Dottor Andrea Contegiacomo - Radiologo Interventista

27/06/2022

assisted hepatic with &

approach for complex lesion management for

22/02/2022

day in 👨🏻‍🎓🏅🎊
special tnx to for the wonderful experience ❤️

08/12/2021

Percutaneous ultrasound-guided abdominal is a mini-invasive technique for patients with persistent ascites not responding to conservative therapies.
The procedure is usually performed under guidance but also CT or blind approaches are possible.

PROCEDURAL STEPS
After local anesthesia, the access to peritoneal cavity is obtained with a small through which a guidewire is wrapped into the abdomen. According to Seldinger's technique, the tube is moved over the guidewire after the needle has been removed.

Percutaneous ultrasound-guided abdominal drainage is a mini-invasive technique for patients with persistent ascites not responding to medical therapies.The p...

30/11/2021

Trans-jugular under guidance and measurement

21/11/2021

is the treatment of choice in patients with intermediate stage HCC, according to the Barcellona Clinic Liver Cancer (BCLC) staging system.
The procedure consists in the placement of a micro-catheter in the arteries feeding the tumor for the locoregional infusion of chemotherapic drugs directly in the tumor, reducing hepatic and systemic toxicity. In DEB-TACE the chemotherapic drug is delivered to the tumor into microspheres that enhance the effect of drug by inducing tumor ischemia (vessel occlusion) slow delivery.

La TACE (Chemioembolizzazione trans-arteriosa) è il trattamento di scelta nei pazienti con HCC in stadio intermedio, secondo il sistema di stadiazione Barcellona Clinic Liver Cancer (BCLC).
La procedura consiste nel posizionamento di un piccolo catetere (microcatetere) nelle arterie che alimentano il tumore con successiva infusione locoregionale di farmaci chemioterapici direttamente all'interno del tumore stesso, riducendo significativamente la tossicità sistemica epatica e sistemica. Nella DEB-TACE il farmaco chemioterapico viene somministrato al tumore all'interno di microsfere che potenziano l'effetto del farmaco inducendo l'ischemia tumorale e un rilascio lento del farmaco.

is the treatment of choice in patients with intermediate stage HCC, according to the Barcell...

10/11/2021

What fantastic audience! ❤️

15/10/2021

A complex case of in a patient with a pelvic mass infiltrating the left iliac vein with subsequent complete of the external iliac and common femoral veins. The risk of performing a percutaneous biopsy was the proximity to gluteal vessels (posteriorly), bowel loops (anteriorly), and the possible embolic neoplastic migration during tissue sampling. On this basis we decided to perform an biopsy after inferior vena cava placement in order to prevent pulmonary embolization. No complications occurred.




more videos on youtube: http://www.youtube.com/AndreaContegiacomo

22/07/2021

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The BIRIMANKHWE is an animal, a chameleon. In Malawi it is depicted with an eye looking forwards and one backwards.Going towards the future without forgetting the past.For this too, stories are needed.

11/07/2021

Voglio raccontarvi alcune storie (in ordine di apparizione), che nei giorni passati in mi hanno riempito il e meritano di essere raccontate per celebrarne gli protagonisti. Sono strade molto diverse ma che convergono sul traguardo della e per un paese che merita il e l’aiuto di chi è per e non per più fortunato.

Sono le storie di Numeri, malawaiano ed uno dei due di tutto il paese che ha scelto di lavorare per la sua gente, senza cercare in paesi che avrebbero potuto offrirgli una qualità di migliore, e che ogni giorno offre la propria professionalità al proprio paese.

di padre Mario, missionario da 45 anni in Malawi dove ha passato più della metà e per il quale ha rischiato e rischia tutt’oggi la propria vita, e nel quale ha costruito una realtà splendida i cui ingredienti sono , e una sicura dove rifugiarsi.

di Gabriele, di base toscano che, da 20 anni, aiuta Mario e i missionari a portare avanti un di salute negli e nelle zone rurali del paese visitando e curando centinaia di persone ogni giorno.

di Agostino che, orfano di moglie e figlio, ha trovato la di ed aiutare il prossimo mettendo al servizio della le sue doti ingegneristiche costruendo pozzi, aggiustando ponti e aprendo scuole in tutto il territorio di .

di Banda, nato in un piccolo villaggio, oggi grande , nostro di , che ci ha aiutato a comprenderne usanze, costumi, criticità e splendore del proprio paese e della propria gente, rivedendo sé stesso in ognuno dei bambini e adolescenti che abbiamo incontrato nel nostro percorso e che ogni giorno ha riempito i nostri cuori con gesti o parole, rivolti a questi ragazzi, degni dei grandi del passato.

è infine la di tutte quelle persone che abbiamo incontrato nel nostro percorso e che a loro modo, con i loro mezzi e le loro , ogni giorno aiutano il prossimo come possono.

