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Objective To evaluate the diagnostic value of non-invasive imaging modalities to evaluate lower limb arterial disease associated with diabetes.Methods Two hundred and twenty seven patients (292 lower limb arteries) with lower limb arterial disease due to diabetes underwent both DSA and one of the pre-operative imaging modalities including CTA,CE-MRA and DUS were included in this study.The diagnostic consistency of CT angiography(CTA),contrast enhanced magnetic resonance angiography (CE-MRA) and Doppler ultrasonography(DUS) compared with DSA were calculated respectively.CTA was performed in 169 lower limb arteries,while 123 in CE-MRA and DUS in 192.DSA was used as the gold standard.Consistency analysis was performed to evaluate the three imaging modalities with lower limb artery classified as Grade 1,Grade 2 and Grade 3.Results The sensitivity of CTA to evaluate mild stenosis in Grade 1 to Grade 3 was 100％(56/56),97.6％(82/84) and 93.8％(30/32) respectively,while 100％(19/19),94.4％ (34/36)and 61.5％ (8/13) for severe stenosis.The diagnostic accuracy of mild and severe stenosis was 95.9％ (162/169) to 99.4％ (168/169),which showed good consistency with the result of DSA with Kappa value of 0.760 to 0.916,and P＜0.05.The sensitivity of CE-MRA to evaluate mild stenosis in Grade 1 to Grade 3 was 93.2％(68/73),97.2％(103/106) and 93.2％ (69/74)respectively,while 91.3％ (21/23),80.8％ (42/52)and 42.1％ (8/19)for severe stenosis.The diagnostic accuracy of mild and severe stenosis was 86.2％ (106/123) to 96.7％ (119/123),which showed good consistency with the result of DSA with Kappa value of 0.767 to 0.868 and P＜0.05.The sensitivity of DUS to evaluate mild stenosis in Grade 1 to Grade 3 was 89.9％ (62/69),88.8％ (87/98) and 79.2％ (42/53) respectively,while 73.1％ (19/26),84.8％ (39/46) and 44.4％ (8/18) for severe stenosis.The diagnostic accuracy of mild and severe stenosis was 89.7％ (174/194) to 93.8％ (182/194),which showed good consistency with the result of DSA with Kappa value of 0.476 to 0.864 and P＜0.05.Conclusions The non-invasive imaging modalities,namely CTA,CE-MRA and DUS all have good diagnostic consistency compared with DSA.CTA is superior to CE-MRA and DUS in evaluating the severe stenosis of lower limb arterial disease in diabetes patients.
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Objective +o evaluate percutaneous intervetional therapy for portal vein anastomotic occlusion after liver transplantation.Method From July 2005 to July 2013,13 patients (9 male and 4 female; aged 25-65 years) with portal vein occlsion underwent interventional therapy.All patients accepted the imaging examation and 8 patients had typical clinical signs of portal hypertension.Percutaneous hepatic balloon venoplasty and stent placement was performed,trans-catherter urokinase infusion for thrombolysis and embolization for collateral pathways performed if necessary.+echnical success rate,complication rate and clinical symptoms were analyzed.Follow-ups including clinical course,stent patency and potal vein thrombosis which evaluated by imaging were performed.Result +echnical success was achieved in l1of 13 patients (84.6％) and 15 stents were deployed.Seven patients with localized portal vein occulsion accepted balloon dilation and stents deployment,4 patients with long segment cculsion also accept trans-catherter urokinase infusion for thrombolysis and embolization for collateral pathways.Portal vein flow recovered in all 11 patients.Procedure related complication occurred in 2 patient with hemothorax.During the follow-up period of 4-42 months,the clinical signs of portal hypertension were not observed in all patients.Stent stenosis was found in one patient with ultrasound in 23 months,but stent patency was proved by the percutaneous portal angiography.Conclusion Interventional therapy is effective for portal vein occulsion after liver transplantation,comprehensive interventional therapy should be performed in long segment portal vein cculsion.
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ObjectiveTo evaluate the effectiveness of the interventional treatment for portal vein stenosis in patients who had undergone liver transplantation.MethodsFromApr.2004 to Oct.2011,30 patients with portal vein stenosis after liver transplantation were referred for angiographic analysis and interventional treatment. All patients had typical clinical signs and symptoms or surveillance by imaging.After percutaneous transhepatic portography and balloon angioplasty,stents were deployed.Embolization was performed on patients with varices or portal vein flow changes.The therapeutic results were monitored by the follow-up on clinical symptoms,laboratory tests and imaging examinations.ResultsAngiography was performed successfully on all patients.Twenty-four patients received balloon dilation and 26 stents were deployed subsequently.The guide-wire cannot pass through the lesion of portal trunk in 1patient.Four patients received balloon angioplasty only.The technical success rate was 96.7％ (29/30).Stainless steel coils were applied in 7 patients for varices embolization.The complication related to interventional treatment was bleeding in thoracic cavity which happened in 2 patients.Portal vein patency was maintained in all the patients who received interventional treatment for 1-72 months (mean 21.5 months).No re-stenosis was identified.ConclusionInterventional therapy is an effective method for the treatment of portal vein stenosis after liver transplantation and excellent patency can be achieved by this method.
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Objective To evaluate the long-term safety, efficacy and complications of placement vena cava filter in prevention of pulmonary embolism. Methods Seventy-three patients with proven diagnosis of deep venous thrombosis (DVT) and (or) pulmonary embolism (PE) by Doppler ultrasonography, DSA, CT or MRI, received percutaneous inferior vena cava filters (IVCF) from January 1994 to June 2005. The clinical data and imaging findings were evaluated retrospectively. The patients underwent telephone interview or questionnaire, abdominal X-rays, Doppler ultrasonography, computed tomographic pulmonary angiography (CTPA) or indirect CT venography (CTV) after a follow-up duration of 5 months to 11 years. Results Seventy-eight vena cava filters were used. There was 1 case of incomplete filter opening when placing filter. In follow-up, thrombi were trapped in the filter in 2 cases, filter tilting happened in 1 case, and there were no filter migration, filter disruption, filter perforation. Five of 73 cases were lost in follow-up visit, 14 patients died after implantation (5 days to 41 months, average 14.5 months). Among the 54 living patients, the identified recurrent PE was not noted. Three cases of recurrent DVT, 1 case of inferior vena caval thrombosis and 1 case of thrombosed filters were seen in follow- up. Conclusion Inferior veua cava filter is safe and effective for the long-term prevention pulmonary embolism, and the long-term major complications after filter placement are not frequent.