One Year Clinical Outcomes of Renal Artery Stenting: The Results of ODORI Registry

The safety, efficacy and long term clinical benefits of renal artery revascularization by stenting are still a matter of debate. The aim of our study was to define the safety and efficacy of renal artery stenting with the Tsunami peripheral stent (Terumo Corporation, Tokyo, Japan). The ODORI was a prospective, multicentre registry which enrolled 251 consecutive patients, (276 renal arteries) in 36 centres across Europe. The primary endpoint was acute procedural success defined as <30% residual stenosis after stent placement. Secondary endpoints included major adverse events, blood pressure control, serum creatinine level, and target lesion revascularization (TLR) at 6 and 12 months. Patients were 70 ± 10 years old, 59% were male, 33% had diabetes, and 96% hypertension. The main indications for renal stent implantation were hypertension in 83% and renal salvage in 39%. Direct stent implantation was performed in 76% of the cases. Acute success rate was 100% with residual stenosis of 2.5 ± 5.4%. Systolic/diastolic blood pressure decreased from a mean of 171/89 at baseline to 142/78 mmHg at 6 months (p < 0.0001 vs. baseline), and 141/80 mmHg at 12 months (p < 0.0001 vs. baseline). Mean serum creatinine concentration did not change significantly in the total population. However, there was significant improvement in the highest tercile (from 283 μmol/l at baseline to 205 and 209 μmol/l at 6 and 12 months respectively). At 12-months, rates of restenosis and TLR were 6.6 and 0.8% respectively. The 12 month cumulative rate of all major clinical adverse events was 6.4% while the rate of device or procedure related events was 2.4%. In hypertensive patients with atherosclerotic renal artery stenosis Tsunami peripheral balloon-expandable stent provides a safe revascularization strategy, with a potential beneficial impact on hypertension control and renal function in the highest risk patients

The role of endovascular therapy in acute mesenteric ischemia

Background Endovascular therapy, including aspiration thrombectomy and local thrombolytic therapy, often associated with angioplasty and stent placement, has been described in the literature. The purpose of this study was to review case series of patients with acute mesenteric ischemia treated with endovascular therapy and evaluate their outcomes. Methods An online review using PubMed was carried out to identify all English articles about this topic in the time interval from 2005 to 2016. The following variables were extracted: number of patients, cause of occlusion, symptoms, arteries involved, number of sessions of treatment, technical success, clinical success, recurrence rate, complications, mortality rate, number of patients who underwent diagnostic laparoscopy or surgical resection of ischemic bowel. Results Eighteen papers met the inclusion criteria and were included. Among the patients with arterial mesenteric ischemia treated with endovascular approach, the technical success rate was high (up to 100%) and data regarding clinical success are encouraging, even though they are few and heterogeneous. Technical success rate and clinical success of patients with acute venous mesenteric ischemia approached with endovascular treatment was 74-100% and 87.5-100% respectively. Conclusions Current advances in endovascular therapies have made these treatments feasible for mesenteric ischemia

Bronchial artery embolization for management of massive cryptogenic hemoptysis: a case series

<p>Abstract</p> <p>Introduction</p> <p>Hemoptysis constitutes a common and urgent medical problem. Swift and effective management is of crucial importance, especially in severe, life-threatening cases. In cases of idiopathic hemoptysis, in which no underlying pulmonary pathology can be identified, treatment is challenging. We report our experience with bronchial artery embolization in the treatment of massive idiopathic hemoptysis.</p> <p>Cases presentation</p> <p>We report three consecutive cases of acute severe idiopathic hemoptysis. Our patients (two men aged 51 and 56 years and one woman aged 46 years), were of Caucasian ethnicity. We discuss the results and management of the patients, and review the literature. All three patients were treated safely and successfully with transcatheter embolization of the bronchial arteries using tris-acryl gelatin microspheres. Hemoptysis was controlled. All cases were followed up for 12 months, and there was no recurrence of bleeding.</p> <p>Conclusion</p> <p>Bronchial artery embolization is an effective tool for the evaluation and treatment of massive idiopathic hemoptysis.</p

AMS INSIGHT—Absorbable Metal Stent Implantation for Treatment of Below-the-Knee Critical Limb Ischemia: 6-Month Analysis

