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Objective:To study the treatment outcomes of transjugular intrahepatic portal shunt (TIPS) on refractory hepatic sinus obstruction syndrome (HSOS) caused by Gynura segetum.Methods:The clinical data of 15 patients with refractory HSOS caused by Gynura segetum treated at the Department of Vascular Surgery, Henan Provincial People's Hospital from January 2017 to April 2021 were retrospectively analyzed. There were 7 males and 8 females, with ages ranging from 30 to 85 years, mean ± s. d. (61.2±14.1) years. Albumin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, glutamyl transferase, and portal vein pressure were compared before and after TIPS. The liver function and renal function of these patients were followed up.Results:When compared with pre-operation, the albumin, alanine aminotransferase, aspartate aminotransferase and other indexes were significantly improved after TIPS (all P<0.05). The portal vein pressure of 15 patients significantly decreased from the preoperative volume of (41.7±3.5) cmH 2O (1 cmH 2O=0.098 kPa) to (28.3±4.4) cmH 2O ( t=10.41, P<0.001). The preoperative liver function was Child-Pugh grade A in 1 patient, grade B in 8 patients, grade C in 6 patients. The postoperative Child-Pugh grading was grade A in 14 patients and grade B in 1 patient. Ascites, gastrointestinal bleeding, abdominal pain, abdominal distention and spontaneous peritonitis all disappeared in these 15 patients. Postoperative hepatic encephalopathy developed in 2 patients and hepatic myelopathy in 1 patient. Conclusion:TIPS for treatment of HSOS caused by Gynura segetum resulted in a rapid recovery of liver function, rapid symptomatic relief, with a low incidence of hepatic encephalopathy/hepatic myelopathy.
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Objective:To evaluate multi-channel transcatheter embolotherapy for type Ⅱ endoleak originating from lumbar arteries after endovascular abdominal aortic aneurysm repair (EVAR).Methods:Data of 8 cases of type Ⅱ endoleak after EVAR from Oct 2017 to Nov 2020 at the Department of Vascular and Endovascular Surgery, Henan Provincial People's Hospital were retrospectively analyzed.Results:All patients who suffered from type Ⅱ endoleak that originated from lumbar arteries after EVAR were successfully treated with coils and mixture of Compant medical glue and iodipin through multi-channel. The technical success rate was 100%, the operative time was 80-150 min. Right lower limb dyskinesia occurred in 1 patient after operation, the symptom disappeared by anticoagulation and trophic neurotherapy for 2 months. Type Ⅱ endoleak didn't recur in all patients, and no mortality during the 4-38(14.1) months follow-up period.Conclusion:Multi-channel transcatheter embolotherapy has definite effects for the treatment of type Ⅱ endoleak from lumbar arteries after EVAR, with high technical feasibility, few perioperative complications, low mortality among other advantages. The results of short and medium term are satisfactory.
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Objective:To explore the feasibility, safety and effectivity of applying transmesenteric vein extrahepatic portosystemic shunt (TEPS) to treat extrahepatic portal vein obstructive disease (EHPVOD).Methods:From December 2020 to April 2021, 12 patients with EHPVOD in the Vascular Surgery Department of Zhengzhou University People′s Hospital were prospectively enrolled in the study. The infra-umbilical median longitudinal minilaparotomy was performed to expose the branch of superior mesenteric vein (SMV). RUPS-100 was introduced into the trunk of SMV. A balloon with a diameter of 20 mm was introduced through right internal jugular vein (RIJV) into inferior vena cava (IVC). Under fluoroscopy, RUPS-100 was used to puncture the balloon in IVC. A stiff guide wire was used to establish the pathway between RIJV and SMV. Finally the portosystemic shunt between IVC and SMV was established with a covered stent-graft. The total operative time, the time of establishing portosystemic shunt alone, the dosage of contrast agent, the preoperative and postoperative pressure of SMV were recorded. Paired t test was used to compare the preoperative and postoperative pressure of SMV. Results:All 12 patients were successfully performed TEPS. The total operative time was (113±32) min, the time of establishing portosystemic shunt alone was (31±5) min, the dosage of contrast agent was (129±48) ml. The postoperative pressure of SMV [(14.3±2.1) mmHg] decreased significantly ( t=20.125, P<0.01) compared to baseline [(27.8±2.7) mmHg]. All portal hypertension symptoms released after the operations.There was 1 case of delayed incision healing, 1 case of bacteremia and 1 case of slight hepatic encephalopathy, but all of them were cured. There was no death case. Postoperative CT showed all portosystemic shunts were patent. Conclusion:TEPS is a new, safe, effective and feasible treatment method for patients of acute and chronic EHPVOD.
