Urgent endovascular ligature of a ruptured splenic artery pseudoaneurysm in a patient with acute pancretatitis: a case report

8Introduction: We report on the successful endovascular treatment of a ruptured splenic artery pseudoaneurysm. Our patient had acute pancreatitis superimposed on chronic calcific pancreatitis and chronic renal impairment. Contrast-enhanced ultrasonography was used to assess post-embolization results. Case presentation: Our patient was a 67-year-old white Caucasian man with recurrent pancreatitis. Computed tomography angiography showed a pancreatic pseudocyst with a ruptured pseudoaneurysm, which was successfully embolized using an endovascular percutaneous approach. At six months, persistent renal failure led to contrast-enhanced ultrasonography. This confirmed the absence of turbulent blood flow and extravasation of contrast medium in the pseudocyst. Conclusion: Our experience with this case leads us to support the role of interventional radiology as a first-line treatment tool. Contrast-enhanced ultrasonography can be used to follow-up embolization procedures in patients with impaired renal functionnoneJerardi, A.M.; Petrillo, M.; Capasso, R.; Fontana, F.; Bacuzzi, A.; Duka, E.; Laganà, D.; Carrafiello, G.Jerardi, A. M.; Petrillo, M.; Capasso, R.; Fontana, F.; Bacuzzi, A.; Duka, E.; Laganà, D.; Carrafiello, Gianpaol

Usefulness of paclitaxel-releasing high-pressure balloon associated with cutting balloon angioplasty for treatment of outflow stenoses of failing hemodialysis arteriovenous shunts

Aim: To evaluate the technical and clinical success, primary patency (PP) and complications of angioplasty performed with paclitaxel-coated balloon (PCBs) associated with cutting balloon and for the treatment of the outflow stenoses of failing hemodialysis arteriovenous shunt. Material and methods: From September 2014 to September 2015, 50 patients with 66 stenoses were registered. Vascular accesses were autogenous (n = 20) and prosthetic (n = 30). Stenosis were documented during follow-up with routine echo-color Doppler, clinical evaluation and in the remaining incidentally during fistulography. Angioplasty was performed with cutting balloon and afterward with PCB. The mean follow-up time was 8 months (range 6–15 months). Technical success, clinical success, primary patency and complications were registered. Results: Technical success was 100 %. Clinical success was 94.7 %. Primary patency rate was 87.7 %; in five patients, a significant re-stenosis (≥50 %) was registered. A residual asymptomatic stenosis (<30 %) was registered in four cases (7 %). No major complications were registered. Conclusions: A short-term patency benefit may be obtained including PCB in angioplasty treatment of failing hemodialysis arteriovenous shunts

Cone beam computed tomography images fusion in predicting lung ablation volumes: a feasibility study

Background: Recently different software with the ability to plan ablation volumes have been developed in order to minimize the number of attempts of positioning electrodes and to improve a safe overall tumor coverage. Purpose: To assess the feasibility of three-dimensional cone beam computed tomography (3D CBCT) fusion imaging with ''virtual probe'' positioning, to predict ablation volume in lung tumors treated percutaneously. Material and Methods: Pre-procedural computed tomography contrast-enhanced scans (CECT) were merged with a CBCT volume obtained to plan the ablation. An offline tumor segmentation was performed to determine the number of antennae and their positioning within the tumor. The volume of ablation obtained, evaluated on CECT performed after 1 month, was compared with the pre-procedural predicted one. Feasibility was assessed on the basis of accuracy evaluation (visual evaluation [VE] and quantitative evaluation [QE]), technical success (TS), and technical effectiveness (TE). Results: Seven of the patients with lung tumor treated by percutaneous thermal ablation were selected and treated on the basis of the 3D CBCT fusion imaging. In all cases the volume of ablation predicted was in accordance with that obtained. The difference in volume between predicted ablation volumes and obtained ones on CECT at 1 month was 1.8 cm3 (SD\ub12, min. 0.4, max. 0.9) for MW and 0.9 cm3 (SD\ub11.1, min. 0.1, max. 0.7) for RF. Conclusion: Use of pre-procedural 3D CBCT fusion imaging could be useful to define expected ablation volumes. However, more patients are needed to ensure stronger evidence

A new system of microwave ablation at 2450 MHz: preliminary experience

9noneThe aim of this study was to assess the feasibility of the application of the new system (Emprint Microwave Ablation System, Covidien Boulder, CO, USA) and to identify its advantages. In particular the attention was focused to the spherical ablation zone obtained and its usefulness in terms of effectiveness. The new system is composed of: a 2450 MHz generator that delivers a maximum power of 100 W, a fiberglass antenna and a pump for internally cooled antenna. Ten liver nodules (8 hepatocellular carcinomas and 2 metastasis) were percutaneously treated (mean diameter 24.9 mm, range 16-35 mm). Technical success, ablation duration time, overall procedure time and safety were registered. To define the shape of the ablation zone, multiplanar reformatting (MPR) was performed. Roundness index transverse was calculated: a value near 1 represents a more spherical ablation zone shape, and a value distant from 1 implies an oval configuration. Technical success was 100 %. Mean ablation time was of 3.85 min (range 3-5 min), mean overall procedure time was 30.5 min (range 25-40 min). No major complications were recorded. Roundness index transverse presented a mean value of 0.94, meaning that a spherical shape of ablation zone was achieved. One of the most promising innovations of the new microwave technology is the spherical shape of the ablation volume that could be related with an improving of the effectiveness and safety.noneIerardi, Anna Maria; Mangano, Alberto; Floridi, Chiara; Dionigi, Gianlorenzo; Biondi, Antonio; Duka, Ejona; Lucchina, Natalie; Lianos, Georgios D; Carrafiello, GianpaoloIerardi, Anna Maria; Mangano, Alberto; Floridi, Chiara; Dionigi, Gianlorenzo; Biondi, Antonio; Duka, Ejona; Lucchina, Natalie; Lianos, Georgios D; Carrafiello, Gianpaol