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Biomedical subjects

C Rabbia

Publications and source records attributed to C Rabbia.

At least 19 recordsLinked to original sources
PubMed1998

Feasibility of intraoperative balloon angioplasty and additional stent placement of isolated stenosis of the brachiocephalic trunk.

OBJECTIVE: We sought to evaluate the feasibility and results of intraoperative balloon angioplasty and additional stent placement of isolated stenosis of the brachiocephalic trunk. PATIENTS AND METHODS: Between May 1993 and October 1996, we treated eight patients with local stenosis of the innominate artery. Seven lesions were situated in the proximal and one in the middle third of the brachiocephalic trunk. Five patients were men and three were women, with ages ranging from 55 to 72 years (mean 59.5 years). All stenoses provoked severe blood flow reduction and caused clinical symptoms. Procedures were performed in an operating suite with fluoroscopic imaging capabilities. Through an anterolateral cervical approach the right common carotid artery was surgically exposed and then clamped to avoid atheroembolization during the subsequent procedure. Retrograde catheterization was performed to reach the stenosis of the brachiocephalic trunk. The lesion was dilated with a balloon catheter and successively stented. Follow-up examinations (color-coded duplex sonography, accompanied by clinical inspection and systolic blood pressure) were scheduled every 6 months. RESULTS: In all patients the dilation of the stenosis of the innominate artery and the stent placement were successful without any side effects. No embolic events or other complications occurred. The postintervention angiography showed successfully dilated stenoses and patent stents in all cases. The technical success rate was 100%. CONCLUSIONS: On the basis of our preliminary data, we believe that, in selected patients, intraoperative balloon angioplasty of stenosis of the innominate artery with stent placement from the right common carotid artery approach is a safe and effective alternative to conventional operations.

Aged↗
PubMed1998

Arteriovenous fistulas induced by femoral arterial catheterization: percutaneous treatment.

PURPOSE: To evaluate the use of stent-grafts for the percutaneous closure of arteriovenous fistulas that develop after cardiac catheterization. MATERIALS AND METHODS: From January 1994 to November 1997, 14 arteriovenous fistulas in 13 patients (eight men, five women; age range, 46-65 years; mean age, 53.5 years) were treated. Eleven fistulas were situated between the deep femoral artery and the common femoral vein, and three fistulas were between the superficial femoral artery and the common femoral vein. All fistulas were closed with stent-grafts positioned in the artery at the level of the fistula. RESULTS: The percutaneous treatment of arteriovenous fistulas was successful in all cases. The findings at angiography performed after the procedure demonstrated the closure of the fistulas and the correct positioning of the prostheses; veins were no longer visible. One complication occurred--a partial thrombosis of the common femoral vein at the puncture site after manual compression. CONCLUSION: On the basis of the preliminary data, the authors believe that the percutaneous closure of arteriovenous fistulas with stent-grafts is a safe and effective alternative to conventional surgery.

Aged↗
PubMed1998

Experience with the Stentor endograft at four Italian centers.

PURPOSE: To report the outcome of an Italian multicenter trial of endovascular abdominal aortic aneurysm (AAA) exclusion using the Stentor device. METHODS: Between April 1995 and July 1996, 66 patients (63 men; average age 69 years, range 53 to 84) with infrarenal AAAs meeting the inclusion criteria were enrolled. The average diameter of the aneurysm was 4.6 cm (range 4.2 to 7). Three (4.5%) of the 66 AAAs were anastomotic aneurysms. RESULTS: Sixteen (25%) tubular and 50 (76%) bifurcated endograft procedures were attempted; 4 (6.1%) were converted and 1 terminated owing to technical faults with the bifurcated graft's second limb. One tube graft was too short and failed to exclude an anastomotic aneurysm. Sixty (91%) endograft procedures were completed successfully. Six (9.1%) vascular complications occurred, three in one patient who subsequently died of pulmonary embolism 72 hours postoperatively (1.5% mortality). There were four (6.1%) proximal endoleaks; two sealed spontaneously in < 1 month, and a third was converted (7.6% conversion rate). The fourth is being observed. Clinical success (aneurysm exclusion with no death or endoleak) at 30 days was 86.3% (57/66). In the 23-month follow-up of 57 eligible patients, 2 patients died of unrelated causes and 1 graft limb thrombosed, requiring a crossover femoral bypass. One patient was converted to surgical repair at 5 months postoperatively when increasing aneurysm size signaled an undisclosed endoleak (1.8% late conversion rate). Five other secondary endoleaks were treated with endovascular techniques. CONCLUSIONS: The Stentor was technically feasible in 10% to 40% of AAA candidates in this study, although deployment of the second limb was problematic in the bifurcated device. Introduction of the second-generation Vanguard endograft brought this study to an end.

