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Papers by Roberto Gandini

Research paper thumbnail of Transjugular intrahepatic portosystemic shunt before abdominal surgery in cirrhotic patients: A retrospective, comparative study

Canadian journal of gastroenterology = Journal canadien de gastroenterologie

Surgery in cirrhotic patients is associated with high morbidity and mortality related to portal h... more Surgery in cirrhotic patients is associated with high morbidity and mortality related to portal hypertension and liver insufficiency. Therefore, preoperative portal decompression is a logical approach to facilitate abdominal surgery and hopefully to improve postoperative survival. The present study evaluated the clinical outcomes of 18 patients (mean age 58 years) with cirrhosis (seven alcoholics and 11 nonalcoholics) who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement before antrectomy (n=5), colectomy (n=10), small-bowel resection (n=1), pancreatectomy (n=1) and nephrectomy (n=1). TIPS was performed a mean (+/-SD) of 72+/-21 days before surgery and induced a marked mean decrease in portohepatic gradient from 21.4+/-3.9 mmHg to 8.4+/-3.4 mmHg. Cirrhotic patients (n=17) who underwent elective abdominal surgery without preoperative TIPS placement were used as the control group. Both groups were matched for age, etiology of cirrhosis, indications for surgery, ...

Research paper thumbnail of Percutaneous transluminal angioplasty for treatment of critical hand ischemia with a novel endovascular approach: “The radial to ulnar artery loop technique”

Journal of Vascular Surgery, 2010

Research paper thumbnail of Transcatheter Embolization of a Large Symptomatic Pelvic Arteriovenous Malformation with Glubran 2 Acrylic Glue

Cardiovascular and Interventional Radiology, 2008

A young patient affected by a pelvic arteriovenous malformation (pAVM) with recurrent episodes of... more A young patient affected by a pelvic arteriovenous malformation (pAVM) with recurrent episodes of hematuria following exercise, underwent transcatheter embolization using Glubran 2 acrylic glue (GEM, Viareggio, Italy). All branches of the pAVM were successfully occluded. The patient showed prompt resolution of symptoms and persistent occlusion of the pAVM at the 6 month follow-up.

Research paper thumbnail of Foot Embolization During Limb Salvage Procedures in Critical Limb Ischemia Patients Successfully Managed With Mechanical Thromboaspiration: A Technical Note

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, Jan 4, 2015

To illustrate the use of a mechanical thromboaspiration device originally designed for clot retri... more To illustrate the use of a mechanical thromboaspiration device originally designed for clot retrieval in acute stroke in the treatment of acute distal embolism occurring during percutaneous revascularization of the femoropopliteal and below-the-knee arterial segments. The Penumbra system was adapted for aspiration of thrombus in the distal foot arteries as a standalone device. The 2 over-the-wire, tapered lumen catheters have long working lengths (139 cm for the 4MAX to 153 cm for the 3MAX) that allow advancement below the ankle even with a retrograde contralateral approach. Once the occluded arterial segment is reached, the catheters are connected to the dedicated pump for continuous vacuum aspiration. The use of the device is illustrated in 3 diabetic patients (1 woman and 2 men; ages 88, 70, and 73 years, respectively) undergoing limb salvage procedures who experienced distal embolization that would have seriously jeopardized the foot circulation. The lumens of the occluded arter...

Research paper thumbnail of Inexplicable Late Type Ia Endoleak Associated With the Low-Profile Ovation Endograft in a Patient With Favorable Neck Anatomy: Treatment With Transcaval Coil Embolization

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, Jan 10, 2015

To report an unusual late type Ia endoleak after endovascular aneurysm repair with a low-profile ... more To report an unusual late type Ia endoleak after endovascular aneurysm repair with a low-profile sealing ring endograft and its treatment with transcaval sac embolization. An 82-year-old man was treated for a 47-mm abdominal aortic aneurysm associated with a 35-mm left common iliac artery aneurysm using an Ovation Abdominal Stent Graft System. Correct endograft placement was documented at 3-month follow-up. Seven months after the repair, the patient was admitted to the emergency department with acute left inguinal pain. Computed tomography showed aneurysm sac enlargement (57 mm) and a contained rupture of the left common iliac artery due to a late type Ia endoleak. The endoleak was embolized with coils and thrombin via a transcaval approach. Sac shrinkage without signs of endoleak was observed at 12-month follow-up. In this case, late endograft failure with sealing ring collapse created an inflow channel into the aneurysm sac, with massive type Ia endoleak.

Research paper thumbnail of Commentary: drug-coated balloon angioplasty to improve carotid stenting outcomes after postendarterectomy restenosis: fad or an answer to the problem of recurrent restenosis?

