[show abstract][hide abstract] ABSTRACT: Interventional radiologists have played a main role in the technical evolution of gastrostomy, from the first surgical/endoscopical approaches to percutaneous interventional procedures. This study evaluated the results obtained in a 12-year series.
During the period December 1996 to December 2008, 254 new consecutive gastrostomies and 275 replacement procedures were performed in selected patients. All of the cases were treated by a T-fastener gastropexy and tube placement. The procedures were assessed by analyzing indications, patient selection, duration of the procedures, and mortality.
All 254 first gastrostomies were successful; replacement procedures were also successfully performed. One (0.2%) patient with severe neurologic disorders died after the procedure without signs of procedure-related complications, and seven (1.3%) major complications occurred (four duodenal lesions with peritoneal leakage, two gastric bleedings, and one gastric lesion). Minor complications were easily managed; three tube ruptures were resolved.
This long-term series and follow-up showed that a group of interventional radiologist can effectively provide gastrostomy placement and long-term tube management. Percutaneous gastrostomy is less invasive than other approaches and it satisfies the needs even of high-risk patients.
Gut and liver 09/2010; 4 Suppl 1:S44-9. · 1.31 Impact Factor
[show abstract][hide abstract] ABSTRACT: To retrospectively evaluate the outcome of carotid artery stent placement (CAS) without the use of embolic protection devices (EPDs) in a large cohort of patients.
Institutional review board approval and informed consent from all patients were obtained. Preprocedure color Doppler ultrasonography (US), magnetic resonance (MR) imaging, or computed tomography (CT) were used to evaluate stenosis severity (70% or greater). Clinical findings and combined 30-day complication rates in 400 patients (289 men, 111 women; mean age, 73 years +/- 8 [standard deviation]) who underwent unprotected CAS for asymptomatic (n = 156; 39%) or symptomatic (n = 244, 61%) stenoses were analyzed. Follow-up at 30 days included neurologic evaluation and color Doppler US.
Self-expanding stents were successfully deployed in 397 of 400 (99.25%) patients. Among the 397 patients, nine (2.27%) major complications (all in patients with prior symptoms) had occurred at 30 days, including three (0.76%) major (all in patients who had stopped antiplatelet prophylaxis) and six (1.5%) minor strokes--three intraprocedural and three delayed. Minor complications included 16 (4%) transient ischemic attacks, four in asymptomatic and 12 in symptomatic patients. The 30-day combined adverse outcomes (transient ischemic attack, ipsilateral stroke, death) were significantly correlated with prior presence of symptoms (symptomatic, 8.6%; asymptomatic, 2.6%; P < .03).
Stent placement without EPD was performed with a high technical success rate. For asymptomatic patients, the combined 30-day adverse-outcomes rate was within the limits recommended by the American Heart Association for carotid endarterectomy and compared favorably with results reported for CAS with EPD. When a transient ischemic attack is excluded, the 30-day combined death and stroke rate among patients with prior symptoms also compared favorably with published results.
[show abstract][hide abstract] ABSTRACT: Stenoses of internal carotid artery (ICA) are one of the most common causes of cerebral stroke. It is well stated in the current Literature that when the stenosis is >70%, invasive treat- ment, whether by surgery or by stent place- ment, decreases the risk of a cerebral accident. Cerebral aneurysm is a relevant cause of stroke but the pathophysiological mechanism of the possible stroke due to the aneurysm rupture is completely different. The incidence of cerebral aneurysm in patients with ICA stenosis is esti- mated to be 2.3-4.9%. The coexistence of the two diseases, although uncommon, may present a diagnostic and therapeutic dilemma. We have to take into account that the treatment of this patients may be performed by physicians with different cultural background ( Vascular Surgeon, Interventional Cardiologist, Interven- tional Radiologist, Interventional Neuroradi- ologist ) and this has a dramatic impact on the diagnostic point of view despite the guidelines in this field are well known. The common use of Eco-color Doppler and Cerebral CT does not allow the array of informations needed for carotid intervention. On the other hand DSA is not the alternative for the great invasivity and the iatrogenic risk of complex examinations ( extra - intracranial). The significant diagnostic impact of Brain MRI and Extra & Intracranial Angio MRI may be the added value for the non invasive diagnosis and mainly in the rare situation of cerebral aneurysm in patients with ICA. In any case the MRI pattern allows defining valid indications to the procedure. The assessment of not valid indications to the procedure are instead the presence of multiple lacunar infarcts (the treatment could not change the prognosis), disease of the small arteries (an unsuitable treatment could get worse the prog- nosis towards the insanity) and the concomitant intracranial stenoses.