Endoluminal treatment of infrapopliteal artery lesions is a matter of controversy. Bioabsorbable stents are discussed as a means to combine mechanical prevention of vessel recoil with the advantages of long-term perspectives. The possibility of not having a permanent metallic implant could permit the occurrence of positive remodeling with lumen enlargement to compensate for the development of new lesions. The present study was designed to investigate the safety of absorbable metal stents (AMSs) in the infrapopliteal arteries based on 1- and 6-month clinical follow-up and efficacy based on 6-month angiographic patency. One hundred seventeen patients with 149 lesions with chronic limb ischemia (CLI) were randomized to implantation of an AMS (60 patients, 74 lesions) or stand-alone percutaneous transluminal angioplasty (PTA; 57 patients, 75 lesions). Seven PTA-group patients “crossed over” to AMS stenting. The study population consisted of patients with symptomatic CLI (Rutherford categories 4 and 5) and de novo stenotic (>50%) or occlusive atherosclerotic disease of the infrapopliteal arteries who presented with a reference diameter of between 3.0 and 3.5 mm and a lesion length of <15 mm. The primary safety endpoint was defined as absence of major amputation and/or death within 30 days after index intervention and the primary efficacy endpoint was the 6-month angiographic patency rate as confirmed by core-lab quantitative vessel analysis. The 30-day complication rate was 5.3% (3/57) and 5.0% (3/60) in patients randomized for PTA alone and PTA followed by AMS implantation, respectively. On an intention-to-treat basis, the 6-month angiographic patency rate for lesions treated with AMS (31.8%) was significantly lower (p = 0.013) than the rate for those treated with PTA (58.0%). Although the present study indicates that the AMS technology can be safely applied, it did not demonstrate efficacy in long-term patency over standard PTA in the infrapopliteal vessels

Polypoid hamartoma of Brunner&apos;s gland of the duodenum

Background/Aims: Brunner’s gland adenoma is an extremely rare but important entity. Controversy exists over its etiology and pathogenesis, but the present view is that it is a duodenal hamartoma with a predominance of Brunner’s gland elements. Methods: A case of a 76-year-old woman with a reddish pedunculated polyp prolapsing between the bulb and the second part of the duodenum seen at endoscopy and removed surgically through a longitudinal duodenotomy is presented. Results: The cut surface of the tumor had a grayish color, revealing multiple cystic spaces which on microscopic examination proved to be enlarged Brunner’s glands. The hyperplastic glands formed lobules which were surrounded by bundles of fibromuscular and connective tissue. In the adjacent duodenum, large numbers of lobules of well-differentiated Brunner’s glands with mucus-secreting epithelial cells were seen. Conclusion: The reported case supports the theory that Brunner’s gland adenomas are duodenal hamartomas with a predominance of Brunner’s gland elements and further shows that a continuity exists in Brunner’s glands of the tumor and those of the adjacent duodenum. Copyright (C) 1999 S. Karger AG, Basel

Μη σεμινωματώδεις όγκοι του όρχεος από αρχέγονα εμβρυκά κύτταρα. Η συμβολή της υπολογιστικής τομογραφίας στην εκτίμηση της πρώιμης ανταπόκρισης στη χημειοθεραπεία

