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ObjectiveTo explore the methods and effectiveness of interventional revascularization of complex arteriosclerosis obliterans (ASO)of lower extremity arteries according to their imaging characteristics.Methods Seventy-eight patients with lower extremity ASO complex lesions classified as TASC Ⅱ C/D ( n =68 ) and TASC Ⅱ B ( n =10) underwent antigrade or combined antigrade-retrograde subintimal angioplasty.Their clinical situations were Fontaine stage Ⅲ/Ⅳ or severe stage Ⅱ.All the long occlusion,flush occlusion,multiple occlusion,popliteal artery occlusion,below knee artery occlusion and aortoiliac artery occlusion were identified as complex lesion imaging features and as the indication of interventional treatment if only there were visible outflow vessels and suitable puncture site.Statistical analysis was used to compare ankle-brachial index (ABI) pretreatment and post-treatment by t test.Results Successful revascularization was achieved in 73 patients technically.No obvious complications occurred.Ischemia symptoms improved quickly after accomplishment of recanalization.Average ABI increased from 0.45 ±0.07 to 0.76 ±0.11 after the treatment(t =- 19.78,P ＜0.01 ).Symptoms in 5 patients who failed to get arterial recanalization were stable.Follow up of 6 to 12 months in 47 patients showed stable improvement in 22 of them.Conclusion It is more practical to choose and expand application of interventional treatment for complex ASO according to imaging characteristics of lesions than according to TASC classification.
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Objective To investigate the value of percutaneous transsplenic varices embolization (PTSVE) for treatment of upper gastrointestinal bleeding. Methods Twenty cases with liver cirrhosis and portal hypertension suffered upper gastrointestinal bleeding. PTSVE was administered to them with hardener and coils. Among them, 8 cases had massive hepatocellular carcinoma (HCC) in right lobe; 10 cases with hepatocellular carcinoma had portal vein tumor thrombus and occlusion; the other two cases with liver cirrhosis had portal vein thrombosis. All of these cases were not suitable for percutaneous transhepatic varices embolization (PTHVE) . PTSVE was performed under the guidance of fluoroscopy. Results Technical success was achieved in 18 patients. A total of 35 gastric coronary veins were embolized. In all these cases, upper gastrointestinal bleeding stopped after PTSVE. There was no recurrence within 1 month follow-up. No serious complication occurred. Conclusion PTSVE is a safe and efficient alternative treatment for upper gastrointestinal bleeding, especially for cases with portal vein occlusion or with massive HCC in right lobe of liver.
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Objective To discuss the therapeutic efficacy of bidirectional subintimal angioplasty in the treatment of atherosclerotic occlusive of lower limbs.Methods Five patients with long segment of obstructed artery in lower limb were enrolled in the study.Of five patients,occlusion of the lower segment of abdominal aorta and bilateral iliac artery was seen in one,occlusion of iliac artery in 2 and occlusion of superficial femoral artery in the remaining two.Antegrade subintimal angioplasty procedure was unsuccessful in all five patients as the wire could not be placed into the true lumen,so retrograde subintimal angioplasty by puncturing the distal segment of the occlusive artery was employed.Through the newly created channel the retrograde guide wire was manipulated to be pulled out of vessel through the antegrade catheter.The subintimal tract was dilated with angioplasty balloon and the stent implantation was performed.Results Bidirectional subintimal angioplasty was successfully accomplished in all five patients,with a total of nine stents being implanted.Conclusion Bidirectional subintimal angioplasty is a safe and effective procedure for bringing the subintimal recanalization to success,this technique can be regarded as a remedial measure when unidirectional subintimal angioplasty ends up in failure.
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Objective To investigate the diagnostic value of DSA for micro hepatocelluar carcinoma(MHCC)in patients with hepatic cirrhosis. Methods Three hundred and fourty cases of hepatic cirrhosis who were going to receive bone marrow stem cells transplantation via hepatic artery underwent hepatic arterial DSA. No definite evidence of hepatoma had been found during the former CT scan and ultrasound test in these patients. Multi-angle projection DSA was performed to display the characteristics of MHCC and super-selective TACE treatment was given in cases of the diagnosed MHCC. Results MHCC were found by DSA in 20 cases who were all of post-hepatitis B cirrhosis and with single-lesion of sized 0.4 - 1.0 cm. DSA showed the characteristics of nodular stains in early or middle arterial phase in angiography. 18 lesions were in the right lobe and 2 in the left lobe. AFP were negative in 16 cases and positive in 4 cases. Super-selective segmental TACE were performed with micro catheter system for the treatment. Conclusions DSA is more sensitive to detect MHCC in the patients with hepatic cirrhosis, comparing with regular contrasted CT scan or ultrasound.