15/06/2021

laparoscopic approach for : tailored for a complex disease!
increases treatment outcome and ’



Feat. Gabriele Spoletini @ Fondazione Policlinico Universitario Agostino Gemelli IRCCS

03/07/2020

New video online!

is an essential tool for the management of patients with suspected . Interventional radiologists play a key role when bronchoscopy fails or is not possible due to the lesion position. CT-guided lung biopsy (https://www.youtube.com/watch?v=aQbF6BMGEo0&t=9s) is usually the method of choice for these patients, but ionizing radiation doses are increased and a real time view of the lesion and the lungs is not allowed. The use of guidance is possible when the lesions are peripheral and a contact surface with the thoracic wall exists.
This video shows all the procedural steps of a -guided lung biopsy in a patient with multiple morbidities and a pleural effusion.

is an essential tool for the management of patients with suspected ...

24/11/2019

BLEEDING MANAGEMENT AFTER TRAUMA

Full video @
www.youtube.com/watch?v=jTXv8Z85LwM

17/11/2019

is still a challenge for many professional figures in the field. When the patient is a rapid and effective management is required to prevent cardiovascular shock and death.
Interventional radiology plays a key role in the stable patient, providing multiple options .

DIAGNOSTIC WORKUP
Angiographic-CT is the imaging test of choice in patients with suspected bleeding. Basal acquisition is performed for the identification of the hematoma and bone fractures. Arterial, Portal and Venous phases are subsequently performed in order to identify the bleeding vessel.

PROCEDURAL STEPS AND TECHNIQUE
Vascular access is performed usually at the common femoral or radial artery site. Pain control is achieved with local anesthesia. Vessel puncture is performed at free-hand or under ultrasound/fluoroscopic guidance with a 18G cannula. Once the needle is in the vascular lumen a guidewire is passed through the needle and an arterial vascular sheath is finally placed in the artery. On the basis of the CT examination a diagnostic catheter is placed in large vessel as near as possible to the suspected bleeding vessels. A diagnostic angiography run is performed and bleeding site is usually identified. A microcatheter is moved to the site of bleeding and embolization is performed with the most appropriate embolic agent (Coils, Glue, PVA, Gelfoam, Plug, Stent, ecc…). A final diagnostic angiographic run confirms the bleeding cessation.

Trauma is still a challenge for many professional figures in the medical field. When the p...

10/11/2019

RENAL BIOPSY PROCEDURE EXPLAINED STEP BY STEP @
www.youtube.com/watch?v=4ux9LZa2poI

04/11/2019

FULL VIDEO @
www.youtube.com/watch?v=4ux9LZa2poI
www.facebook.com/dr.andrea.contegiacomo/videos/496934254228294/

Renal biopsy is an established tool for the diagnosis of multiple renal diseases. Reasons to perform renal biopsy are various, from renal masses to sudden renal failure or transplant rejection. When possible, the use of ultrasound (US) guidance is preferable because kidney moves during ventilation and the real time control of the needle provider by US makes the procedure easier. Unfortunately sometimes lesions are not visible at US examination because too small or deep. In these cases CT guidance is required during renal biopsy to obtain tissue specimens for pathological analysis.

TECHNIQUE AND PROCEDURAL STEPS
Computed tomography is the modality of choice for lesions that are not clearly visible at US examination. Patient collaboration is essential because the kidney moves during the respiratory acts (inflation and deflation). The patient is positioned on the CT bed in a comfortable position because the procedure has a variable duration of about 20-60 minutes in which position should be invariate. Percutaneous posterior approach is usually adopted to avoid abdominal structures such as liver, spleen, bowel loops or pancreas. Local anesthesia is administered with a small needle in order to minimize procedural pain, usually described as poor by patients. The biopsy needle is inserted up to the renal parenchyma. Needle sampling system is activated once the tip is properly located in the nodule and the needle is extracted.
All the procedure is performed under imaging guidance and needle tip position can always be checked if necessary.

COMPLICATION AND MANAGEMENT
In a small number of cases, complications may occur during the renal biopsy procedure; among these, bleeding and urinary system injury are the most common.

- Parenchymal bleeding occurs when the needle passes through renal vessels. This condition is usually more frequent when the lesion is close to the hilum. In the majority of cases, bleeding is self-limiting. In a very poor number of cases the bleeding persists and an endovascular management by embolization is required.

- Urinary system injury causes an urinary leak with the formation of an urinoma (urine collection close to the kidney). The urinoma is usually asymptomatic but a superinfection can occur in these patients with subsequent percutaneous CT (https://www.youtube.com/watch?v=ipD8ubbH3SI) or US-guided drainage.

The video proposes a standard CT-guided renal biopsy procedure lingering on procedural steps and technical aspects. the patient is affected by a renal lesion located in the pelvis

03/11/2019

FULL VIDEO:
https://www.youtube.com/watch?v=aQbF6BMGEo0
www.facebook.com/dr.andrea.contegiacomo/videos/398004194247916
Interventional radiology plays a key role in the diagnosis of suspected pulmonary nodular lesions.
The sample of a vital specimen is critical for lesion typing and characterization. Larger the specimen, higher is the possibility to obtain sufficient material for receptors (EGFR receptor) analysis with important prognostic implications.

