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Objective To evaluate the feasibility,safety and effectiveness of integrated treatmentwith comprehensively interventional techniques for acute deep venous thrombosis(DVT)of lower extremity. Methods During the period from June 2016 to June 2017,a total of 23 patients with acute DVT ofunilateral lower extremity were admitted to authors' hospital to receive integrated treatment. AngioJetthrombectomy,balloon angioplasty and iliac vein stent implantation were performed in the same setting.Angiography was performed immediately after the procedure. If the thrombus clearance rate was grade Ⅲand there were no large free clots(>5mm)in the lower extremity vein and inferior vena cava,the inferiorvena cava filters would be retrieved through their sheath,otherwise,the inferior vena cava filters would bereleased. All patients received continuous transcatheter infusion of urokinase until the thrombosis wasconfirmed to be completely dissolved. The patients were followed up at outpatient clinic at 1,3,6 and 12months after the treatment,and reexamination of color ultrasound and/or lower limb venography was used toassess the blood flow in the deep veins and in the stents. Results Angiography postoperatively showedthrombus clearance rate of grade Ⅲ was obtained in 20 patients(87%)who were successfully accomplishedintegrated treatment. The inferior vena cava filters had been retrieved after thrombolysis in 3 patients(13%)with thrombus clearance rate of grade Ⅱ. Twenty-one stents were implanted directly after thrombectomy in21 patients with iliac vein stenosis. There were no serious complications such as pulmonary embolism,severe hemorrhage,etc. Venous patency was confirmed by color ultrasound or lower limb venography. Conclusion Integrated treatment with comprehensively interventional techniques is feasible,safe,andeffective for acute DVT of lower extremity
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Objective To evaluate the efficacy of transcatheter arterial embolization (TAE) in treating oronasal cavity hemorrhage,and to discuss the the occurrence and prevention of complications.Methods The clinical data of 121 patients with refractory and fatal oronasal cavity hemorrhage,who were admitted to authors' hospital during the period from December 2005 to October 2013 to receive treatment,were retrospectively analyzed.A total of 116 patients were treated with TAE,and these patients were followed up for 1-3 months to evaluate the embolization effect and the occurrence of procedure-related complications was analyzed.Results Of the 116 patients,complete control of bleeding after TAE was achieved in 96 (82.7％),rebleeding within one week after TAE was seen in 19 (16.4％) and the bleeding was controlled by medication,and in the remaining one (0.9％) re-bleeding occurred within one week after TAE and embolization therapy had to be carried out again.No obvious complications occurred in 77 patients (66.4％);maxillofacial pain and numbness,low fever,limitation of mouth opening and other mild complications were observed in 35 patients (30.1％);one patient (0.9％) developed facial skin necrosis and severe headache;and 3 patients (2.6％) showed stroke symptoms due to cerebral embolism.Conclusion For the treatment of refractory and fatal oronasal cavity hemorrhage,TAE can quickly and effectively achieve the purpose of hemostasis;careful selection of proper embolization material based on the the different causes of bleeding and the responsible blood vessels is the key to ensure a successful TAE.The common postoperative complications include postembolization syndrome,local ischemia,local necrosis caused by peripheral ischemia;the main serious complications are skin necrosis of maxillofacial region and cerebral infarction caused by ectopic embolization.
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Objective To evaluate the efficacy and safety of rabbit VX2 liver tumor model by percutaneous intratumoral injection with 188Re labeled stannic sulfur colloid.Methods The VX2 liver tumor model was established in 45 rabbits,which were randomly assigned to 3 groups (n =15) according to material used in intratumoral injections,as follows:0.1 ml normal saline (Group A,control group),absolute ethanol 1ml (Group B),37MBq (1mCi) 188Re labeled stannic sulfur colloid 0.1 ml (Group C).Five rabbits from each group were killed at intervals of 1,4 and 7d after injection and the volume of tumors were measured.Meanwhile,the histopathological changes and extent of cell apoptosis were evaluated.ALT and urea levels before the operation and at intervals of 1,4,7d post injection were also detected.Results In the first day after the injection,there was no significant statistical heterogeneity of the tumor volumes between each group.At 4th day post injection,tumor volumes of group A [(1 873.1 ± 77.3) mm3] showed significant statistical heterogeneity with group B [(905.7 ± 113.3) mm3] and C [(860.2 ± 59.6) mm3] (P ＜0.01),while there were no obvious statistical significance between group B and group C (P =0.421).At 7th day post injection,there were marked statistical significance of tumor volumes between A,B and C groups[respectively,(4093.1 ± 126.5)mm3,[(2569.5 ±64.6)mm3 and (2 169.6 ± 141.9)mm3](P＜0.01).At any time after injection,the apoptosis index (AI) of peritumoral tissue in group B and C was higher than control group with statistical significance (P ＜ 0.001).At 4th day post injection,AI of group C remained higher than group B (P ＜ 0.05).At 7th day,AI of group C progressively decreased,and there were no statistical difference between group B and group C (P ＞ 0.05).Conclusion Percutaneous intratumoral injection of 188Re labeled stannic sulfur colloid is a safety and effective approach to the treatment of VX2 liver tumor in rabbits.
