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Objective To evaluate the curative effect and safety of lumbar artery embolization in treating massive hemorrhage caused by percutaneous transforaminal endoscopic discectomy (PTED).Methods From January 2013 to December 2016,lumbar artery angiography was performed in 4 patients with massive hemorrhage caused by PTED.Based on the angiographic findings,lumbar artery embolization therapy with embolic microspheres and spring coils was carried out.Results Lumbar artery angiography revealed that extravasation of contrast agent was detected in 3 patients and pseudoaneurysm in one patient.The bleeding completely stopped immediately after lumbar artery embolization in all 4 patients.The patients were followed up for 1-3 months,and no re-bleeding or serious complications occurred.Conclusion It is very difficult to make medical and surgical management for massive hemorrhage caused by PTED.Lumbar artery embolization is safe,effective and minimally-invasive for the treatment of massive hemorrhage caused by PTED.This therapy is worthy of clinical use.
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Objective To evaluate the mid-term and long-term effects of early endovascular emboli-zation in treating ruptured posterior communicating artery aneurysm. Methods Early endovascular embolization therapy was carried out in 36 patients with ruptured posterior communicating artery aneurysm (36 aneurysms in total), and the effects of embolization therapy were evaluated by using Raymond grading method. The unified imaging review program was formulated, and the mid-term and long-term effects were evaluated at half, 1, 2, 3 and 5 years after the treatment. Results The technical success rate was 100% in 36 patients (36 aneurysms in total). Raymond grading evaluation showed that gradeⅠwas seen in 32 patients, gradeⅡ in 2 patients, and grade Ⅲ in 2 patients. Recurrence of aneurysm was found in 5 patients (13.89%) at half (n=1), 2 (n=1), 3 (n=1) and 5 years (n=2) after the treatment. Re-rupture of the recurrent aneurysm was seen in one patient (2.78%). No death occurred during the following-up period. Conclusion Early endovascular embolization for ruptured posterior communicating artery aneurysm can effectively improve the prognosis of subarachnoid hemorrhage, and regular imaging examination can promptly detect the recurrence of aneurysm. Effective interventions are helpful for preventing deterioration and rupture of aneurysm.
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Objective To evaluate the clinical efficacy and safety of transcatheter arterial chemoembolization (TACE) with oxaliplatin (OXA), fluorouracil (5-Fu) and pirarubicin (THP) scheme in treating primary liver cancer. Methods A total of 65 patients with primary liver cancer were treated with TACE using infusion of OXA/5-Fu/THP scheme (TACE group). Other 21 patients with primary liver cancer, who were encountered at the Department of Interventional Radiology of authors’ hospital during the same period as the patients of TACE group, received simple transarterial embolization (TAE group). The therapeutic effect, the occurrence of adverse reactions, the progression-free survival time (PFS) and overall survival time (OS) of the two groups were comprehensively evaluated. The results were compared between the two groups. Results In the TACE group, the objective response rate (ORR) and disease control rate (DCR) were 55.4%and 81.5%respectively, and the median PFS and median OS were 11.5 months and 18.5 months respectively. Single factor analysis indicated that patients, who had liver function of Child-Pugh A and received more times or treatment, and who had small-sized tumor and no portal vein tumor thrombus or metastasis, usually had a better prognosis, and the differences were statistically significant (P<0.05). The prognosis of the patients with Barcelona staging (BCLC) B was better than that of the patients with Barcelona staging C, and the difference was statistically significant (P=0.000). Cox multivariate analysis revealed that the portal vein tumor thrombus and tumor metastasis were independent risk factors for the prognosis of the patients. Compared with the TAE group, TACE with OXA/5-Fu/THP scheme could effectively improve the mean progression-free survival time. Conclusion For the treatment of primary liver cancer, TACE with infusion of OXA/5-Fu/THP is clinically effective with fewer adverse reactions.