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, 2015

Research paper thumbnail of Transjugular intrahepatic portosystemic shunt patency and clinical outcome in patients with Budd-Chiari syndrome: covered versus uncovered stents

Radiology, 2006

To retrospectively compare primary patency and reintervention rates, clinical outcome, and improv... more To retrospectively compare primary patency and reintervention rates, clinical outcome, and improvement in hepatic dysfunction (Child-Pugh score) in patients with Budd-Chiari syndrome treated with transjugular intrahepatic portosystemic shunt (TIPS) using bare stents or expanded polytetrafluoroethylene (PTFE)-covered stents. Approval of study and treatment protocol and waiver of informed consent for the retrospective study were obtained from institutional review board. Informed consent was obtained from each patient before procedure. Four male and nine female consecutive patients (mean age, 35.7 years) with Budd-Chiari syndrome treated with TIPS from January 1994 to November 2003 were included. In six patients, TIPS creation was performed with bare stents (group A). After April 2001, TIPS creation was performed in seven patients with expanded PTFE-covered stent-grafts (group B). Follow-up (group A mean, 22.7 months +/- 10.53 [standard deviation]; group B mean, 23.1 months +/- 7.81) w...

Research paper thumbnail of Carotid artery stenting: findings based on 8 years’ experience

La radiologia medica, 2008

Carotid artery stenting (CAS) may be an alternative to surgical endarterectomy not only in high-r... more Carotid artery stenting (CAS) may be an alternative to surgical endarterectomy not only in high-risk patients. Few data are available regarding the long-term clinical efficacy of CAS with the use of cerebral protection devices and the incidence of restenosis. Our experience demonstrates that if certain requirements are fulfilled, CAS can be considered a safe and effective treatment with high short-and long-term success rates. In the past 8 years, we treated 1,003 patients (1,096 arteries) affected by internal carotid artery stenosis, 93 with bilateral stenosis. Of these, 567 (51.74%) were symptomatic and 529 (48.26%) asymptomatic lesions. The preprocedural evaluation was performed with Doppler ultrasound (US), magnetic resonance (MR) angiography/computed tomography (CT) angiography and a neurological evaluation. Antiplatelet therapy was administered before and after the procedure. Technical success was achieved in 1,092 cases (99.6%), and a cerebral protection device was successfully used in 1,019 procedures (92.9%). The 30-day transient ischaemic attack (TIA)/stroke/death rate was 2.16%: death (0.18%) major stroke (0.45%) and minor stroke/TIA (1.53%). During a follow-up up to 8 years, restenoses occurred in 39 cases (3.57%), of which 28 were post-CAS (2.57%) and 11 post-CAS performed for restenosis after carotid endarterectomy (1%). Only five symptomatic restenoses>80% were treated with a repeated endovascular procedure. A retrospective analysis of our experience suggests that CAS is a safe and effective procedure with better results than endarterectomy. In up to 8 years of follow-up, CAS seems to be effective in preventing stroke, with a low restenosis rate.

Research paper thumbnail of Late Symptomatic Venous Stenosis in Three Hemodialysis Patients Without Previous Central Venous Catheters

Artificial Organs, 2000

It is well known that catheters placed in the subclavian or internal jugular veins may develop st... more It is well known that catheters placed in the subclavian or internal jugular veins may develop stenosis in the vein in which the catheter lies. Because the arteriovenous fistula (AVF) relies on good venous outflow, patients with ipsilateral central venous stenosis are subject to the malfunctioning of AVF. Until now, no data were published on patients showing central vein stenosis (CVS) without a previous central venous catheter (CVC) or a pacemaker. In this article, we report on 3 hemodialysis patients manifesting CVS ipslateral to AVF. None of these patients previously had undergone CVC. The stenosis observed had characteristics and symptoms similar to those observed in stenoses consequent to CVC. We concluded that CVS also may occur in subclavian or axillary veins proximal to a working AVF in hemodialysis patients who have never had a CVC and in the absence of compressive phenomena.

Research paper thumbnail of Long-term Results of Drug-Eluting Balloon Angioplasty for Treatment of Refractory Recurrent Carotid In-Stent Restenosis

Journal of Endovascular Therapy, 2014

To evaluate the potential role, safety, and efficacy of paclitaxel-eluting balloon angioplasty fo... more To evaluate the potential role, safety, and efficacy of paclitaxel-eluting balloon angioplasty for treatment of recurrent carotid in-stent restenosis (ISR). Among 856 consecutive patients who underwent carotid artery stenting from May 2002 to January 2008, 41 patients had a significant ISR (>80% stenosis). Of these, 9 patients (7 women; mean age 78.1±5.6 years) had recurrent ISR despite multiple endovascular treatments (3.4±0.9 interventions) within a short period of time (2-5 months). These patients were treated with drug-eluting balloon (DEB) angioplasty for neointimal hyperplasia. Imaging (ultrasound or computed tomographic angiography) was performed at 1, 3, and 6 months and yearly thereafter. Technical success was obtained in 100% of cases, with angiographic stenosis decreasing from 87%±4% to 6%±4% post treatment. Peak systolic velocity decreased significantly from 4.7±1.5 m/s to 0.6.±0.3 m/s after the procedure. Over a mean follow-up of 36.6±2.7 months, ultrasound imaging indicated recurrent ISR in only 3 patients at 18, 25, and 32 months after DEB angioplasty, respectively. The target vessel revascularization rate was 33.3% at 36 months. No neurological or myocardial events were recorded during follow-up. One patient died at 3 months. DEB may have a potential role improving outcomes of those patients treated for early recurrent carotid ISR.

