[Role of endovascular surgery in presence of rupture of the thoracic aorta in patients with severe multisystemic post-traumatic surgical lesions]. / Ruolo della chirurgia endovascolare nelle rotture aortiche del politraumatizzato con lesioni polidistrettuali di pertinenza chirurgica.

The endovascular treatment (ET) of traumatic rupture of the thoracic aorta (TRTA) may represent, particularly in patients with severe multisystemic post-traumatic surgical lesions, an alternative approach to traditional surgery. We observed (October 2001- November 2004) 5 male patients (age: range 23-42 years - average 32,4) affected by TRTA (3 isthmic aortic ruptures - 2 distal descending thoracic aorta ruptures), all successfully treated with an endovascular approach. The Glasgow Coma Score (GCS) ranged between 5 and 13. After performing resuscitation manoeuvres, all patients were investigated with total body CT scans in order to evaluate the thoracic aorta and to identify associated visceral lesions. In 4 cases were evident associated visceral lesions (3 cases: bone, abdominal and neurosurgical trauma - 1 case: bone, abdominal, neurosurgical and thoracic trauma). All the procedures were performed in the operative room using DSA (Digital Subtraction Angiography). The mean operating time was 105 minutes (range 80 - 125). We didn't observed early and late complications (follow-up: average 24 months, range 12-36). In conclusion the ET of TRTA represents in 'critical' patients with severe polytrauma an alternative approach to traditional surgery in order to 'stabilizing' the cardiovascular clinical parameters and to treating 'safety' the other associated surgical lesions.

Detection of internal carotid artery stenosis. Comparison of 2D-MR angiography, duplex scanning, and arteriography.

The purpose of this study was to compare digital subtraction angiography (DSA) and duplex scanning with 2D-Magnetic Resonance Angiography (MRA) to evaluate the accuracy of MRA in determining carotid stenosis. All three methods were applied to 101 carotid arteries in 51 patients. Diameter stenosis of the internal carotid artery was categorized as follows: 0 to 39%, 40% to 59%, 60% to 94%, 95% to 99%, and occlusion (100%). All images were read in blind fashion by different physicians. DSA is still considered the "gold standard" investigation. In 78 arteries the degree of stenosis according to MRA correlated exactly with that of conventional angiography. In the remaining 23, carotid arteries MRA upgraded the stenosis in 13 and downgraded it in 8. The principal problem is the overestimation of the lesion, which was particularly revealing in lesions of more than 60%. Furthermore to date MRA is not able to evaluate the presence of ulceration. For this reason 2D-MRA alone is not a reliable method for evaluating the presence of carotid artery stenosis.

[Role of Doppler color ultrasonography in the diagnosis of carotid vessel anomalies]. / Ruolo dell'eco color Doppler nella diagnosi delle anomalie di decorso dei vasi carotidei.

Anomalies of the carotid vessels are compared with a frequency of 4-16% in the angiographic experience but such data don't reflect the real prevalence. In fact those anomalies are often asymptomatic for which only few patients with this anomaly are evaluated by morphological studies. The authors reviewing their experience of 3033 echo duplex of the cervical vessels have underlined 166 patients with anomalies of the carotid vessel course. In these cases has been evaluated the capacity of the echo duplex to characterize such anomalies also in relation to other imaging techniques like traditional angiography and magnetic resonance. The echo duplex is a good test and could be used not only to study symptomatic patients but also to screen the general population.

Popliteal artery entrapment: MR findings.

A 35-year-old woman with a history of claudication was examined by means of echodoppler, angiography, and MR imaging using gradient rephased sequences, performed at rest and during stress. Magnetic resonance imaging allowed the evaluation of the relationships between the gastrocnemius muscle and the popliteal artery at rest and the evidence of the occlusion during stress. This combined morphological and functional evaluation makes MR a procedure of choice for assessment of young adults with intermittent claudication.

Healing of aortic prosthetic grafts: a study by magnetic resonance imaging.