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Objective To compare the clinical effect of hepatic artery perfusion of antibiotics with that of intravenous administration of antibiotics in treating pyogenic liver abscess which is unsuitable for puncture drainage management. Methods Between October 2010 and October 2013, a total of 32 cases with bacterial liver abscesses which were unsuitable for puncture drainage management were encountered at the Third Affiliated Hospital of Wenzhou Medical University. The patients were divided into group A (n = 15) and group B (n = 17). Hepatic arterial perfusion of antibiotics was carried out in the patients of group A, while intravenous administration of antibiotics was employed in the patients of group B. Percutaneous puncture drainage was adopted in the patients when their imaging examination showed liquefaction within the lesion. Results The hospitalization time, recovery time of body temperature, hemogram recovery time and liquefaction extent of the lesion in group A were much better than those in group B , and the differences were statistically significant (P < 0.05). Conclusion Hepatic arterial perfusion of antibiotics is an important and effective treatment for bacterial liver abscesses.
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To investigate the assessed value of serum lactate dehydrogenase (LDH) and vascular endothelial growth factor (VEGF) for short-term efficacy of transcatheter arterial chemoembolization (TACE). Methods: Serum concentrations of LDH and VEGF from 70 patients with primary liver cancer on the 1st day before therapy and the 3rd, 7th, 14th, and 21st day after TACE ther-apy was determined. The benefit group includes complete remission, partial remission, and stable disease, while the invalid group in-cludes only disease progression. Results:The serum levels of LDH and VEGF in the invalid group were significantly higher than those in the benefit group on the 14th and 21st days after TACE (P<0.05). The percentage changes of the serum concentrations of LDH and VEGF in the invalid group were higher than those in the benefit group on the 21st day after TACE. Percentage changes on the 21st day after TACE were drawn into the ROC curve;the areas under the curve were 65.9%and 85.5%. The optimal cutoff points of LDH and VEGF, which correspond to the Youden index, were 0.272 and 0.745, respectively. Conclusion:The expression levels of VEGF and LDH can be used to assess the short-term efficacy of TACE. A lower expression level corresponds to short-term efficacy.
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Objective Diabetic infrapopliteal artery occlusive disease Deep balloon angioplasty ( percutaneoustransluminal an-gioplasty, PTA) near the middle of the treatment effect and the Department of internal medicine ,conservative treatment .Methods Sixty patients with type II diabetes mellitus complicated with severe infrapopliteal arterial occlusive patients , divided into treatment group (41 cases) and Department of internal medicine treatment group (19 cases),all patients had CTA or MRA or DSA imaging;in-terventional treatment group using Deep balloonPTA ,3 days before operation and postoperative long-term Plavix and culture as anti platelet , blood glucose controltherapy;Department of internal medicine treatment group with control of blood glucose ,precedent in im-proving microcirculation ,debridement dressing and anti infection;observed in 2 week,1 month,3 months,6 months ,1 year,2 years,3 years, two groups were compared after treatment of clinical symptoms and changes signs ,ankle brachial index (ABI),the dorsal artery of foot diameter and blood flow velocity ,evaluation and the total efficiency of 6 months,1 year,2 years,3 years and cut rate .Results Interventional arterial blood flow improved significantly after operation in treatment group ,the clinical symptoms,signs were improved obviously, ankle brachial index improved significantly ,compared with the Department of internal medicine treatment group statistical significance ( P <0.05 ) ,and the total efficiency of 3 years the rate of limb salvage and Department of internal medicine therapy group with significant difference ( P <0.05).Conclusions Deep balloon PTA treating diabetic infrapopliteal artery occlusive disease cura-tive effect,can significantly improve the rate of limb salvage;Department of internal medicine treatment forelderly ,important organ dys-function patients .
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Objective To explore the difficulty and strategy of percutaneous transheptic stenting for the junction of malignant hepatic duct obstruction. Method Twenty-three patients with highly malignant biliary obstruction received percutaneous transheptic biliary drainage (PTBD) by placement of stent and/or internal-external drainage tube. All the 23 patientws were followed up to determine the successful rate of surgery, the incidence of complications, decreased serum level of bilirubin, patency time of biliary stent and survival time. Results The initial operation was sucessful in 22 cases, accounting for 95.65%. Twenty-one patients had significant decline in total bilirubin (60%) and 2 had not (10%). The levels of alanine aminotransferase (GPT) and aspartate aminotransferase (GOT) decreased markedly and returned to nomral in an average of 18 d. After operation, 2 patients had fever,1 biliary tract bleeding, 6 pain in the right upper abodminal region, 1 localized peritonitis around the puncture point, 3 GPT increase and 1 drainage tube slip. There were no serious complications such as hemorrhea and biliary fistula etc. The symptoms of all these complications disappeared in 2 to 5 days through haemostasis, anti-inflammatory therapy and liver function protection. The median survival time was 8.5 months. Conclusion Although the merging of malignant hepatic duct obstruction stenting is difficult, try to pass through the obstruction by guide wire and master the right methods of operation can significantly improve the successful rate of surgery.
