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Objective:To study the efficacy, feasibility and safety of transjugular intrahepatic portosystemic shunt (TIPS) in treatment of recurrent portal hypertension after splenectomy and devascularization in patients presenting with upper gastrointestinal bleeding.Methods:Cirrhotic patients with recurrent portal hypertension after splenectomy and devascularization and presenting with upper gastrointestinal bleeding from August 2015 to December 2020 were studied. Thirty-nine patients were included in this study. There were 24 males and 15 females, with age of (51.56±9.08) years old. These patients were treated with TIPS by using the Viabahn stent. Intraoperative portal vein pressure, success operative rate, hemostasis rate after surgery, changes in hematological indicators and postoperative efficacy and complication rate were studied.Results:Thirty-eight of 39 patients successfully underwent TIPS shunt and 1 patient failed because of portal vein spongiosis. The success rate was 97.44%(38/39). Thirty-three patients underwent TIPS and variceal vein embolization, while 5 patients were treated with TIPS alone. Thirty-nine Viabahn stents with a diameter of 8 mm were implanted in 38 patients, of which 5 patients had the stent expanded to its nominal diameter of 8 mm. The remaining 33 patients (86.84%) had a shunt with a diameter of 6 mm. The hemostasis rate of postoperative gastrointestinal bleeding was 97.37% (37/38). The portal vein pressure and portal venous pressure gradient decreased from (31.28±6.24), (20.61±5.14) mmHg (1 mmHg=0.133 kPa) to (19.58±4.69), (9.24±3.07) mmHg respectively, the differences were significant (all P<0.001). All patients were followed-up for 3 to 36 months, with a median follow-up of 12 months. The postoperative rebleeding rate was 6.90% (2/29). The incidence of hepatic encephalopathy was 13.79% (4/29), and the incidence of shunt disorder was 13.79% (4/29). Conclusion:TIPS was safe, effective and feasible in treating patients with recurrent portal hypertension after splenectomy and devascularization presenting with upper gastrointestinal bleeding. Most patients obtained good clinical outcomes with a 6 mm diameter shunt.
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Ohjective To evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of sinusoidal obstruction syndrome (SOS) caused by gynura segetum.Methods The clinical data of 9 patients with SOS caused by gynura segetum (5 males and 4 females) who underwent TIPS were retrospectively analyzed from February 2017 to June 2018.The Child-Pugh scores were (9.5 ± 1.3) and the MELD scores were (12.5 ± 5.0).The success rates,complications and follow-up results were evaluated.Results TIPS was performed successfully in all the 9 patients.The portal venous pressure gradient dropped from (22.4 ± 2.7) mmHg to (10.4 ± 3.2) mmHg (P ＜ 0.05).There was no complication such as abdominal hemorrhage and biliary peritonitis.Nine patients were followed-up for 1 ～17months,mean 7.8 ± 6.0 months.One month after treatment,the Child-Pugh scores were (7.1 ± 1.8),compared with that of the preoperative scores,the difference was statistically significant (P ＜ 0.05).The MELD scores were (5.3 ± 4.6),compared with that of the preoperative scores,the difference was also statistically significant (P ＜ 0.05).At the end point of the follow-up,color Doppler ultrasound and portal CTA showed that the TIPS shunt was patent and hepatic congestion was relieved in all the 9 patients.All patients were alive.Conclusion TIPS was a safe and efficacious treatment for SOS caused by gynura segetum.
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Objective To evaluate the safety and efficacy of Viabahn covered stent in treatment of hepatic artery pseudoaneurysm (HAPA) caused by surgery.Methods Clinical data of 7 patients with postoperative massive intra-abdominal hemorrhage and diagnosed as HAPA with emergency angiography were collected from November 2015 to May 2016.All the patients underwent Viabahn covered stent implantation.Perioperative and postoperative clinical data of the patients were recorded,and with 1-month follow-up.Results All the 7 cases were diagnosed as extrahepatic HAPA and successfully completed Viabahn covered stent procedure,and curative rate was up to 100％.One case experienced transient vasospasm in the hepatic artery proximal to the stent.All the patients repeated hepatic artery CT angiography scans one week after surgery,with no evidence of bleeding.With 1-month follow-up,all the patients were in stable conditions.Conclusion Viabahn covered stent is minimally invasive,simple and effective interventional approach for HAPA.