Thirty-six patients with aortoiliac reconstruction were studied by magnetic resonance imaging (MRI) to determine the diameter, baseline signal, and subsequent magnetic signal characteristics of postoperative periprosthetic collection (PPC). Our study confirmed the presence of PCC in most cases (32/36). The diameter was significantly (p < 0.05) correlated with the type of disease being treated, the type of proximal anastomosis created, and whether or not drainage and postoperative transfusion were used. PPC usually disappeared within 3 to 6 months postoperatively. Modifications of magnetic signals T1 and T2 require approximately the same amount of time to diminish. During follow-up investigations in this series, there was one case of prosthetic infection characterized by the persistence of PPC and a strong T2 signal 6 months after surgery, the latter corresponding to incomplete or delayed healing. The MRI aspects of normal healing of aortic grafts were analyzed to correctly interpret the MRI aspects of complications in surgery of the aorta.

[Magnetic resonance: the usefulness of gradient-echo refocusing sequences in the diagnosis of aneurysms of the abdominal aorta]. / Risonanza magnetica: utilità delle sequenze gradient echo refocusing nella diagnostica degli aneurismi dell'aorta addominale.

Sixteen patients bearing aneurysms of the abdominal aorta were studied by means of a 0.5 T MR unit. Spin-echo T1-weighted sequences and gradient-echo refocusing sequences were performed. All patients were previously submitted to US; in 8 cases angio CT was performed, and in 6 patients angiography of the abdominal aorta. A comparative analysis with the US findings showed a high correlation coefficient for the maximum diameters (R = 0.93) while site and size evaluations were not accurate. A very high correlation coefficient for the maximum diameters (0.97) was found at the comparative analysis with CT findings, while in two cases an erroneous suprarenal location was described. Angiographic examination provided valuable information about renal and iliac involvement, but the maximum diameters could not be accurately assessed. Spin-echo MRI allowed good evaluation of the maximum size, of location and extent of the aneurysm, as well as of iliac involvement; this technique, however, was useless in the characterization of the thrombus. Gradient-echo refocusing sequences have proven very useful for the identification of endoluminal contours and for the correct evaluation of the thrombus. Spin-echo sequences, on the contrary, accurately assessed only 7 cases, whereas the diagnosis was uncertain in the remaining 4 patients.

Stress MR imaging for evaluation of popliteal artery entrapment.

The popliteal artery entrapment (PAE) syndrome has been recognized as a cause of arterial occlusion in young people. It is the result of an anomaly of the relationship between the popliteal artery and the gastrocnemius muscle. Eight young health volunteers (16 legs) and six patients (10 legs) with suspected PAE underwent magnetic resonance (MR) imaging. Gradient-echo images were obtained in axial planes with the leg at rest and during active plantar flexion against resistance. Imaging at rest allowed identification of PAE signs in only one leg, which had an anomalous medial course of the popliteal artery. In the other cases, only the stress technique was able to show signal loss in the popliteal artery due to muscular compression (two legs) or the presence of accessory muscle slip around the vessel (two legs), as confirmed at surgery. MR imaging is therefore a useful technique for the diagnosis of PAE because of its capability of combining information obtainable with other modalities.

Role of magnetic resonance imaging in the evaluation of aortic graft healing, perigraft fluid collection, and graft infection.

The authors report their preliminary experience in the use of Magnetic Resonance Imaging (MRI) in ten patients who underwent aortic reconstruction. Examinations were performed 1, 4, 12 and 24 weeks after surgery, to examine the presence, size, magnetic characteristics and evolution of periprosthetic collections. The results have shown that periprosthetic collection can be considered normal after aortic reconstructive surgery, because such a perigraft collection (PFC) was present in 90% of the patients studied 1 week after operation, and had disappeared within 24 weeks in all cases. The magnetic characteristics were evaluated by T1 [repetition time (TR) = 480 msec and echo time (TE) = 20 msec] and T2 weighted spin-echo sequences (TR = 1800 msec and TE = 70/120 msec). Variations in the magnetic characteristics, found in sequential examinations, correlated with modifications of the collection and suggested that it was originally blood. The MRI examination performed 24 weeks after surgery gave a low signal intensity in T1 and T2 weighted sequences (w.s.) suggesting periprosthetic fibrosis. These preliminary observations may constitute a starting point for better evaluation of the normal appearance and evolution of the periprosthetic fluid collections following aortic graft implantation and, may be useful for the early detection of infection especially in asymptomatic patients.