Research paper thumbnail of Treatment of Symptomatic High-Flow Female Varicoceles with Stop-flow Foam Sclerotherapy

CardioVascular and Interventional Radiology, 2013

To assess the efficacy of stop-flow foam sclerotherapy (SFFS) in high-flow pelvic varicoceles usi... more To assess the efficacy of stop-flow foam sclerotherapy (SFFS) in high-flow pelvic varicoceles using 3 % sodium tetradecyl sulfate (STS) foam. Our institutional review board granted approval and waived informed consent for this retrospective study of 26 patients (mean age 37.3 years, range 23-46 years) with pelvic congestion syndrome (PCS) who had high-outflow venous collaterals treated by SFFS between June 2005 and June 2011 in our department. PCS was diagnosed by physical and transvaginal color Doppler ultrasound examination, while high-outflow venous collaterals were detected at selective ovarian venography. SFFS was performed by injection of 3 % STS foam into the pelvic varices after balloon occlusion of the major venous vessels (hypogastric and/or ovarian veins) to which the high-outflow venous collaterals were tributary. Follow-up was performed at 1, 3, 6, and 12 months by physical and transvaginal color Doppler ultrasound examination and by a questionnaire-based assessment of pain using a symptom severity score. The procedure was technically successful in all patients. After the injection of 3 % STS foam, all patients had a colic like pain that spontaneously resolved after 5 min. During follow-up, no recurrences of PCS were detected. Significant improvement of symptoms (Student's t test P < 0.01) was observed at 1, 3, 6, and 12 months. SFFS using 3 % STS foam is a safe and effective treatment for high-flow female varicoceles and should be considered as an alternative to other endovascular and surgical options.

Research paper thumbnail of Virtual histology-intravascular ultrasound as a diagnostic alternative for morphological characterization of carotid plaque

Journal of Cardiovascular Medicine, 2014

Research paper thumbnail of Chronic contained rupture of an abdominal aortic aneurysm: from diagnosis to endovascular resolution

Cardiovascular and interventional radiology, 2008

A male patient, 69 years old, presented with fever, leucocytosis, and persistent low back pain; h... more A male patient, 69 years old, presented with fever, leucocytosis, and persistent low back pain; he also had an abdominal aortic aneurysm (AAA), as previously diagnosed by Doppler UltraSound (US), and was admitted to our hospital. On multislice computed tomography (msCT), a large abdominal mass having no definite border and involving the aorta and both of the psoas muscles was seen. This mass involved the forth-lumbar vertebra with lysis, thus simulating AAA rupture into a paraspinal collection; it was initially considered a paraspinal abscess. After magnetic resonance imaging examination and culture of the fluid aspirated from the mass, no infective organisms were found; therefore, a diagnosis of chronically contained AAA rupture was made, and an aortic endoprosthesis was subsequently implanted. The patient was discharged with decreased lumbar pain. At 12-month follow-up, no evidence of leakage was observed. To our knowledge, this is the first case of endoprosthesis implantation in ...

Research paper thumbnail of Bailout Alternative Use of Re-entry Device to Achieve a Chronically Occluded Superficial Artery Recanalization without Detectable Origin

CardioVascular and Interventional Radiology, 2014

ABSTRACT IntroductionSFA chronic total occlusion (CTO) without a proximal stump is a challenging ... more ABSTRACT IntroductionSFA chronic total occlusion (CTO) without a proximal stump is a challenging situation for peripheral interventionist [1]. Sometimes, even the combined antegrade/retrograde approach with popliteal access doesn’t allow a safe and effective recanalization of such chronically occluded vessel; thus there is a need of additional technical improvements. We describe a technique to overcome this situation by the alternative use of a reentry device to cross-occluded SFA CTO without detectable origin in two patients with several comorbidities that precluded a surgical approach.Case 1An 82-year-old woman symptomatic in the previous 3 months for right foot ischemic rest pain presented at our department. A lower extremity angiogram was performed through a contralateral retrograde femoral access sheath showed a stumpless intrastent occlusion of the right SFA over its whole length, reconstituting at the level of the popliteal artery. Despite different angiographic projections acquired at d ...

Research paper thumbnail of Treatment of type II endoleak after endovascular aneurysm repair: the role of selective vs. nonselective transcaval embolization

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, 2014

To assess the technical and midterm results in the treatment of type II endoleaks comparing nonse... more To assess the technical and midterm results in the treatment of type II endoleaks comparing nonselective (nTCE) vs. selective (sTCE) transcaval embolization. During a 4-year period, 26 patients (18 men; median age 73 years, range 68-78) underwent direct transcaval aneurysm puncture followed by embolization of the sac (nTCE, n=9) or of the feeding vessels (sTCE, n=17). Intrasac pressure was recorded immediately after aneurysm sac puncture and at the end of the procedure. Technical success was defined as successful deployment of embolization material in the sac or in the feeding vessel. Clinical success was defined as absence of endoleak with stabilization of the sac on follow-up CTA. Technical success was 100% in the 9 patients treated with nTCE. Mean intrasac pressures before and after nTCE were 58.6±18.4 (range 51-105) and 6.5±1.2 mmHg (range 4-9), respectively. Over a mean 25.9±11.0 months of follow-up, 4 patients developed recurrent endoleak at a mean 9.7±3.9 months. Three patien...

