FRANCISCO CESAR CARNEVALE
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
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- Safety, efficacy, and prognostic factors in endovascular treatment of pelvic congestion syndrome(2014) NASSER, Felipe; CAVALCANTE, Rafael N.; AFFONSO, Breno B.; MESSINA, Marcos L.; CARNEVALE, Francisco C.; GREGORIO, Miguel A. deObjective: To evaluate the safety and effectiveness of transcatheter embolization using coils for treatment of pelvic congestion syndrome (PCS) and to elucidate prognostic factors for clinical success. Methods: Data were retrospectively analyzed from 113 women with PCS who underwent endovascular embolization of ovarian and pelvic varicose veins at Hospital Clinic Universitario, Zaragoza, Spain between January 2001 and January 2011. Pain score was evaluated before and after the procedure via a visual analog scale (VAS). Associated symptoms (dysmenorrhea, dyspareunia, urinary urgency, and lower limb symptoms) were also evaluated. Patients were followed up for 12 months. Results: The technical and clinical success was 100%. At 12 months, 53% of patients had no pelvic pain and 47% reported a reduction in pelvic pain. The average VAS was 7.34 before the procedure and 0.47 at 12 months. Complete relief of pain and associated symptoms was achieved for 37% of patients. Urinary urgency, lower limb symptoms, and vulvar and lower limbs varicosities were prognostic factors related to incomplete treatment success. The global complication rate was low (5/113,4.4%). Conclusion: Transcatheter embolization was a safe and effective treatment for PCS. Lower limb symptoms, urinary urgency, and varicosities were associated with incomplete clinical success.
- The ""PErFecTED Technique"": Proximal Embolization First, Then Embolize Distal for Benign Prostatic Hyperplasia(2014) CARNEVALE, Francisco C.; MOREIRA, Airton Mota; ANTUNES, Alberto A.Prostatic artery embolization requires a refined technique to achieve good imaging and clinical success. The PErFecTED (Proximal Embolization First, Then Embolize Distal) technique has produced greater prostate ischemia and infarction than previously described methods with clinical improvement of lower urinary symptoms and lower recurrence rates. The microcatheter should cross any collateral branch to the bladder, rectum, corpus cavernosum, gonad, or penis and be placed distally into the prostatic artery before its branching to the central gland and peripheral zone. This technique allows better distribution of embolic material in the intraprostatic arteries and reduces risk of spasm or thrombus. Because benign prostatic hyperplasia develops primarily in the periurethral region of the prostate, the urethral group of arteries should be embolized first. Subsequent distal investigation and embolization completes occlusion and stasis of blood flow to the prostatic parenchyma. Since we added the second step to the PErFecTED technique, we have observed infarcts in all patients submitted to prostatic artery embolization.
- Prostatic Artery Embolization to Treat Lower Urinary Tract Symptoms Related to Benign Prostatic Hyperplasia and Bleeding in Patients with Prostate Cancer: Proceedings from a Multidisciplinary Research Consensus Panel(2014) GOLZARIAN, Jafar; ANTUNES, Alberto A.; BILHIM, Tiago; CARNEVALE, Francisco Cesar; KONETY, Badrinath; MCVARY, Kevin T.; PARSONS, J. Kellogg; PISCO, Joao-Martins; SIEGEL, David N.; SPIES, James; WASSERMAN, Neil; GOWDA, Naveen; AHRAR, Kamran
- MRI Findings After Prostatic Artery Embolization for Treatment of Benign Hyperplasia(2014) FRENK, Nathan E.; BARONI, Ronaldo H.; CARNEVALE, Francisco C.; GONCALVES, Octavio M. G.; ANTUNES, Alberto A.; SROUGI, Miguel; CERRI, Giovanni G.OBJECTIVE. The purpose of this article is to assess and describe the MRI findings after prostatic artery embolization for treatment of benign prostatic hyperplasia. MATERIALS AND METHODS. We retrospectively evaluated 17 patients who underwent prostatic artery embolization as part of different prospective studies to evaluate this alternative treatment of benign prostatic hyperplasia. Clinical results were evaluated by assessment of urinary catheterization and International Prostate Symptom Score (IPSS). Serial MRI examinations were performed, and the prostatic central gland and peripheral zone were evaluated for signal intensity changes and the presence and characteristics of infarcted areas. Statistical analysis was performed with ANOVA for repeated measures and Student t test. RESULTS. All patients had clinical success, as defined by the removal of indwelling urinary catheter or decreased IPSS after embolization. Infarcts were seen in 70.6% of the subjects, exclusively in the central gland, were almost always characterized by hyperintensity on T1-weighted images and predominant hypointensity on T2-weighted images, and became smaller (mean reduction, p < 0.001) and isointense to the remaining of the central gland over time. Volume reduction of the prostate after embolization was significant (averaging 32.0% after 12-18 months; p < 0.001) only in patients with infarcts. No statistically significant association was seen between the development of infarcts and IPSS. CONCLUSION. MRI can be used for assessing the development of infarcts and volume reduction in the prostate after embolization. Further studies are needed to correlate these findings to clinical outcome.
bookPart 0 Citação(ões) na Scopus Benign prostatic hyperplasia(2014) CARNEVALE, F. C.; MOREIRA, A. M.