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Objective To evaluate the method and result of thyroid artery embolization as a new therapy for hyperthyroidism. Methods Twenty two patients with hyperthyroidism underwent selective thyroid artery embolization. Totally 52 thyroid arteries were embolized with microspheres. The indications to this therapy were following: hyperthyroid patients having indications to surgical and 131 I therapy, clinically being difficult to complete the preparation for subtotal thyroidectomy and having high risk for surgical process because of their huge thyroid gland. Results Serum level of thyroid hormones dropped significantly [median T3 from 8 8 nmol/L(4 3～ 43 0 nmol/L) to 4 0 nmol/L(1 1～9 2 nmol/L), median T4 from 206 4 nmol/L(77 4～748 2 nmol/L) to 144 5 nmol/L(25 8～279 9 nmol/L), P
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Objective To explore the feasibility and proper technique of subintimal racanalization in treating chronic aorto-iliac artery occlusion. Methods Subintimal racanalization via right brachial artery access was performed in a 57-years-old man with chronic total occlusion of aorto-iliac artery. Subintimal pathways were created with two hydrophilic guidwires (Teromo), which were inserted into the subintimal space from the occluded end of the abdominal aorta and got into the right and left external iliac arteries separately. Subintimal arterial flossing with antegrade-retrograde intervention was employed in left side to overcome the difficulty in reentering the true lumen. The exchange guidwires were conducted out of the femoral artery puncture sites on both sides in sequence, in this way the bilateral femoral pathways were established. Aorto-iliac artery balloon angioplasty and retrograde stent implantation, including one aortal and 5 iliac stents, were carried out by kissing technique from the femoral site. Results The aorto-iliac artery lumen was successfully reopened after the procedure. The internal lumen shape of the stents was satisfactory and the blood flow was unobstructed. The ischemic symptoms of the lower extremities disappeared completely. The ankle brachial index (ABI) rose from 0.32 to 0.96, and the condition remained stable in a follow-up period of 10 months. Conclusion Subintimal racanalization therapy is practical and safe for treating total aorto-iliac artery occlusion, especially for the patients with chronic arterial sclerosis.
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Objective To evaluate interventional techniques for the treatment of visceral aneurysms. Methods A total of 11 aneurysms were found in 9 patients with visceral aneurysms who received interventional treatment. Of the 9 patients, single aneurysm at both superior mesenteric artery (SMA) and right colonic artery was seen in one, 2 aneurysms at same splenic artery in one, one aneurysm at splenic artery in 5, aneurysm at right gastric artery in one and pseudoaneurysm at hepatic artery in one. In 9 patients the transcatheter endovascular coil embolization was successfully carried out for 10 aneurysms, including splenic (n = 7), right colonic artery (n = 1), right gastric artery (n = 1) and hepatic pseudoaneurysm (n = 1). One stent-graft was used for the SMA aneurysm. Results Technical success was achieved in all cases without any serious complications. Conclusion Interventional embolization with coils can successfully occlude most visceral aneurysms, while stent-graft should be used when the aneurysm is difficult to be occluded with coil.
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Objective To explore the application of non-breathholding photography technology in angiography. Methods 183 cases with abdominal and thoracic DSA examination were separated into non-breathholding experimental group and conventional breath-hold control group in proper order. The experimental group collected images in natural breathing and the conventional group gained images after inspiratory breathholding in imaging process. The images of two groups were adjusted by the post-processing functions and were print film; the quality of the images was evaluated. Results In the chest experimental group(n =37) had 36cases(97.30% )satisfactory and 1 case(2.70% ) unsatisfactory, and the control group(n=36)had 32cases(88.89%) satisfactory and 4 (11.11%) unsatisfactory. In the abdominal experimental group(n=55) had 53 cases(96.36%) satisfactory and 2 cases(3.64%) unsatisfactory images, and the control group(n=55) had 49 cases(89.09%) satisfactory and 6cases(10.91%) unsatisfactory images. There is no significant difference of the image quality between the two groups in each part (chest part ?2=2.02, 0.1