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Objective To summarize the experience in the diagnosis and treatment of symptomatic splanchnic artery dissection. Methods A total of 21 patients with symptomatic splanchnic artery dissection, who were admitted to the Affiliated First Hospital of China Medical University during the period from June 2006 to March 2014, were included in this study. Combined with the literature, the clinical data, including the diagnosis and treatment, were analyzed. Results Contrast-enhanced abdominal CT and CT angiography revealed superior mesenteric artery dissection in 15 cases, celiac artery dissection in 5 cases and splenic artery dissection in one case. Conservative therapy was employed in 5 patients; among them one was complicated with hepatic artery thrombosis. Of the 16 patients who received endovascular stent placement, additional intestinal resection was performed in 2 and transcatheter thrombolysis treatment in other 2. No procedure-related severe complications occurred in perioperative period. All the patients were followed up for 2-74 months (mean of 19.1 months). In patients who received endovascular stent placement, the abdominal pain and the bloody stool were relieved or disappeared, and no abdominal pain recurred. CT angiography showed that in-stent blood flow was fluent, the stent was in good position, and neither stenosis nor thrombosis was observed. One patient with superior mesenteric artery dissection died of stroke three months after the treatment. Conclusion It is very important to make early diagnosis and to adopt early treatment for symptomatic splanchnic artery dissection. CT angiography can confirm the diagnosis in most cases, but attention should be paid to some atypical manifestations. For the treatment of splanchnic artery dissection, endovascular stent placement is mini-invasive, safe and reliable.
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Objective To evaluate the safety and effectiveness of treating the endovascular stents placement for spontaneous isolated dissection of splanchnic artery ( SIDSA).Methods Sixteen consecutive patients with diagnosis of SIDSA through CTA and DSA were retrospectively analyzed .All patients had acute persistent abdominal pain and treated by endovascular stents placement.The serious complications and symptoms improvement were reviewed after the operation.The symptoms recurrence and repeated color doppler ultrasonography and CTA were also reviewed in the follow up.Results Twelve superior mesenteric artery ( SMA) dissection and four celiac artery ( CA) dissection were diagnosed among sixteen patients.The dissection length was 1.07 to 11.87 cm and the median length was 3.93 cm.The distance from the original dissection to the orifice of superior mesenteric artery or celiac artery was 0.50 to 6.44 cm and the median was 1.98 cm.Eight stent-grafts and 3 bare stents were successfully implanted in 11 patients.One case with celiac dissection was failed to treat because of the severe compression of true lumen and the guide wire cann′t cannulate to the distal true lumen.Four patients with superior mesenteric artery dissection gave up interventional therapy , Among these 4 patients , 2 patients had small tear site and small false lumen , 1 patient had extremely long dissection , and one case had blood supply of target organs from both true and false lumen.No severe complications such as hemorrhage , intestinal necrosis , hepatic failure and splenic necrosis occurred during the eleven successful endovascular interventions.The abdominal pain in 10 cases was disappeared or significantly relieved , 1 case with superior mesenteric vein thrombosis and severe intestinal ischemia before intervention underwent intestinal resection for necrosis.The follow up period was 1 to 74 months in eleven successful cases , and the median follow-up period was 16 months.One patient with SMA dissection after endovascular treatment was died of sudden stroke three months later .Others had satisfactory outcome and the repeated color doppler ultrasonography and CTA were normal .Conclusions Endovascular stents placement is a safe and effective therapy for symptomatic spontaneous isolated dissection of splanchnic artery.
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Objective To evaluate the technique and result of endovascular treatment for right subclavian artery stenosis or occlusion.Methods Seventeen patients [13 males,4 females ; (56 ± 11)years old] with right subclavian artery stenosis or occlusion were treated with endovascular surgery which included recanalization,balloon angioplasty and stenting via femoral or brachial artery route.Cerebral protection devices were used in 6 cases to avoid cerebral embolism.Results Sixteen of the seventeen patients acquired successful recanalization in 8 cases with subclavian artery stenosis (100％ technical success rate) and in other 8 cases with subclavian artery occlusion (88.9％ technical success rate).Five cases were treated with balloon angioplasty,and 11 cases were treated with balloon angioplasty combined with stenting.Good patency was seen in the 16 cases immediately after the procedure.The cerebral protection devices prevented all the cases from cerebral embolism and were retrieved suceessfully.Sixteen cases were followed up from 1 to 66 months [mean (24 ± 18) months].Restenosis was found in one case 10 months later and was successfully treated with re-PTA.One case with aortoarteritis died of cerebral infarction 18 months later.No symptom recurrence was found in other cases and ultrasound or CTA of followup showed excellent patency.Conclusions Balloon angioplasty and stenting are safe and effective for the treatment of right subclavian artery occlusion.