Research paper thumbnail of Male Varicocele: Transcatheter Foam Sclerotherapy with Sodium Tetradecyl Sulfate—Outcome in 244 Patients 1

Radiology, 2008

To retrospectively evaluate the recurrence rate, resolution of pain, improvement of semen paramet... more To retrospectively evaluate the recurrence rate, resolution of pain, improvement of semen parameters, and achievement of pregnancy after transcatheter foam sclerotherapy (TCFS) in varicocele by using sodium tetradecyl sulfate (STS) foam. The institutional review board approved the study; informed consent was waived. A retrospective study was conducted in 244 consecutive male patients (mean age, 28.2 years; range, 17-42 years) with 280 varicoceles treated with TCFS between January 2000 and January 2004. The gonadal vein was selectively catheterized by using left antecubital transbrachial venous access; a foam of 3% STS and air was injected. Follow-up was performed with physical and Doppler ultrasonographic examinations and by using a questionnaire-based assessment of pain and pregnancy. Semen analysis was performed according to World Health Organization guidelines. Significant differences in semen parameters before and after treatment were determined by using the Wilcoxon signed rank test. Technical success rate was 97.1% (272 varicoceles). Complete follow-up results (mean, 40.3 months +/- 19.46 [standard deviation]) in 225 varicoceles (80.4%) revealed eight (3.6%) grade II-III recurrent varicoceles and resolution of pain in 164 (96.5%) of 170 cases. Statistically significant improvement of all semen parameters was achieved in infertile patients after treatment (P < .001). Of 59 patients with pretreatment sperm alterations who desired pregnancy, 23 (39.0%) achieved pregnancy (mean follow-up, 28.6 months +/- 7.77). TCFS in male varicocele with 3% STS foam was associated with a low recurrence rate, a high rate of pain resolution, and a significant improvement of pretreatment sperm parameter alterations; a substantial increase in pregnancy achievement was obtained for patients with pretreatment sperm alterations who desired pregnancy.

Research paper thumbnail of Transjugular Intrahepatic Portosystemic Shunt Patency and Clinical Outcome in Patients with Budd-Chiari Syndrome: Covered versus Uncovered Stents 1

Research paper thumbnail of Percutaneous transluminal angioplasty for treatment of critical hand ischemia with a novel endovascular approach: “The radial to ulnar artery loop technique”

Journal of Vascular Surgery, 2010

A 44-year-old patient with type I diabetes with critical upper limb ischemia of the left hand was... more A 44-year-old patient with type I diabetes with critical upper limb ischemia of the left hand was referred to our department with ischemic tissue loss and rest pain. After unsuccessful use of the endovascular antegrade approach, retrograde revascularization with percutaneous transluminal angioplasty (PTA) of the ulnar artery and the Palmar arch through the radial artery was successfully performed (the radial to ulnar artery loop technique). Relief of the patient's symptoms was immediate and ischemic lesions were healed at 6-month follow-up. This technique, which has been used for the first time in critical upper limb ischemia, may significantly increase the success rate of percutaneous angioplasty, especially when antegrade recanalization fails.

Research paper thumbnail of Combined Direct Puncture of the PTFE Graft and Contralateral Snare Loop Technique for Catheterization of an Occluded Femoropopliteal Graft

Journal of Vascular and Interventional Radiology, 1998

... Auteur(s) / Author(s). GANDINI R. ; MASPES F. ; PAMPANA E. ; SAKR A. ; SIMONETTI G. ; Revue /... more ... Auteur(s) / Author(s). GANDINI R. ; MASPES F. ; PAMPANA E. ; SAKR A. ; SIMONETTI G. ; Revue / Journal Title. Journal of vascular and interventional radiology ISSN 1051-0443 CODEN JVIRE3 Source / Source. 1998, vol. 9, n o 2, pp. 241-244 [4 page(s) (article)] ...

Research paper thumbnail of Emergency Endograft Placement for Recurrent Aortocaval Fistula After Conventional AAA Repair

Journal of Endovascular Therapy, 2002

To report a novel case in which a stent-graft was used to emergently treat an aortocaval fistula ... more To report a novel case in which a stent-graft was used to emergently treat an aortocaval fistula that recurred after conventional abdominal aortic aneurysm (AAA) repair. A 67-year-old man was treated urgently for ruptured AAA with surgical placement of a 16-mm Dacron interposition graft. During the procedure, an aortocaval fistula was repaired primarily. The patient was discharged in satisfactory condition but returned 20 days later with dyspnea, bilateral perimalleolar edema, and a bruit in the mesogastric region. The high flow fistula was again present just above the aortic bifurcation at the distal anastomosis of the existing graft. The patient's condition deteriorated rapidly, so a bifurcated Vanguard stent-graft was deployed in an emergency procedure. Subsequent imaging confirmed satisfactory closure of the fistula. The patient was discharged 8 days after endograft placement, and he continues to be without signs of fistula recurrence at 2 years. Endograft treatment of vascular lesions in the acute setting is becoming more common as our experience with the devices grows. Endovascular repair of primary aortocaval fistulas appears to be an efficacious and minimally invasive means of dealing with these lesions in AAA patients.

