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Objective:To evaluate the feasibility, safety, treatment outcome, and the individualized surgical procedure selection of the interventional treatments of chylous leakage.Methods:From July 2019 to January 2022, the clinical data of 60 consecutive patients with chylous leakage underwent interventional treatment were respectively analyzed. The cases included chylothorax ( n=37), chylous ascites ( n=10), chyluria ( n=4), chylothorax combined with chylous ascites ( n=5), chylothorax combined with chylopericardium ( n=2), and pelvic chylous effusion ( n=2). Conservative treatment was considered to have failed for all patients. The lymphangiography was firstly performed to detect chylous leakage, then an individualized procedure was selected according to the lymphangiography results. The treatment outcomes and complications were recorded, and follow-up was performed. Results:Lymphangiography was technically successful in 55 of 60 patients (91.7%), and no cisterna chyli and thoracic duct opacification was observed in 5 patients. The procedures for the patients included lymphangiography alone ( n=23), thoracic duct embolization ( n=23), thoracic duct disruption ( n=5), lymphatic embolization for pelvic chylous effusion ( n=4), and balloon plasty for thoracic duct ( n=5). Clinical success was achieved in 53 of 60 cases (88.3%). The complication rate was 8.3% (5/60), and all complications were minor. The median follow-up time was 11 months (range 0.5-30 months) for 56 patients, and 4 patients were lost to follow-up. There was one patient presenting the reoccurrence of symptom, and 8 patients died. Conclusions:The interventional treatment of chylous leakage is safe with good outcomes and low complication rate. Individualized treatment procedures based on the lymphangiography findings is feasible and with good curative effect.
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Chyluria is characterized by the presence of chyle in the urine. The most common cause of non-parasitic chyluria is the upstream obstruction of the thoracic duct and reflux of the chyle into the renal collecting system. Traditional treatments include dietary modifications and surgery. The recently developed new interventional technique to treat chyluria. Here, we firstly reported one case of chyluria caused by thoracic duct obstruction in China, which was successful treated with intranodal lymphangiography combined by percutaneous balloon plasty. The symptoms of chyluria were completely relieved after our operation, which provides a minimally invasive, safe and effective method for patients with ineffective chyluria after conservative treatment or surgery.
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Objective:To explore the safety and efficacy of Castor branched stent-graft exclusion in the treatment of aortic dissection and aneurysm involving left subclavian artery.Methods:The clinical and imaging data of 88 patients with aortic dissection or aneurysm involving left subclavian artery diagnosed by CTA or DSA in our hospital from December 2017 to December 2019 were collected retrospectively, including 67 aorta dissections, 7 thoracic aortic aneurysms and 14 aorta penetrating ulcer. All patients were treated with branched stent-graft under the guidance of DSA. The postoperative curative effect and complications were observed. The paired t test was used to compare the maximum aortic diameter of the lesion before and 6 months after the operation. Results:Eighty-eight patients were successfully treated with integrated stent, the success rate of operation was 100%, and the disease-related symptoms of all patients were basically or completely relieved. The mortality rate within 1 month after the operation was 2.7% (2/88). The two deaths were complicated with other serious diseases before the operation, and the cause of death was not related the operation. All patients were followed up except 4 patients who lost contact after discharge. During the follow-up, there were 1 case of retrograde type A dissection, 1 case of new aneurysm of aortic arch, 2 cases of in-stent stenosis of left subclavian artery branch, 3 cases of mild stroke, no persistent endoleak and no death or other serious complications. The mean maximum aortic diameter at 6 months after operation [(34±4)mm] was significantly lower than that before operation [(38±6 mm)] ( t=6.63, P<0.05). Conclusion:Castor branched stent-graft is simple, mini-invasive and effective in the treatment of aortic dissection and aneurysms involving the left subclavian artery.
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Objective:To evaluate the safety and feasibility of intranodal lymphangiography combined thoracic duct embolization in the treatment of chylous leakage.Methods:The clinical data of ten patients with chylous leakage from July to December 2019 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. There were 6 cases of chylothorax, 1 case of chylous ascites, and 3 cases of chylothorax combined with chylous ascites, respectively. Conservative treatment was invalid in all cases. The locations of cisterna chyli and thoracic duct were defined by percutaneous puncture intranodal lymphangiography. Then the percutaneous transabdominal puncture of cisterna chyli was performed and the microcatheter was inducted. The location of fistula was visualized by thoracic duct lymphangiography, and the embolization was performed by microcoils combined tissue adhesive agents. The post-operative curative effect and complications were recorded.Results:One patient did not receive thoracic duct embolization because it was failed to visualize cisterna chyli by intranodal lymphatic angiography; thoracic duct embolization was successfully performed in the other 9 patients after chylous leakage fistula was located. Percutaneous transabdominal puncture of cisterna chyli was successfully accomplished in 8 patients. As for the other patient, after repeated failure of puncture, fluoroscopy-guided retrograde puncture at the proximal thoracic duct was performed successfully. After the operation, the drain output was completely disappeared within 3 to 7 days in 8 patients, and decreased down to 120 ml/d in 1 patient. Mild abdominal hemorrhage was found in 1 patient after thoracic duct embolization, without any treatment. No serious complications was found in all cases.Conclusion:Intranodal lymphangiography and thoracic catheter embolization is safe and effective in the treatment of chylous leakage, with a low complication rate.