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Objective To study the safety and efficacy of accessory hepatic vein (AHV) stenting to treat primary Budd-Chiari syndrome (BCS).Methods The clinical data of 20 BCS patients with AHV ostial stenosis or occlusion were retrospectively analyzed.These 20 patients underwent balloon dilation and AHV stenting.Thirteen patients underwent AHV stenting via the right jugular vein approach,5 patients via the right femoral vein approach,and 2 patients via the percutaneous transhepatic combined with the right femoral vein approach.On follow-up,patency of the AHV stent was evaluated by color Doppler ultrasound.The cumulative primary and secondary patency rates were assessed with the Kaplan-Meier curves.Results AHV stenting was successful in 20 patients.Angiography showed that the AHV was patent after stenting.The mean pressure gradient between the AHV and the inferior vena cava reduced from (19.2 ± 4.8) cmH2O (1 cmH2O =0.098 kPa) before treatment to (4.5 ± 1.9) cmH2O after treatment (t =7.119,P ＜ 0.01).During the procedure,rupture of the AHV caused by balloon dilation occurred in one patient.This was treated successfully by a covered stent placement.On follow-up from 1 to 80 months [(32.1 ±27.4) months]after treatment for the 20 patients,re-stenosis of the AHV were found in 5 patients.They were treated successfully with re-dilation.The cumulative 1-,3-,and 5-year primary patency rates were 100％,85.1％ and 74.5％,respectively.The cumulative 1-,3-,and 5-year secondary patency rates were 100％,90.9％ and 90.9％,respectively.One patient died of hepatic failure 3 years after the treatment.Conclusion AHV stenting was a safe and efficacious treatment for BCS and it provided good mid-and long-term results.
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Objective To investigate the feasibility,safety and efficiency of the establishment of model for Budd-Chiari syndrome with hepatic vein obstruction through endovascular technology in canine.Methods Twenty four dogs were randomly divided into experimental group (n=18) and control group (n=6).Under the surveillance of digital subtraction angiography,the balloon catheter was sent to the target hepatic vein via right external jugular vein,and then the balloon was filled by contrast agent until the target hepatic vein was blocked completely.In the experimental group,3～5 ml the mixture of N butyl-cyanoacrylate and lipiodol was infused into the target hepatic vein through the end hole of the balloon catheter until the hepatic vein flow stasis was achieved.In the control group,equal volume of normal saline was injected.The changes of liver function,portal vein pressure were measured and pathological varieties of target hepatic vein as well as the liver parenchyma were observed in the different periods in the two groups.Results The successful rate of the technique was 100 percent.There were no serious complications such as pulmonary embolism and death in the two groups.In the experimental group,the serum levels of alanine transpeptidase were (52.5 ± 12.5)U/L,(61.3±5.7)U/L,(38.6±9.4)U/L,which were higher than those in control group(P＜0.05) and prealbuminwere (0.18±0.04)g/L,(0.22±0.02)g/L,(0.19±0.06)g/L,which were lower than those in control group(P＜0.05) in the fourth,sixth and eighth weeks after the procedure,respectively.A common trunk formed by the middle and left hepatic veins which was looked as the targetic hepatic vein were completely occluded.the color of the liver appeared light red,dark red and dull black in the fourth,sixth and eighth weeks after the procedure,respectively.However,the hepatic veins were patented in the control group.In experimental group,histopathological observation revealed hepatic cells congestion and edema while a lot of inflammatory cells were seen in the wall of hepatic vein in the fourth week,the hepatic cells changed with severe edema,adipose kind,inner and middle membranes became thicker in the sixth week,and part of the hepatic cells showed hydropic degeneration,besides,inner and middle membrane became more thicker,there was substantially proliferation in elastic fiber hyperplasia in the eighth week.Conclusion Endovascular technology was a safely and effectively way to establish the canine model of Budd-Chiari syndrome with hepatic vein obstruction.