Research paper thumbnail of Transjugular intrahepatic portosystemic shunt before abdominal surgery in cirrhotic patients: A retrospective, comparative study

Canadian journal of gastroenterology = Journal canadien de gastroenterologie

Surgery in cirrhotic patients is associated with high morbidity and mortality related to portal h... more Surgery in cirrhotic patients is associated with high morbidity and mortality related to portal hypertension and liver insufficiency. Therefore, preoperative portal decompression is a logical approach to facilitate abdominal surgery and hopefully to improve postoperative survival. The present study evaluated the clinical outcomes of 18 patients (mean age 58 years) with cirrhosis (seven alcoholics and 11 nonalcoholics) who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement before antrectomy (n=5), colectomy (n=10), small-bowel resection (n=1), pancreatectomy (n=1) and nephrectomy (n=1). TIPS was performed a mean (+/-SD) of 72+/-21 days before surgery and induced a marked mean decrease in portohepatic gradient from 21.4+/-3.9 mmHg to 8.4+/-3.4 mmHg. Cirrhotic patients (n=17) who underwent elective abdominal surgery without preoperative TIPS placement were used as the control group. Both groups were matched for age, etiology of cirrhosis, indications for surgery, ...

Research paper thumbnail of Percutaneous transluminal angioplasty for treatment of critical hand ischemia with a novel endovascular approach: “The radial to ulnar artery loop technique”

Journal of Vascular Surgery, 2010

Research paper thumbnail of Transcatheter Embolization of a Large Symptomatic Pelvic Arteriovenous Malformation with Glubran 2 Acrylic Glue

Cardiovascular and Interventional Radiology, 2008

A young patient affected by a pelvic arteriovenous malformation (pAVM) with recurrent episodes of... more A young patient affected by a pelvic arteriovenous malformation (pAVM) with recurrent episodes of hematuria following exercise, underwent transcatheter embolization using Glubran 2 acrylic glue (GEM, Viareggio, Italy). All branches of the pAVM were successfully occluded. The patient showed prompt resolution of symptoms and persistent occlusion of the pAVM at the 6 month follow-up.

Research paper thumbnail of Foot Embolization During Limb Salvage Procedures in Critical Limb Ischemia Patients Successfully Managed With Mechanical Thromboaspiration: A Technical Note

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, Jan 4, 2015

To illustrate the use of a mechanical thromboaspiration device originally designed for clot retri... more To illustrate the use of a mechanical thromboaspiration device originally designed for clot retrieval in acute stroke in the treatment of acute distal embolism occurring during percutaneous revascularization of the femoropopliteal and below-the-knee arterial segments. The Penumbra system was adapted for aspiration of thrombus in the distal foot arteries as a standalone device. The 2 over-the-wire, tapered lumen catheters have long working lengths (139 cm for the 4MAX to 153 cm for the 3MAX) that allow advancement below the ankle even with a retrograde contralateral approach. Once the occluded arterial segment is reached, the catheters are connected to the dedicated pump for continuous vacuum aspiration. The use of the device is illustrated in 3 diabetic patients (1 woman and 2 men; ages 88, 70, and 73 years, respectively) undergoing limb salvage procedures who experienced distal embolization that would have seriously jeopardized the foot circulation. The lumens of the occluded arter...

Research paper thumbnail of Inexplicable Late Type Ia Endoleak Associated With the Low-Profile Ovation Endograft in a Patient With Favorable Neck Anatomy: Treatment With Transcaval Coil Embolization

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, Jan 10, 2015

To report an unusual late type Ia endoleak after endovascular aneurysm repair with a low-profile ... more To report an unusual late type Ia endoleak after endovascular aneurysm repair with a low-profile sealing ring endograft and its treatment with transcaval sac embolization. An 82-year-old man was treated for a 47-mm abdominal aortic aneurysm associated with a 35-mm left common iliac artery aneurysm using an Ovation Abdominal Stent Graft System. Correct endograft placement was documented at 3-month follow-up. Seven months after the repair, the patient was admitted to the emergency department with acute left inguinal pain. Computed tomography showed aneurysm sac enlargement (57 mm) and a contained rupture of the left common iliac artery due to a late type Ia endoleak. The endoleak was embolized with coils and thrombin via a transcaval approach. Sac shrinkage without signs of endoleak was observed at 12-month follow-up. In this case, late endograft failure with sealing ring collapse created an inflow channel into the aneurysm sac, with massive type Ia endoleak.

Research paper thumbnail of Commentary: drug-coated balloon angioplasty to improve carotid stenting outcomes after postendarterectomy restenosis: fad or an answer to the problem of recurrent restenosis?