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Objective To evaluate the therapeutic efficacy of agitating thrombolysis technique for Budd-Chiari syndrome complicated with inferior vena cava (IVC) fresh thrombus. Methods From August 2004 to March 2009, 5 patients of Budd-Chiari syndrome (four males and one female, aged 36-48 years) with IVC fresh thrombus were treated with agitating thrombolysis technique. After anpography of IVC the recanalization of IVC was performed, which was followed by agitating thrombolytic therapy. Finally,IVC was dilated with percutaneous transluminal balloon angioplasty. Clinical follow-up of IVC patency was conducted by color Doppler sonography. Results After agitating thrombolysis. The thrombi were completely disappeared in all 5 patients without single occurrence of pulmonary embolism. In all patients, IVC remained patency on color Doppler ultrasonograph after following up for a mean period of 23.8 months. Conclusion Agitating thrombolysis technique is a safe and effective treatment for Budd-Chiari syndrome complicated with IVC fresh thrombus.
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Objective To investigate the distribution of the obstructive lesion of hepatic vein and inferior cava vein in patients with Budd-Chiari syndrome in Henan Province of China.Methods A total of 231 cases with Budd-Chiari syndrome were diagnosed by combination of three imaging techniques which either included colour Dopple ultrasound,multislice CT and vasography or colour Dopple ultrasound,MR angiography and vasography.All the hepatic veins,accessory hepatic veins and inferior vena cavae were imaged and their obstructions were detected and analysed.Results Out of the 231 patients there were 5 cases(2.2%)with simple obstruction of inferior vena cava with normal hepatic branches.Thirty-three cases(14.3%)had simple hepatic vein obstruction with normal inferior vena cava.The remaining 193(83.5%)cases had vein obstruction both in hepatic vein and inferior vena cava.Conclusion The most frequent form of Budd-Chiari symdrome in Henan province of China is the complex obstruction of inferior vena cava and heptic vein,and simple obstruction of inferior vena cava occurs the least.
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Objective To investigate the feasibility and therapeutic effect of stenting therapy by using modified Y-shaped self-expandable metal stent for the stenosis of gastroenteric stoma. Methods According to the particular anatomic structures and the pathological features of the narrowed gastroenteric stoma,the authors designed a modified Y-shaped self-expandable metal stent. Under the fluoroscopic guidance,implantation of modified Y-shaped self-expandable metal stent was performed in 5 patients with narrowed gastroenteric stoma. The technical safety and the clinical results were evaluated. Results The modified Y-shaped self-expandable metal stent was successfully implanted with one procedure in all five patients. After the implantation the symptoms such as nausea,vomiting,abdominal distension were promptly relieved,and the patients' living quality was markedly improved. Conclusion The stenting therapy with modified Y-shaped self-expandable metal stent can rapidly relieve the stenosis of gastroenteric stoma once for all. The technique is feasible and the short-term effect is reliable,therefore,it is worth popularizing this therapy in clinical practice.
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Objective To investigate the mid-term efficacy of retrievable stent filter placement for the treatment of Budd-Chiari syndrome (BCS) complicated with inferior vena cava (IVC) thrombosis. Methods Eight patients of BCS complicated with IVC thrombosis were enrolled in this study. IVC thrombosis included segmental occlusion (n = 2) and membranous occlusion (n = 6). In all patients, the IVC was re-canalized by using blunt wire after anticoagulation and thrombolytic therapy, then, the re-canalized site was expanded with small balloon, which was followed by the placement of retrievable stent filter, and, finally, IVC size was dilated with larger balloon. Anticoagulation and thrombolytic therapy was given after the procedure. And all the retrievable stent filters were withdrawn from the IVC through internal jugular vein when the thrombus in IVC was dissolved. In patients with segmental occlusion of IVC, in addition to the placement of retrievable stent filter a "Z" type vessel stent was also placed during the same interventional session. Follow-up examination with color Doppler sonography was conducted in all patients. Results Technical success was achieved in all 8 patients without pulmonary infarction or other complications both during and after the operation. Immediately after the thrombus completely disappeared, the retrievable stent filter was successfully taken out in all patients. During a following-up period of 3-12 months, color Doppler sonographs showed that the IVC remained patent in 6 patients and had a recurrence of stenosis in 2 patients. Conclusion Placement of retrievable stent filter is a safe and effective treatment for BCS complicated with IVC thrombosis.
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Objective To evaluate the feasibility and safety of percutaneous transluminal angioplasty(PTA)using ? 30 mm balloon catheter to dilate the obstructive lesion of inferior vena cava(IVC)in Budd-Chiari syndrome(BCS). Methods From January 2002 to July 2006,146 consecutive patients with BCS(94 men,52 women)underwent color Doppler sonography including enhanced multislice CT(n = 47),and were confirmed by IVC angiography. All patients but 1 microsomia case were treated by PTA using ? 30 mm balloon catheter for dilation. IVC angiography were immediately performed to show patency of IVC and occurrence of any rupture or not after PTA. Follow-up color Doppler sonography was taken to evaluate the IVC patency and the PTA-related complication about 1 week after PTA. Results The mean transversial and longitudinal diameters of IVC at the junction level of right atrium and IVC were(25.09 ? 6.09) mm and(17.57 ? 3.93) mmrespectively in 46 cases with 3 D multi-slice CT preoperatively(1 case without measurement was due to the closest site with right atrium). There were no IVC rupture during the procedure. Conclusions Treatment of BCS by PTA using ? 30 mm big balloon catheter is feasible and safe.