Aged↗
PubMed1997

Combined surgical and endovascular treatment of a traumatic pseudo-aneurysm of the brachiocephalic trunk with anatomical anomaly.

The authors report a case of combined surgical and endovascular treatment of a traumatic pseudo-aneurysm of the innominate artery in which the left common carotid artery originated from the brachiocephalic trunk. After a conventional surgical intervention with the implantation of the left common artery on the left subclavian artery, to correct the anatomic anomaly, a safe and effective endovascular stent-graft placement excluded the aneurysm. This new technique proposes a good chance for polytraumatized patients to receive a better prognosis and a much faster rehabilitation.

Adult↗
PubMed1997

Exclusion of an internal carotid aneurysm by a covered stent.

The authors report a case of a patient with thromboembolic strokes caused by a high internal carotid artery aneurysm. Considering the position and the anatomic structure of this aneurysm the sac was excluded transluminally by placing an endovascular covered stent.

Aneurysm↗
PubMed1993

[Percutaneous stenting in the treatment of iliac steno+-obstructive lesions].

The authors report their experience with Palmaz stents in the percutaneous treatment of steno-obstructive iliac artery lesions. A hundred and thirty-six patients suffering from claudicatio, pain at rest or distal lesions underwent 156 percutaneous stenting maneuvers. The indications to stenting were: acute obstruction or severe dissection after angioplasty (19 cases), residual stenosis > 30% (80 cases), large ulceration (7 cases), restenosis after previous percutaneous treatment (10 cases) and finally chronic obstruction (40 cases). In 154 cases the maneuver was successful, in 2 the stent was mispositioned because of technical problems and another stent had to be inserted. In 146 cases stenting was performed after transluminal angioplasty, while 10 chronic obstructions underwent stenting with no previous angioplasty to limit distal embolization. In all cases stenting improved the angiographic pattern more than angioplasty alone. Prophylactic drugs after stenting included only anti-aggregating substances. Marked clinical improvement was observed after stenting, and almost all patients gained at least one clinical stage. During stenting, 15 complications occurred (9.6%)--i.e, 2 external iliac artery dissections, 4 mild inguinal hematomas, 1 pseudoaneurysm, 1 segmental obstruction of the superficial femoral artery and 7 distal embolisms during recanalization of chronic occlusions. The complications were caused by the procedure, and especially by the large caliber of the introducer sheat; no complication was related to the stent itself. None of these complications needed major surgery. Over 3-34 months' follow-up (mean: 9 months), 1 obstruction and 2 restenoses occurred in 134 vessels; these lesions were treated successfully with thrombolysis and/or transluminal angioplasty (primary patency: 97.8%, secondary patency: 100%). In the authors' experience, percutaneous stenting represents a simple and fast procedure with very good technical and clinical results which can increase the capabilities of percutaneous revascularization procedures.

Adult↗
PubMed1993

[Echo-Doppler of the supra-aortic vessels. Anatomy and pathologic picture. Comparison with angiography].

Duplex-Doppler US is the most accurate diagnostic method for the evaluation of neck vessels. It yields morphologic information on the vessels--diameter, course and wall--and hemodynamic information on direction, velocity and characteristics of flow. In the detection of stenosis and occlusion of the carotid artery, US diagnostic accuracy, both as reported in literature and as observed in our personal series, is very high. On the other hand, US diagnostic accuracy is lower in the vertebral artery, because of the difficulties in studying the artery origin. The comparison of duplex US and angiographic results suggests the need of using both techniques, especially in the study of the patients to submit to surgery.

Arterial Occlusive Diseases↗
PubMed1992

Carotid body tumors: US evaluation.

The ultrasound (US) findings in 20 patients with 23 carotid-body chemodectomas were reviewed. Twenty-two of 23 tumors could be seen at US; the remaining lesion could not be differentiated from surrounding enlarged lymph nodes resulting from thyroid cancer. The lesions were solid, slightly heterogeneous masses that ranged in size from 1.2 to 5.0 cm and were located within the carotid bifurcation. Pulsed Doppler analysis of blood flow within the tumor mass was possible in eight patients with nine chemodectomas, and low-resistance waveforms were obtained from multiple sites within the mass in all cases. The diagnostic possibility of a chemodectoma has to be considered when a solid mass is detected within the carotid bifurcation. On the basis of these findings, as US diagnosis was possible in 18 of 20 patients in the authors' series. Doppler analysis of the mass to evaluate intratumor blood flow is helpful in differentiating chemodectomas from other solid, nonhypervascular masses.

