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Objective To present a preliminary latest procedure for portal hypertension and evaluate the technical feasibility and efficacy of portacaval shunt creation through the percutaneous transhepatic approach in order to make a hemodynamic comparison with that of the classic TIPS.Methods Thirty-eight patients with portal hypertension(36 men;mean age 57 years,range 32～73)were referred for PTPS procedure because of bleeding varices(n=36),intractable ascites(n=1),and hepatopulmonary syndrome(n=1).The severity of liver disease was classified as Child-Pugh B in 27 and C in 11.The PTPS was created by a percutaneous transhepatic puncture into right portal vein and then through left portal vein to the hepatic segment of IVC followed by a prefabrication stress stent-graft placement at the very site.Results Technical and functional success of 100% was achieved in all patients,without related complications.The postprocedural portal vein-IVC gradients mean 13 cmH_2O was achieved with the follow-up period mean 493 days.No recurrence of variceal bleeding and controlled refractory ascites were achieved,and still more with primary patency rate of the involved vascular structure up to 94.8% at 365 days,much better than classic TIPS. Conclusions Portacaval shunt creation using the prefabrication stress stent via percutaneous transhepatic technique is safe and feasible.The compact coincidence was obtained between the stent and the involved vessel with restoration of intrahepatic portal venous bemodynamics together with partial lowering of portal venous pressure and guaranteeing intrahepatic perfusion through right portal vein.It is also obviously to have postoperative prevention of shunt restenoses and lowering postoperative incidence of hepato-encephalopathy.
ABSTRACT
<p><b>OBJECTIVE</b>To explore a better procedure for transjugular intrahepatic portosystemic shunt (TIPS) in order to improve its safety and to extend its indications.</p><p><b>METHODS</b>To puncture the right portal branch under sonographic guidance in 20 patients with portal hypertension and gastro-esophageal bleeding. The Teflon sheath with gold marker was put into the portal vein; anterior and lateral portography was made, portal pressure was measured and the gastric coronal vein was embolized. The gold marker was put into the portal vein puncture site and the Rups-100 was guided under the gold marker during the TIPS puncture procedure. Anterior and lateral portography was again made to make sure the puncture site was 2 cm away from the portal vein bifurcation. In some cases a 10F sheath was used to suck the thrombosis in the portal vein, and a balloon was used to dilate the parenchyma channel and then a stent was released smoothly.</p><p><b>RESULTS</b>20 reformed TIPS were successfully performed on all patients and their gastric-esophageal bleedings were controlled immediately. 37 punctures were made in 20 of those cases; the average puncture per patient was 1.85+/-0.67, lower than that of the traditional method. The pressure of the portal vein declined from (30.5+/-1.1) mmHg to (16.9+/-0.9) mmHg, P < 0.05, showing that the difference of portal vein pressure before and after the reformed TIPS was significant. 25 stents were placed, and no complications occurred during the procedure in any of the cases.</p><p><b>CONCLUSION</b>Direct portal vein puncture portography and gold marker guided TIPS procedure is feasible and safe; the indications of TIPS could be further extended.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Esophageal and Gastric Varices , General Surgery , Gastrointestinal Hemorrhage , General Surgery , Hypertension, Portal , General Surgery , Portasystemic Shunt, Surgical , Methods , PortographyABSTRACT
Objective To investigate the imaging findings of pelvic lipomatosis in 4 cases with clinical correlation.Methods The imaging data of 4 cases with pelvic lipomatosis proved clinically and pathologically were retrospectively analyzed.CT scan,intravenous urography(IVU)or cystography were performed in all cases.MRI was done in one case,barium enema in one case and urinary cystoscopy in 3 cases.Results Hyperlucent areas in the pelvis("transparent pelvis"sign)were demonstrated on plain X-ray film,CT,IVU and barium enema studies.IVU showed bilateral hydronephrosis,stenosis of lower segment of ureter and dilatation of proximal ureter.The bladder was elevated,simulating an inverted pear. Barium enema study revealed that the rectum and the sigmoid colon were pushed laterally and upwards. Three cases had associated with cystitis cystica by pathology.Conclusion The imaging findings of pelvic lipomatosis,together with clinical information,are helpful to establish the diagnosis.