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, 2015

Research paper thumbnail of Transjugular intrahepatic portosystemic shunt patency and clinical outcome in patients with Budd-Chiari syndrome: covered versus uncovered stents

Radiology, 2006

To retrospectively compare primary patency and reintervention rates, clinical outcome, and improv... more To retrospectively compare primary patency and reintervention rates, clinical outcome, and improvement in hepatic dysfunction (Child-Pugh score) in patients with Budd-Chiari syndrome treated with transjugular intrahepatic portosystemic shunt (TIPS) using bare stents or expanded polytetrafluoroethylene (PTFE)-covered stents. Approval of study and treatment protocol and waiver of informed consent for the retrospective study were obtained from institutional review board. Informed consent was obtained from each patient before procedure. Four male and nine female consecutive patients (mean age, 35.7 years) with Budd-Chiari syndrome treated with TIPS from January 1994 to November 2003 were included. In six patients, TIPS creation was performed with bare stents (group A). After April 2001, TIPS creation was performed in seven patients with expanded PTFE-covered stent-grafts (group B). Follow-up (group A mean, 22.7 months +/- 10.53 [standard deviation]; group B mean, 23.1 months +/- 7.81) w...

Research paper thumbnail of Carotid artery stenting: findings based on 8 years’ experience

La radiologia medica, 2008

Carotid artery stenting (CAS) may be an alternative to surgical endarterectomy not only in high-r... more Carotid artery stenting (CAS) may be an alternative to surgical endarterectomy not only in high-risk patients. Few data are available regarding the long-term clinical efficacy of CAS with the use of cerebral protection devices and the incidence of restenosis. Our experience demonstrates that if certain requirements are fulfilled, CAS can be considered a safe and effective treatment with high short-and long-term success rates. In the past 8 years, we treated 1,003 patients (1,096 arteries) affected by internal carotid artery stenosis, 93 with bilateral stenosis. Of these, 567 (51.74%) were symptomatic and 529 (48.26%) asymptomatic lesions. The preprocedural evaluation was performed with Doppler ultrasound (US), magnetic resonance (MR) angiography/computed tomography (CT) angiography and a neurological evaluation. Antiplatelet therapy was administered before and after the procedure. Technical success was achieved in 1,092 cases (99.6%), and a cerebral protection device was successfully used in 1,019 procedures (92.9%). The 30-day transient ischaemic attack (TIA)/stroke/death rate was 2.16%: death (0.18%) major stroke (0.45%) and minor stroke/TIA (1.53%). During a follow-up up to 8 years, restenoses occurred in 39 cases (3.57%), of which 28 were post-CAS (2.57%) and 11 post-CAS performed for restenosis after carotid endarterectomy (1%). Only five symptomatic restenoses>80% were treated with a repeated endovascular procedure. A retrospective analysis of our experience suggests that CAS is a safe and effective procedure with better results than endarterectomy. In up to 8 years of follow-up, CAS seems to be effective in preventing stroke, with a low restenosis rate.

Research paper thumbnail of Late Symptomatic Venous Stenosis in Three Hemodialysis Patients Without Previous Central Venous Catheters

Artificial Organs, 2000

It is well known that catheters placed in the subclavian or internal jugular veins may develop st... more It is well known that catheters placed in the subclavian or internal jugular veins may develop stenosis in the vein in which the catheter lies. Because the arteriovenous fistula (AVF) relies on good venous outflow, patients with ipsilateral central venous stenosis are subject to the malfunctioning of AVF. Until now, no data were published on patients showing central vein stenosis (CVS) without a previous central venous catheter (CVC) or a pacemaker. In this article, we report on 3 hemodialysis patients manifesting CVS ipslateral to AVF. None of these patients previously had undergone CVC. The stenosis observed had characteristics and symptoms similar to those observed in stenoses consequent to CVC. We concluded that CVS also may occur in subclavian or axillary veins proximal to a working AVF in hemodialysis patients who have never had a CVC and in the absence of compressive phenomena.

Research paper thumbnail of Long-term Results of Drug-Eluting Balloon Angioplasty for Treatment of Refractory Recurrent Carotid In-Stent Restenosis

Journal of Endovascular Therapy, 2014

To evaluate the potential role, safety, and efficacy of paclitaxel-eluting balloon angioplasty fo... more To evaluate the potential role, safety, and efficacy of paclitaxel-eluting balloon angioplasty for treatment of recurrent carotid in-stent restenosis (ISR). Among 856 consecutive patients who underwent carotid artery stenting from May 2002 to January 2008, 41 patients had a significant ISR (>80% stenosis). Of these, 9 patients (7 women; mean age 78.1±5.6 years) had recurrent ISR despite multiple endovascular treatments (3.4±0.9 interventions) within a short period of time (2-5 months). These patients were treated with drug-eluting balloon (DEB) angioplasty for neointimal hyperplasia. Imaging (ultrasound or computed tomographic angiography) was performed at 1, 3, and 6 months and yearly thereafter. Technical success was obtained in 100% of cases, with angiographic stenosis decreasing from 87%±4% to 6%±4% post treatment. Peak systolic velocity decreased significantly from 4.7±1.5 m/s to 0.6.±0.3 m/s after the procedure. Over a mean follow-up of 36.6±2.7 months, ultrasound imaging indicated recurrent ISR in only 3 patients at 18, 25, and 32 months after DEB angioplasty, respectively. The target vessel revascularization rate was 33.3% at 36 months. No neurological or myocardial events were recorded during follow-up. One patient died at 3 months. DEB may have a potential role improving outcomes of those patients treated for early recurrent carotid ISR.