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Objective To study the biodistribution of 188Re-labeled stannic sulfur colloid in rabbit orthotopic VX2 liver cancer model by intratumoral injection and to evaluate its potential for endoradiotherapy.Methods 188Re-labeled stannic sulfur colloid was prepared with direct labeling method.The labeling efficiency and radiochemical purity were measured.Twelve rabbits xenografted by orthotopic VX2 liver cancer were used to determine the biodistribution of 188Re-labeled stannic sulfur colloid.Under CT guidance,37 MBq (0.1 ml) 188Relabeled stannic sulfur colloid was injected directly into the center of the tumor.Four rabbits were sacrificed after gamma imaging at 1,24,48 h post injection.The organ uptake was calculated as ％ID/g,the absorbed dose and T/NT ratio were calculated.One-way analysis of variance was used to analyze the data.Results The labeling efficiency of 188 Re-labeled stannic sulfur colloid was (98.23±0.25)％.The radiochemical purity was (94.23±0.54) ％ at 48 h.The radioactivity essentially accumulated in the tumor area and remained trapped up to 48 h.The radioactivity in other organs was at background level.The T/NT ratios were 88.22± 11.57,32.87±9.13 and 31.65± 10.11 at 1,24 and 48 h post injection respectively,with the corresponding tumor uptakes of (43.318±11.931) ％ID/g,(39.875±9.290) ％ID/g and (37.761±6.849) ％ID/g,which were much higher than those in normal tissues (F=77.350,97.577,417.072,all P＜0.01).Radiation dose to the tumor was (88.12 ± 12.21) Gy.Conclusions 188 Re-labeled stannic sulfur colloid may have a stable distribution at the site of orthotopic VX2 liver cancer after intratumoral injection.Thus it may have potential for the endoradiotherapy of liver cancer.
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Objective To investigate the efficacy and safety of balloon-assisted catheter directed thrombolysis (CDT) for acute lower extremity deep vein thrombosis (DVT).Methods From September 2008 to February 2011,94 patients with acute lower extremity DVT were admitted.The cases in early stage were treated by CDT (Group A,n =50),and the cases in late stage were treated by balloon-assisted CDT ( Group B,n =44).The clinical data of these patients were retrospectively analyzed.The circumference difference between normal and affected limbs,scores of venous patency,and rates of venous patency were recorded for judging the efficacy.The total dose of urokinase and retention time of infusion catheter was compared between the two groups.The incidence of pulmonary embolism and bleeding were used to judge the safety of treatment.The venous patency was followed up by ultrasound or/and venography.Measurement data with normal distribution was described by mean + standard,and was analyzed using T test.Measurement data with non-normal distribution was described by M ( QL,QU ),QL =P25,QU =P75,and was analyzed using Wilcoxon' s test.Categorical variable data was analyzed using Chi-Square test Results The prior treatment circunfference difference between normal and affectéd limbs were (5.37 ±1.97) cm (thigh) & (4.14 ± 1.57) cm (calf) in Group A and (5.41±2.22) cm (thigh) & (4.05 ±1.61) cm (calf) in Group B ; and the difference between the groups was insignificant ( thigh:t =- 0.113,P=0.910; calf:t =0.288,P =0.774).The post treatment correspondences were:(2.96 ± 1.10) cm (thigh) & ( 1.93 ± 0.84 ) cm (calf) in Group A and ( 1.78 ± 1.40) cm ( thigh ) & ( 1.41± 1.17 ) cm (calf) in Group B; the difference between the groups was significant (thigh:t =4.66,P ＜0.0001; calf:t =2.548,P =0.012 ).The prior treatment score of venous patency was 9 (8,10) in Group A and 8.3(7,10) in Group B without significant difference (Z =- 1.5172,P =0.1292).The post treatment score of venous patency was 3.5 ( 2,5 ) in Group A and 0 ( 0,1) in Group B with significant difference ( Z =-5.7702,P ＜0.01).The rate of venous patency after the treatment was 55.0％ (42.3％,72.4％ ) in Group A and 100％ (88.5％,100％ ) in Group B,with significant difference ( Z =4.9148,P ＜ 0.01).The total dose of urokinase used in the treatment was 5.950 ( 5.525,7.225 ) × 106U in Group A and 4.100 (3.600,5.050) × 106U in Group B with significant difference (Z =-6.0133,P ＜ 0.01).The retention time of perfusion catheter was 10 (9,12) d in Group A and 6 (5,7) d in Group B with significant difference ( Z =- 8.0358,P ＜ 0.01).No symptomatic pulmonary embolism occurred in both groups during the treatment and follow-up period.The rate of bleeding complication was 38.0％ (19/50) in Group A and 22.3％ (10/44) in Group B,without significant difference (x2 =2.5590,P =0.1097 ).The removal rate of optional filter was 88.37％ (38/43) in Group A and 100％ (39/39) in Group B,with significant difference ( x2 =4.829,P =0.028 ).The rate of venous patency at the last follow-up point was 50.0％ (44.4％,59.2％ ) in Group A,and 95.4％ (83.6％,100％ ) in Group B,with significant difference (Z =- 3.2721,P =0.0011).Conclusions Balloon-assisted CDT was a promising treatment for acute lower-extremity DVT.It improved the effect of thrombolysis and reduced the dosage of urokinase,and did not increase the risk of pulmonary embolism.
