil, epirubicin and mitomycin in patients over 75 years with locally advanced breast cancer was evaluated.
Ten patients were treated by the transfemoral Seldinger technique, with the catheter tip placed into the internal mammary artery. In order to evaluate the vessels perfusing the tumor, blue dye solution was infused before drug administration. The patients received 5-fluorouracil 750 mg/m2, epirubicin 30 mg/m2 and mitomycin 7 mg/m2 by bolus infusion.
All patients were evaluated for toxicity and response. Twenty-two cycles were administered. The toxicity was mild and did not influence the patients' quality of life; the compliance was excellent. A response rate of 80% (8 out of 10) was obtained; the median overall survival was 33.5 months; no patient had local recurrence.
Intra-arterial chemotherapy is an effective and safe treatment for locally advanced breast cancer in the elderly.
In vivo (Athens, Greece) 11/2006; 20(6A):761-4. · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The final results of a new regimen given intra-arterially for unresectable pancreatic cancer (UPC) are presented.
From January 1994 to January 2006, 5-fluorouracil 1,000 mg/m2, leucovorin 100 mg/m2, epirubicin 60 mg/m2 and carboplatin 300 mg/m2 were administered every 3 weeks into the celiac axis (CA) angiografically (FLEC regimen) to 211 patients with UPC.
Seven hundred and sixty-four cycles were administered. Grade 3-4 hematological toxicity was observed in 24%; ematemesis in 4%; grade 3 gastrointestinal toxicity in 3%; grade 3 alopecia in 15%. One sudden death, a pre-infarction angina and a transitory ischemic attack were observed. No complications related to the angiographic procedure took place, but three tunica intima dissections of the iliac artery occurred; 7.6% of patients with partial responses and 50.7% with stable disease were observed. Two hundred and one patients have died; median overall survival was 9.2 months: 10.5 and 6.6 for stage III and IV, respectively.
The FLEC regimen given intra-arterially is well-tolerated and effective in patients with UPC.
In vivo (Athens, Greece) 01/2006; 20(6A):751-5. · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patients with unresectable biliary tract carcinomas have a very poor prognosis. To improve the efficacy and tolerance of the ECF regimen (epirubicin at a dose of 50 mg/m2, cisplatin at a dose of 60 mg/m2, and 5-fluorouracil [5-FU] at a dose of 200 mg/m2 per day by continuous infusion), the authors designed a novel approach that combined locoregional and systemic chemotherapy with the same agents at the same dosages.
Thirty consecutive patients with advanced or metastatic biliary tumors were treated with epirubicin at a dose of 50 mg/m2 and cisplatin at a dose of 60 mg/m2 administered as a bolus in the hepatic artery on Day 1, combined with systemic continuous infusion of 5-FU at a dose of 200 mg/m2 per day, from Day 1 to Day 14, every 3 weeks.
Tumor sites were the intrahepatic bile ducts in 25 patients and the gallbladder in 5 patients. The overall response rate was 40% (12 of 30 patients), including 1 complete response and 11 partial responses. Stable disease was observed in 12 of 30 patients (40%) and progressive disease in 6 of 30 patients (20%). The median progression-free and overall survival periods were 7.1 and 13.2 months, respectively, and the 1-year and 2-year survival rates were 54% and 20%, respectively. Performance status improved in 9 of 30 patients (30%) and a weight gain of > 7% was observed in 4 of 30 patients (13%). The treatment was well tolerated with minimal hematologic toxicity. The major clinical problem was the deep venous thrombosis related to the central venous catheter, which occurred in 5 patients (17%).
This novel combined locoregional and systemic chemotherapeutic regimen was found to be active and safe for patients with advanced biliary tract carcinoma.
Cancer 04/2005; 103(7):1402-7. DOI:10.1002/cncr.20964 · 4.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aim. To evaluate retrospectively the use of percutaneous radiologic gastrostomy (PRG) in dysphagic patients when percutaneous endoscopic gastrostomy (PEG) could not be safely employed (because of stenosis or bleeding risk due to esophagus or head and neck cancer, trismus, trauma or impaired respiratory function from amyotrophic lateral sclerosis (ALS) or chronic obstructive pulmonary disease (COPD)). Materials and methods. Since 1997, sixty-four consecutive patients (51 men, 13 women; mean age 67 years, range 47-84 years) have undergone PRG placement with T-fastener gastropexy un- der local anesthesia. The gastrostomy method, success rate of the technique, complications and 30-day mortality rate after PRG were reviewed. Some of the differences between PEG and PRG were also evaluated. Results. All the 64 procedures were successfully performed (100%), and no technique-related complications were observed. In patients followed up, 11,512 days of home enteral nutrition (HEN) (median 109 days, range 9-1,425 days) were provided; a survival less than 30 days was recorded in only 3 patients (6.5%). Only 1 minor complication in 1 patient (local wound infection and peristomal leakage) and 1 major complication (gastrocolic fistula not requiring surgical in- tervention) were recorded. Conclusions. PRG placement seems to be safe, simple and effective when PEG is difficult or im- possible; it is a valid alternative to surgical gastrostomy. (Nutritional Therapy & Metabolism 2006; 24: 203-9)