Research paper thumbnail of Treatment of Symptomatic High-Flow Female Varicoceles with Stop-flow Foam Sclerotherapy

CardioVascular and Interventional Radiology, 2013

To assess the efficacy of stop-flow foam sclerotherapy (SFFS) in high-flow pelvic varicoceles usi... more To assess the efficacy of stop-flow foam sclerotherapy (SFFS) in high-flow pelvic varicoceles using 3 % sodium tetradecyl sulfate (STS) foam. Our institutional review board granted approval and waived informed consent for this retrospective study of 26 patients (mean age 37.3 years, range 23-46 years) with pelvic congestion syndrome (PCS) who had high-outflow venous collaterals treated by SFFS between June 2005 and June 2011 in our department. PCS was diagnosed by physical and transvaginal color Doppler ultrasound examination, while high-outflow venous collaterals were detected at selective ovarian venography. SFFS was performed by injection of 3 % STS foam into the pelvic varices after balloon occlusion of the major venous vessels (hypogastric and/or ovarian veins) to which the high-outflow venous collaterals were tributary. Follow-up was performed at 1, 3, 6, and 12 months by physical and transvaginal color Doppler ultrasound examination and by a questionnaire-based assessment of pain using a symptom severity score. The procedure was technically successful in all patients. After the injection of 3 % STS foam, all patients had a colic like pain that spontaneously resolved after 5 min. During follow-up, no recurrences of PCS were detected. Significant improvement of symptoms (Student's t test P < 0.01) was observed at 1, 3, 6, and 12 months. SFFS using 3 % STS foam is a safe and effective treatment for high-flow female varicoceles and should be considered as an alternative to other endovascular and surgical options.

Research paper thumbnail of Virtual histology-intravascular ultrasound as a diagnostic alternative for morphological characterization of carotid plaque

Journal of Cardiovascular Medicine, 2014

Research paper thumbnail of Chronic contained rupture of an abdominal aortic aneurysm: from diagnosis to endovascular resolution

Cardiovascular and interventional radiology, 2008

A male patient, 69 years old, presented with fever, leucocytosis, and persistent low back pain; h... more A male patient, 69 years old, presented with fever, leucocytosis, and persistent low back pain; he also had an abdominal aortic aneurysm (AAA), as previously diagnosed by Doppler UltraSound (US), and was admitted to our hospital. On multislice computed tomography (msCT), a large abdominal mass having no definite border and involving the aorta and both of the psoas muscles was seen. This mass involved the forth-lumbar vertebra with lysis, thus simulating AAA rupture into a paraspinal collection; it was initially considered a paraspinal abscess. After magnetic resonance imaging examination and culture of the fluid aspirated from the mass, no infective organisms were found; therefore, a diagnosis of chronically contained AAA rupture was made, and an aortic endoprosthesis was subsequently implanted. The patient was discharged with decreased lumbar pain. At 12-month follow-up, no evidence of leakage was observed. To our knowledge, this is the first case of endoprosthesis implantation in ...

Research paper thumbnail of Bailout Alternative Use of Re-entry Device to Achieve a Chronically Occluded Superficial Artery Recanalization without Detectable Origin

CardioVascular and Interventional Radiology, 2014

ABSTRACT IntroductionSFA chronic total occlusion (CTO) without a proximal stump is a challenging ... more ABSTRACT IntroductionSFA chronic total occlusion (CTO) without a proximal stump is a challenging situation for peripheral interventionist [1]. Sometimes, even the combined antegrade/retrograde approach with popliteal access doesn’t allow a safe and effective recanalization of such chronically occluded vessel; thus there is a need of additional technical improvements. We describe a technique to overcome this situation by the alternative use of a reentry device to cross-occluded SFA CTO without detectable origin in two patients with several comorbidities that precluded a surgical approach.Case 1An 82-year-old woman symptomatic in the previous 3 months for right foot ischemic rest pain presented at our department. A lower extremity angiogram was performed through a contralateral retrograde femoral access sheath showed a stumpless intrastent occlusion of the right SFA over its whole length, reconstituting at the level of the popliteal artery. Despite different angiographic projections acquired at d ...

Research paper thumbnail of Treatment of type II endoleak after endovascular aneurysm repair: the role of selective vs. nonselective transcaval embolization

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, 2014

To assess the technical and midterm results in the treatment of type II endoleaks comparing nonse... more To assess the technical and midterm results in the treatment of type II endoleaks comparing nonselective (nTCE) vs. selective (sTCE) transcaval embolization. During a 4-year period, 26 patients (18 men; median age 73 years, range 68-78) underwent direct transcaval aneurysm puncture followed by embolization of the sac (nTCE, n=9) or of the feeding vessels (sTCE, n=17). Intrasac pressure was recorded immediately after aneurysm sac puncture and at the end of the procedure. Technical success was defined as successful deployment of embolization material in the sac or in the feeding vessel. Clinical success was defined as absence of endoleak with stabilization of the sac on follow-up CTA. Technical success was 100% in the 9 patients treated with nTCE. Mean intrasac pressures before and after nTCE were 58.6±18.4 (range 51-105) and 6.5±1.2 mmHg (range 4-9), respectively. Over a mean 25.9±11.0 months of follow-up, 4 patients developed recurrent endoleak at a mean 9.7±3.9 months. Three patien...