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Objective To compare the clinical efficacy between covered stent and uncovered stent in transjuglar in-trahepatic portosystemic shunt (TIPS) .Methods Thirty patients with liver cirrhosis (portal hypertension), who received TIPS, were retrospectively studied.All patients were divided into two groups covered-stent group(n =20) and uncovered-stent group (n=10).For each patient, portal pressure was measured before and after operation, and the patency of shunt was evaluated by color Doppler ultrasound after operation.The mortality, recurrent bleeding rate and incidence of hepatic encephalopathy were analyzed by Fisher exact probability test.Results The TIPS treatment was successful in all patients, the portal pressure in the covered-stent group reduced from (3.78±0.50) kPa before operation to (2.21±0.44) kPa and that of the uncovered-stent group reduced from (3.67±0.48) kPa to (2.13±0.35) kPa.Twenty-six cases were postoperatively followed-up (17 cases in covered-stent group, 9 cases in uncovered-stent group).The follow-up period varied from 7 days to 62 months (median follow-up period was 23 months).Thirteen patients died of upper gastrointestinal bleeding and hepatic failure.The difference of mortality between covered-stent group (8/17) and uncovered-stent group (5/9) did not reach significant (P>0.05).The recurrent bleeding rate between the covered-stent group (5/17) and the uncovered-stent group (3/9) was not different too (P>0.05).The incidence of hepatic encephalopathy in the covered-stent group (4/17) was not different from that of the uncovered-stent group (2/9) (P> 0.05).The patency rates of 6 months and 12 months reached 100% in the covered-stent group, which were higher than those in the uncovered- stent group 77.8% (7/9) and 55.6% (5/9) (P<0.05) .Conclusions The patency rate of shunt at 12 months after TIPS was higher in the covered-stent group than the uncovered-stent group, while the mortality, recurrent bleeding rate and incidence of hepatic encephalopathy were not significantly different between the two groups.
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Objective To assess the clinical efficacy of fluoroscopically-guided percutaneous cholecystostomy in the treatment of severe acute cholecystitis and to summarize the experience in clinical practice. Methods During the period of Jan. 2006 -Dec. 2008,fluoroscopically-guided percutaneous cholecystostomy was performed in 31 patients with severe acute cholecystitis. The therapeutic results were evaluated by comparing the pre-operative and post-operative laboratory findings and clinical manifestations. Results The procedure of puncture and drainage-tube placement was successfully accomplished in all 31 cases without any complications. One patient with acute renal failure died after the procedure,the remaining 30 patients showed obvious alleviation of symptoms and were discharged with retention of the indwelling drainage-tube. Selective cholecystectomy was carried out in 16 patients with lithic cholecystitis in 1-3 months after percutaneous cholecystostomy. Living with retention of indwelling drainage-tube was chosen by eight patients with lithic cholecystitis. The drainage-tube was extracted in 6 patients with non-lithic cholecystitis in 3-6 weeks after the cholecystitis was cured. Conclusion Fluoroscopically-guided percutaneous cholecystostomy is technically-simple,minimally-invasive and highly-safe treatment for severe acute cholecystitis,it may be regarded as an effective transitive,or even permanent therapy.
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Objective To evaluate the clinical results of transjugular intrahepatic portosystemic shunt(TIPS)creation with 8 mm diameter covered stent-graft. Methods Ninteen concecutive patients with portal hypertension underwent TIPS creation with 8 mm diameter covered stent-graft for variceal bleeding and/or refractory ascites. Evaluation of the results through observing the improvement of clinical symptom and periodic follow up was carried out. Results Technical success achieved in all patients reaching 100% without related complications. Median follow-up was 13.5 months(ranged, 2.7 - 28 months). One case(1/19,5.3%)showed aggravation of hepatoencephalopathy and 2 others(2/19, 10.5%)revealed rebleeding. The primary patency rate was 100%(16/16)after 6 months, and 87.5%(7/8)after 12 months. Improvement or resolved rate of ascites was 66.7% (12/18). Conclusion TIPS creation with 8 mm diameter covered stent-graft can degrade the incidence of hepatic encephalopathy, improve the rate of TIPS patency and keeping the effective shunt flow.