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Objective:To investigate the application of in vitro fenestration endovascular aortic repair(fEVAR) in the juxtarenal abdominal aortic pseudoaneurysm and its up to mid-term results.Methods:The clinical data of 5 cases of juxtarenal abdominal aortic pseudoaneurysm from Oct 2016 to Jul 2019 at the Department of Vascular Surgery, Henan Provincial People′s Hospital was retrospectively analyzed, including therapy options, accesses, techniques of fenestration, bundle of the stent-graft, near to medium-term effects.Results:All patients were treated with fEVAR, the technical success rate was 100%. Stent modify time ranged from 50 to120 minutes, fEVAR time ranged from 75 to 210 minutes. The follow-up period was 15~42 months. All of the stents are in good position, there is no stent-related complications, and no deaths. Primary diseases are well controlled.Conclusion:The treatment for juxtarenal abdominal aortic pseudoaneurysms with fEVAR , as a full-intraluminal method, is of minimal invasion, few perioperative complications, low mortality. Result of up to mid-term follow up is satisfactory.
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Objective:To investigate the safety and efficacy of AngioJet rheolytic thrombectomy (ART) treatment in patients with acute pulmonary embolism (APE).Methods:The clinical data of 21 consecutive APE patients with failed fibrinolytic therapy or fibrinolytic therapy contraindications were reviewed retrospectively, from January 2017 to October 2018 in Henan Provincial people's Hospital. Patients were classified into massive pulmonary embolism (MPE, 10 cases) and sub-massive pulmonary embolism (sMPE, 11 cases) according to the clinical presentation and CT angiography (CTA) results. All the patients were treated with emergency ART. The technical success rate and procedural success rate were calculated based on the angiography results and the occurrence of serious adverse events. The pre- and postoperative parameters including shock index (SI), Miller index (MI), mean pulmonary artery pressure (MPAP) and partial pressure of arterial oxygen (PaO 2) were compared using independent sample t test or Wilcoxon signed ranks test. Results:The technical success rate was 100% (21/21), and the procedural success rate was 71.4%(15/21) with 4 patients presenting severe arrhythmia, 1 patient with intraoperative severe dyspnea and 1 patient with intracranial hemorrhage. Both MPE and sMPE patients showed improvement of clinical symptoms after operation. It showed that the postoperative SI, MI and MPAP values decreased and PaO 2 increased compared with the preoperative values, with significant differences found (all P<0.05). All patients were discharged from hospital, except 1 patients left hospital due to serious illness. The mean follow-up period was (5.3±1.2) months, and 2 MPE patients expired due to cancer and acute myocardial infarction. All survivors didn't show recurrent APE symptoms and follow-up CTA showed no signs of embolism in pulmonary artery. Conclusion:ART can be used safely and effectively in APE patients, and can be prosposed as a new strategy in treatment of APE.
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Objective To discuss the clinical effect of two different routes of thrombolysis for the treatment of acute deep vein thrombosis (DVT).Methods A total of 126 patients with DVT during December 2005 to March 2010 were randomly divided into two groups:(1)transcatheter popliteal vein thrombolysis method (group A);(2)thrombolysis therapy via peripheral vein (group B).The venous patency score and patency improvement were observed by venograms or Duplux.Results After treatment,the reduction rate of edema of leg (0.82?0.14)% and of thigh(0.89?0.07)%,and the venous patency improvement rate (55.41?3.21)% in group A were significantly higer than those in thrombol group B(0.63?0.11)%,(0.57?0.09)%and (32.34?3.77)%,respectively (all P