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Objective To explore the clinical value of endovascular embolization treatment with Guglielmi detachable coil (GDC) for the patients with ruptured intracranial aneurysm. Methods 15 cases of patients with ruptured intracranial aneurysm were undengone endovascular embolization with GDC. According to Hunt Hess classification, 8 belonged to grade Ⅰ, 6 for grade Ⅱ, and 1 in grade Ⅳ. All the patients were diagnosed with cerebral DSA and CT scan. Results 13 cases of the 15 patients (86.7%) were succeeded in embolization with GDC. Other 2 cases were failed with embolization, died of hemorrhage on the fourth day and in fourth month respectively. There were no complications and hemorrhage in the 13 cases in the follow up 3 to 25 months. Other follow up methods all showed normal appaerance and position including skull X ray films of 13 patients and carotid artery DSA of 2 patients at an interval of 6 months. Conclusion Endovascular embolization treatment with GDC is an effective method for ruptured intracranial aneurysm to avoid hemorrhage.
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Objective To evaluate the effectiveness of interventional procedures in the treatment of acute pulmonary embolism(PE). Methods Pulmonary arterial thrombolytic therapy, suction and fragmentation of thromhi, anti-spasm, and balloon dilation were performed in eighteen cases with clinically highly suspected PE confirmed by emergent pulmonary artery angiography beforehand. Wedged pulmonary arterial pressure, pulmonary recanalization rate, the display ratio of distal pulmonary capillary net, blood gas analysis, blood oxygen saturation, and the improvement of clinical symptoms and signs were used for evaluation of the effectiveness. Seventeen of the alive cases with dislodgement of deep vein thrombi of the lower extremities were confirmed for the formation of PE and then thrombolytic treatment of the thrombotic deep vein was performed after the placement of inferior vena cava filter. Results Pulmanory artery angiographies showed embolism of the pulmonary arterial trunks or more than two of the branches. The post-treatment pulmonary patency reached 80%-90% in three cases, 90%-95% in eleven cases and 100% in five cases. The display ratio of distal pulmonary capillary net was over 90% in all the cases. Wedged pulmonary arterial pressure decreased to below 25 mmHg in thirteen cases, and to 25-30 mmHg in five cases. Blood oxygen saturation rate improved immediately to 90%-95% in ten cases and to 95%-100% in eight cases. Cough, hemoptysis, dyspnea, and chest pain were completely relieved in thirteen cases and significantly relieved in five cases. Digestive track bleeding was complicated in one case. Conclusions Pulmonary artery angiography is the golden standard for the diagnosis of pulmonary embolism. Interventional therapy is very effective for acute pulmonary embolism, which can significantly reduce the mortality rate.
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Objective To study the effect of interventional treatment of iliac and femoral vein stenosis concomitant with deep venous thrombosis. Method Fifty-three patients were divided into 5 groups. In group A after placing into inferior vena cava a filter,11 patients adopted Amplatz Trombectomy Device for thrombolysis or ORSIS thrombolysis and persistent thrombolysis through popliteal vein. In group B thrombus was taken out through guiding catheter and then persistent thrombolysis through popliteal vein after placing into inferior vena cava filters in 9 cases. In group C 13 patients adopted persistent thrombolysis through femoral arteries. In group D 8 patients received persistent thrombolysis through popliteal vein. In group E persistent thrombolysis through foot veins was carried out in 12 patients. Seventeen patients received implanted stents and balloon-expansion in iliac and femoral veins. Results Symptoms disappeared in 26 patients(49.0%), significantly improved in 21 patients (39.6%), improved in 3 patients (5.7%), did not improve in 3 patients (5.7%), respectively. The repatency of iliac and femoral vein was achieved in more than 80% of the 17 patients. Complications developed in 3 cases in the course of thrombolysis. Conclusion The effect of mechanical removal of thrombus, persistent thrombolysis through catheter and transluminal angioplasty is safe and satisfactory.