Adult↗
PubMed1992

Prospective study on captopril renography in hypertensive patients.

Six hundred and sixty-seven hypertensive patients were analyzed by captopril-enhanced scintigraphy. If time to reach maximal activity (Tmax) was > or = 5 min using 99mTc-diethylenetriaminepentaacetic acid (DTPA) or > or = 3 min with 123I-o-iodohippurate (OIH) and 99mTc-mercaptoacetyltriglycine (MAG3) and washout time > or = 15 min, a control study with nifedipine was performed. If the difference between Tmax under captopril and nifedipine premedication was > or = 5 min with 99mTc-DTPA or > or = 3 min with 123I-OIH and 99mTc-MAG3, the renogram was defined highly suggestive of renovascular hypertension. In the evaluation of bilateral abnormalities an additional parameter was considered, i.e. the presence of functional asymmetry of the emuntories susceptible of partial reversal in the control study under nifedipine. Based on these criteria, 58 out of 667 (8.7%) scintigrams were found to be abnormal. Thirty-five of these 58 patients and 32 of the remaining 609 scintigraphically negative cases underwent additional arteriographic examination. A renal vascular stenosis > or = 50% was found in 33 out of 35 (94.2%) patients with positive scintigraphy and in 3 out of 32 patients with negative scintigraphy. By examining results of the 67 patients undergoing arteriography, the sensitivity of captopril-enhanced scintigraphy was estimated to be 91.6%, with a specificity of 93.5%, an accuracy of 92.5%, and predictive values of a positive or negative result of 94.2 and 90.6%, respectively. By restricting analysis to bilateral stenosis, sensitivity was found to be 76.9%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Use of nuclear magnetic resonance in cranio-facial pathology. Preliminary study].

The use of MRT in craniofacial pathology has been evaluated above all as regards the possibility offered by this technique for studying the soft parts with better results than already sophisticated investigations like the CT scan. The technique's limitations are the long duration of the investigation, the impossibility of carrying it out in carriers of pacemakers, the inadequate visualisation of the bone and calcifications, the fairly high cost; the advantages are the fact that ionising radiation is not employed, the ureter sensitivity for the soft parts, the good vessel evaluation and the possibility of obtaining oriented sections in every space plane without moving the patient. The use of MRT is therefore rich in prospects.

Humans↗
PubMed1986

Body surface potential maps in old inferior myocardial infarction. Assessment of diagnostic criteria.

We assessed the accuracy of criteria for diagnosing an inferior myocardial infarction from body potential maps. Body surface potential maps were recorded from 140 lead points on the entire chest surface in three groups of subjects: group A consisted of 15 patients with an old inferior myocardial infarction and typical electrocardiographic signs of necrosis; group B consisted of 15 patients with an old inferior myocardial infarction, but without electrocardiographic signs of necrosis (inferior myocardial infarction was documented during the acute phase); group C consisted of 30 healthy controls. In each subject body surface potential distributions were examined every 2 msec of the QRS complex. Moreover, the potential-time integrals relating to three intervals (QRS, the first 20 and the first 40 msec of the QRS complex) were calculated at each lead point and transferred to diagrams representing the thoracic surface explored (isointegral maps). For each time interval, the mean isointegral map obtained from group C subjects was subtracted from the isointegral map of each patient. The value obtained at each lead point was then divided by the standard deviation of the normal values for that point; the resulting values indicating the standardized differences from normal values were transferred to another map (deviation index isointegral map, DI map). We considered a reliable index of inferior myocardial infarction an area where the time-integral values were at least 2 SD lower than normal, in the inferior half of the thorax. A number of variables relative to instantaneous potential distribution and to isointegral maps were considered. The DI maps of the first 40 msec of QRS gave the most accurate criteria; in fact, an area of negative values 2 SD lower than normal was found in all group A patients and in 11 out of 15 group B patients (sensitivity 100% in group A, 73% in group B and specificity, 83%). Thus our results indicate that body surface potential maps have greater diagnostic information content than the 12 standard electrocardiographic leads and demonstrate the usefulness of the time integral analysis of body surface potentials for diagnostic interpretation.

Adult↗
PubMed1983

[Chemodectoma of the pterygo-maxillary fossa].

Cervicocephalic chemodectomas are rare non-chromaffin paraganglionic tumours, most often originating in the carotid body or the jugular ganglion. Their main features are a reluctance to invade adjacent tissue and the absence of general clinical signs. Since they are histologically quite varied they may at times be difficult to recognise. A chemodectoma of a hitherto unreported type is described. Encountered in the pterygo-maxillary fossa it was identified by computerised axial tomography and angiography.

Adult↗