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Objective To establish VX2 hepatic carcinoma model in rabbits by implanting the tumor fragment into the liver through percutaneous puncture under ultrasound guidance and to observe its growing and metastatic characteristics, to determine the optimal time for interventional experiment study with the model. Methods Inoculation of VX2 carcinoma fragment was performed in 28 New Zealand white rabbits. PET/CT and ultrasonography (US) examinations were carried out in the second, third and forth week after the inoculation, and each time two tumor-bearing rabbits were sacrificed for pathologic study. Results The successful rate of model establishment was 89.28% (25/28). On PET or CT scans, single lesion in the liver was demonstrated in 25 rabbits. Two, three and four weeks after the inoculation, the maximum diameter of the tumor was (4.82±0.80) mm, (16.05±2.89) mm and (30.08±5.38) mm respectively, while the metastasis rates was 0% (0/25), 13.04% (3/23), 76.19% (16/21) respectively. No significant necrosis was found in the second week after inoculation, only tiny coagulation necrosis was revealed in the third week, and massive necrosis was seen in the forth week. Conclusion Percutaneous inoculation of the tumor fragment into the liver under ultrasonographic guidance is a simple method to establish VX2 hepatic carcinoma in rabbits with a high successful rate. The third week after inoculation is the suitable time for making interventional experiment study.
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Objective To study the clinical appilication of detachable balloon embolization techenique in carotid cavernous fistula. Methods 27 cases consisted of 26 cases of typical TCCF and 1 case of CCF caused by left anterio cerebral artery(A1) aneurysm ruptured . 27 cases were treated by endovascular embolization with detachable balloon. Transcranial Doppler ultrasound(TCD) was used before and after embolization.All the patients were followed-up for more than 6 months. Results 22 cases of TCCF were cured by detachable embolization and their internal carotid artery(ICA) remained patent. The first segement of left anteriol cerebral artery was embolized by two detachable balloons in the patient with CCF caused by ruptured aneurysm. Internal carotid artery was embolized by two balloons in 4 cases. There was no severe complication in this group. Conclusions Detachable balloon embolization is a safe and effective method for internal carotid cavernous fistula.
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Objective By analysing the relation between the proportion of NBCA and the arteriovenous circulation time will give the optimal proportion of NBCA for embolizing cerebral AVM with microcatheter clinically.Methods (1) The fresh aterial blood fractions from intracranial hemorrhage in vitro of 16 cases were mixed with the 20%、33%、50%、70% and 80% NBCA respectively and evaluated the coagulation times with the different densities of NBCA in the fresh aterial blood in vitro; (2) two cases were performed with superselective embolotherapy to five feeding arteri. Results (1) the correlation index between different densities of NBCA and the fresh areterial blood in vitro , T (c) =e 1.9994-1.487D , (2) about 90% nidus of AVM were occluded after embolization, and the fistulas of AVF were basically closed after embolization.Conclusions There is a mathematical model between the arteriovenous circulation time and the proportion of NBCA, thus providing the theoretical clinical application of the embolotherapy of CAVM with microcatheter.
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Objective To evaluate preoperative embolization therapy in deep oral cavity tumor.Methods Superselective embolization of tumor-feeding artery branched from external carotid artery with gelfoam by Seldinger technique was carried in 18 cases with oral cavity tumor.Results After preoperative embolization,hemorrhage and complication rate during operation were markedly reduced.The respectable rate of the tumor was increased.Conclusion Preoperative superselective external carotid artery branch embolization is useful and simple,which makes the subsequent surgery in deep oral cavity tumor more safe and effective.