The aim of this study is to investigate the predictive value of Computed Tomography (CT) during the early phase of induction chemotherapy - and more specifically at day 21 -in a subgroup of patients with metastatic testicular nonseminomatous germ - cell tumours (NSGCT) of favourable prognosis, according to specific criteria (" good - risk patients"). The study is focused on: a) The early identification of those patients who will need postchemotherapy surgical excision of residual disease, in order to schedule properly this difficult surgical procedure and b) The reduction in the total amount of chemotherapy and in particular of the number of cycles (from 4 to 3). Twenty - six (26) patients with metastatic testicular NSGCT undergoing induction chemotherapy were studied. The site of maximum disease was detected at day 21. The change in disease bulk, measured as maximum transverse diameter (MTD), was compared with appearances on a CT scan immediately after chemotherapy and post - treatment response. Of those patients showing o poor response on the day 21 scan (i.e. no change, or less than 50% reduction in MTD), 70% required early surgical excision of residual disease, while none of the good responders (i.e. greater than 50% reduction in MTD), required immediate surgery (p<0.001). It is concluded that a limited day 21 CT scan may represent an independent predictor of good and poor response to chemotherapy, thus enabling reduction in chemotherapy and its toxicity in good responders and early identification of those who may need surgical excision, thereby permitting easier scheduling of these often difficult surgical procedures.Ο σκοπός της διατριβής αυτής είναι η διερεύνηση της προγνωστικής αξίας της μεθόδου της Υπολογιστικής Τομογραφία (Υ.Τ) κατά την πρώιμη φάση της χημειοθεραπείας εφόδου - και ειδικότερα την 21η ημέρα από την έναρξη της - σε μία υποομάδα ασθενών με μη σεμινωματώδεις όγκους του όρχεος από αρχέγονα εμβρυικά κύτταρα (non seminomatous germ cell tumours - NSGCT) οι οποίοι με βάση ορισμένα κριτήρια, θεωρήθηκε ότι έχουν καλή πρόγνωση ("good risk patients"). Η μελέτη αυτή έχει δύο σκέλη : α) την πρώιμη ανίχνευση των ασθενών εκείνων που θα χρειασθούν χειρουργική αφαίρεση υπολειμματικής νόσου μετά την ολοκλήρωση της χημειοθεραπείας εφόδου ώστε να προετοιμαστεί καλύτερα η συχνά δύσκολη και ευαίσθητη αυτού του τύπου επέμβαση. β) Την ελάττωση του συνολικού ποσού της χημειοθεραπείας κύρια μέσω της μείωσης του αριθμού των κύκλων (από 4 σε 3) στους ασθενείς εκείνους που δείχνουν από τα αρχικά στάδια της χημειοθεραπείας ότι πρόκειται να ανταποκριθούν θετικά σ' αυτή.Μελετήθηκαν 26 ασθενείς με μεταστατικό NSGCT στους οποίους χορηγήθηκε χημειοθεραπεία εφόδου. Η θέση του μέγιστου φορτίου της μεταστατικής νόσου εντοπίσθηκε με την Υ.Τ. σταδιοποίησης και μόνο αυτή η περιοχή επανεξετάσθηκε με Υ.Τ. με περιορισμένο αριθμό τομών κατά την 21η ημέρα από την έναρξη της χημειοθεραπείας (μετά την ολοκλήρωση του πρώτου κύκλου). Η μεταβολή στο μέγεθος της μάζας με κριτήριο τη Μέγιστη Εγκάρσια Διάμετρο MTD συγκρίθηκε με το μέγεθος της μάζας στην Υ.Τ. αμέσως μετά την ολοκλήρωση της χημειοθεραπείας εφόδου, η οποία και αναδεικνύει την ανταπόκριση της μάζας στο σύνολο των κύκλων χημειοθεραπείας. Από τους ασθενείς εκείνους που έδειξαν "πτωχή" ανταπόκριση στην Υ.Τ. της 21ης ημέρας (δηλ όχι μεταβολή η μικρότερη του 50% μείωση της (MTD), το 70% χρειάσθηκε πρώιμη χειρουργική αφαίρεση της υπολειμματικής - μετά τη χημειοθεραπεία εφόδου - νόσου, ενώ από την άλλη πλευρά κανείς από εκείνους τους ασθενείς που είχαν " καλή " ανταπόκριση στον πρώτο κύκλο χημειοθεραπείας (δηλ.μεγαλύτερη από 50% μείωση της MTD), δεν χρειάσθηκε άμεση επέμβαση μετά την ολοκλήρωση της χημειοθεραπείας εφόδου.(Ρ< 0,001).Συμπεραίνεται ότι Υ.Τ. με περιορισμένο αριθμό τομών κατά την 21η ημέρα από την έναρξη της χημειοθεραπείας στους ασθενείς με μεταστατικό μη σεμινωματώδη όγκο του όρχεος με "καλή πρόγνωση" πιθανότατα αποτελεί ένα ανεξάρτητο προγνωστικό παράγοντα "καλής" η "πτωχής" ανταπόκρισης στη χημειοθεραπεία, παρέχοντας έτσι την δυνατότητα, αφ' ενός ελάττωσης του συνολικού ποσού της χημειοθεραπείας και συνεπώς της τοξικότητας εξαιτίας αυτής στους ασθενείς με καλή ανταπόκριση και αφετέρου έγκαιρης ανίχνευσης εκείνων που ανταποκρίνονται πτωχά και αναμένεται να χρειασθούν χειρουργική εξαίρεση της υπολειμματικής νόσου έτσι επιτρέπεται ευκολότερος και πληρέστερος προγραμματισμός των συχνά δύσκολων αυτού του τύπου χειρουργικών επεμβάσεων