Research paper thumbnail of Male Varicocele: Transcatheter Foam Sclerotherapy with Sodium Tetradecyl Sulfate—Outcome in 244 Patients 1

Radiology, 2008

To retrospectively evaluate the recurrence rate, resolution of pain, improvement of semen paramet... more To retrospectively evaluate the recurrence rate, resolution of pain, improvement of semen parameters, and achievement of pregnancy after transcatheter foam sclerotherapy (TCFS) in varicocele by using sodium tetradecyl sulfate (STS) foam. The institutional review board approved the study; informed consent was waived. A retrospective study was conducted in 244 consecutive male patients (mean age, 28.2 years; range, 17-42 years) with 280 varicoceles treated with TCFS between January 2000 and January 2004. The gonadal vein was selectively catheterized by using left antecubital transbrachial venous access; a foam of 3% STS and air was injected. Follow-up was performed with physical and Doppler ultrasonographic examinations and by using a questionnaire-based assessment of pain and pregnancy. Semen analysis was performed according to World Health Organization guidelines. Significant differences in semen parameters before and after treatment were determined by using the Wilcoxon signed rank test. Technical success rate was 97.1% (272 varicoceles). Complete follow-up results (mean, 40.3 months +/- 19.46 [standard deviation]) in 225 varicoceles (80.4%) revealed eight (3.6%) grade II-III recurrent varicoceles and resolution of pain in 164 (96.5%) of 170 cases. Statistically significant improvement of all semen parameters was achieved in infertile patients after treatment (P < .001). Of 59 patients with pretreatment sperm alterations who desired pregnancy, 23 (39.0%) achieved pregnancy (mean follow-up, 28.6 months +/- 7.77). TCFS in male varicocele with 3% STS foam was associated with a low recurrence rate, a high rate of pain resolution, and a significant improvement of pretreatment sperm parameter alterations; a substantial increase in pregnancy achievement was obtained for patients with pretreatment sperm alterations who desired pregnancy.

Research paper thumbnail of Transjugular Intrahepatic Portosystemic Shunt Patency and Clinical Outcome in Patients with Budd-Chiari Syndrome: Covered versus Uncovered Stents 1

Research paper thumbnail of Percutaneous transluminal angioplasty for treatment of critical hand ischemia with a novel endovascular approach: “The radial to ulnar artery loop technique”

Journal of Vascular Surgery, 2010

A 44-year-old patient with type I diabetes with critical upper limb ischemia of the left hand was... more A 44-year-old patient with type I diabetes with critical upper limb ischemia of the left hand was referred to our department with ischemic tissue loss and rest pain. After unsuccessful use of the endovascular antegrade approach, retrograde revascularization with percutaneous transluminal angioplasty (PTA) of the ulnar artery and the Palmar arch through the radial artery was successfully performed (the radial to ulnar artery loop technique). Relief of the patient's symptoms was immediate and ischemic lesions were healed at 6-month follow-up. This technique, which has been used for the first time in critical upper limb ischemia, may significantly increase the success rate of percutaneous angioplasty, especially when antegrade recanalization fails.

Research paper thumbnail of Combined Direct Puncture of the PTFE Graft and Contralateral Snare Loop Technique for Catheterization of an Occluded Femoropopliteal Graft

Journal of Vascular and Interventional Radiology, 1998

... Auteur(s) / Author(s). GANDINI R. ; MASPES F. ; PAMPANA E. ; SAKR A. ; SIMONETTI G. ; Revue /... more ... Auteur(s) / Author(s). GANDINI R. ; MASPES F. ; PAMPANA E. ; SAKR A. ; SIMONETTI G. ; Revue / Journal Title. Journal of vascular and interventional radiology ISSN 1051-0443 CODEN JVIRE3 Source / Source. 1998, vol. 9, n o 2, pp. 241-244 [4 page(s) (article)] ...

Research paper thumbnail of Emergency Endograft Placement for Recurrent Aortocaval Fistula After Conventional AAA Repair

Journal of Endovascular Therapy, 2002

To report a novel case in which a stent-graft was used to emergently treat an aortocaval fistula ... more To report a novel case in which a stent-graft was used to emergently treat an aortocaval fistula that recurred after conventional abdominal aortic aneurysm (AAA) repair. A 67-year-old man was treated urgently for ruptured AAA with surgical placement of a 16-mm Dacron interposition graft. During the procedure, an aortocaval fistula was repaired primarily. The patient was discharged in satisfactory condition but returned 20 days later with dyspnea, bilateral perimalleolar edema, and a bruit in the mesogastric region. The high flow fistula was again present just above the aortic bifurcation at the distal anastomosis of the existing graft. The patient's condition deteriorated rapidly, so a bifurcated Vanguard stent-graft was deployed in an emergency procedure. Subsequent imaging confirmed satisfactory closure of the fistula. The patient was discharged 8 days after endograft placement, and he continues to be without signs of fistula recurrence at 2 years. Endograft treatment of vascular lesions in the acute setting is becoming more common as our experience with the devices grows. Endovascular repair of primary aortocaval fistulas appears to be an efficacious and minimally invasive means of dealing with these lesions in AAA patients.