TECHNIQUE AND PROCEDURAL STEPS
Computed tomography is the gold standard imaging modality for lung biopsy guidance, even if ultrasonography and magnetic resonance have been also described in the literature. Patient collaboration is essential because the lung moves during the respiratory acts (inflation and deflation). The patient is positioned on the CT sliding bed in a comfortable position because the procedure has a variable duration of about 20-60 minutes in which position should be maintained invariate. Percutaneous Intercostal approach is always adopted: after that local anesthesia is performed with a small needle the biopsy needle is inserted across the intercostal space and the lung parenchyma up to the nodule. Needle sampling system is activated once the tip is properly located in the nodule and the needle is extracted.
All the procedure is performed under imaging guidance and needle tip position can always be checked if necessary.

COMPLICATION AND MANAGEMENT
In a small number of cases, complications may occur during the lung biopsy procedure; among these, pneumothorax and parenchymal bleeding are the most common.

- Pneumothorax is defined as the entry of air into the pleural cavity resulting in increased intra-cavitary pressure and partial / complete collapse of the lung parenchyma. Pneumothorax occurs in almost 20% of all lung biopsy procedure but in the majority of cases it has no clinical relevance and the patient remains asymptomatic. A small number of patients (5% of the 20% reported above) indeed experiences minimal respiratory discomfort during or after the procedure. The cause of pneumothorax is usually the small superficial hole induced by the needle and the risk increases if multiple trans-pleural passes are performed during the procedure. Other risk factors are emphysema, small and deep lesions, poor patient collaboration. Pneumothorax management is achieved with chest tube placement usually performed across the biopsy needle percutaneous puncture site, avoiding a new puncture. The procedure is similar to that for pleural collection (https://www.youtube.com/watch?v=cZlmi1xJOKE)

- Parenchymal bleeding occurs when the needle passes through vessels in the lung parenchyma. This condition is more frequent when the lesion is close to the hilum or when the needle path is longer. Moderate hemoptysis is expected in these patients as the consequence of alveolar filling but it is usually self-limiting. In a very poor number of cases the bleeding persists and an endovascular management by embolization is required.

The video shows a case of lung biopsy in which the procedure is explained step by step.

03/11/2019

FULL VIDEO:
www.youtube.com/watch?v=aQbF6BMGEo0
www.facebook.com/dr.andrea.contegiacomo/videos/398004194247916
Interventional radiology plays a key role in the diagnosis of suspected pulmonary nodular lesions.
The sample of a vital specimen is critical for lesion typing and characterization. Larger the specimen, higher is the possibility to obtain sufficient material for receptors (EGFR receptor) analysis with important prognostic implications.

TECHNIQUE AND PROCEDURAL STEPS
Computed tomography is the gold standard imaging modality for lung biopsy guidance, even if ultrasonography and magnetic resonance have been also described in the literature. Patient collaboration is essential because the lung moves during the respiratory acts (inflation and deflation). The patient is positioned on the CT sliding bed in a comfortable position because the procedure has a variable duration of about 20-60 minutes in which position should be maintained invariate. Percutaneous Intercostal approach is always adopted: after that local anesthesia is performed with a small needle the biopsy needle is inserted across the intercostal space and the lung parenchyma up to the nodule. Needle sampling system is activated once the tip is properly located in the nodule and the needle is extracted.
All the procedure is performed under imaging guidance and needle tip position can always be checked if necessary.

COMPLICATION AND MANAGEMENT
In a small number of cases, complications may occur during the lung biopsy procedure; among these, pneumothorax and parenchymal bleeding are the most common.

- Pneumothorax is defined as the entry of air into the pleural cavity resulting in increased intra-cavitary pressure and partial / complete collapse of the lung parenchyma. Pneumothorax occurs in almost 20% of all lung biopsy procedure but in the majority of cases it has no clinical relevance and the patient remains asymptomatic. A small number of patients (5% of the 20% reported above) indeed experiences minimal respiratory discomfort during or after the procedure. The cause of pneumothorax is usually the small superficial hole induced by the needle and the risk increases if multiple trans-pleural passes are performed during the procedure. Other risk factors are emphysema, small and deep lesions, poor patient collaboration. Pneumothorax management is achieved with chest tube placement usually performed across the biopsy needle percutaneous puncture site, avoiding a new puncture. The procedure is similar to that for pleural collection (https://www.youtube.com/watch?v=cZlmi1xJOKE)

- Parenchymal bleeding occurs when the needle passes through vessels in the lung parenchyma. This condition is more frequent when the lesion is close to the hilum or when the needle path is longer. Moderate hemoptysis is expected in these patients as the consequence of alveolar filling but it is usually self-limiting. In a very poor number of cases the bleeding persists and an endovascular management by embolization is required.

The video shows a case of lung biopsy in which the procedure is explained step by step.