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Percutaneous vertebroplasty (PVP) is a minimally-invasive technique,which has been widely employed in the treatment of hemangiomas,vertebral compression fractures,spinal metastases,myeloma and other diseases.Clinically,it is generally believed that the curative effect of PVP is closely related to the injected amount of bone cement.However,there is still great controversy over the optimal injection volume of bone cement.Based on the current researches both at home and abroad,this article aims to make a brief introduction about the relevant vertebral biomechanical factors that might affect the injection volume of bone cement,the influence of the injected volume of bone cement on the vertebral strength,rigidity and adjacent vertebral bodies.The main current disputes are pointed out so as to lay the foundation for further study.
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Clinically,heparin-induced thrombocytopenia (HIT) is an uncommon but serious disease,which is induced by the use of immune unfractionated heparin or low-molecular-weight heparin.The overall incidence of HIT is about 0.6％-5.0％.Nevertheless,in clinical practice it is profoundly dangerous,especially for patients who are receiving cardiovascular surgery or interventional therapy.At present,HIT is a hot clinical research subject.This paper aims to make a brief review about HIT pathogenesis,epidemiology,clinical evaluation and treatment,etc.
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Objective To investigate the relationship between the cystic fluid characteristics of symptomatic sacral canal cyst and the interventional therapeutic prognosis.Methods A total of 114 patients with symptomatic sacral canal cyst were enrolled in this study.Clinically,all patients complained of discomfort at lumbosacral area.Among the 114 patients,86 were primary sacral canal cyst and 28 were recurrent sacral canal cyst.Under DSA guidance,percutaneous puncturing of the cyst was performed,2-5 ml cerebrospinal fluid (CSF) was aspirated and sent for laboratory tests.Then a small amount of nonionic contrast agent was injected into the cyst to determine whether the cyst was communicated with the subarachnoid space or not.Finally,double-needle method was used to aspirate the cyst fluid.Results Radiography showed that communication between the cyst and subarachnoid space was detected in 66 patients (group A),while no communication between the cyst and subarachnoid space was observed in 48 patients (group B).In patients with primary symptomatic sacral canal cyst,the differences in the sugar and chloride levels of CSF between group A and group B were statistically significant.In patients with recurrent symptomatic sacral canal cyst,the differences in the sugar,protein and chloride levels of CSF between group A and group B were also statistically significant.Statistically significant correlation existed between the single or multiple CSF changes and the interventional therapeutic prognosis.Conclusion Sacral canal cysts can be classified into two types:cyst-subarachnoid space communicating type and cyst-subarachnoid space non-communicating type.The characteristics of CSF in patients with primary symptomatic sacral canal cyst are different from those in patients with recurrent symptomatic sacral canal cyst.Multiple CSF changes,the increased sugar level and decreased chloride level in CSF are well correlated with the interventional therapeutic prognosis.
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Interventional radiology is a new kind of minimally-invasive therapeutics that has developed on the basis of radiological imaging diagnosis.Interventional radiology is defined as a clinical subject that carries out the specific diagnosis and treatment under the guidance of medical imaging equipment and with the help of puncture needle,guide wire,catheter,etc.The interventional radiology categories include interventional diagnosis and interventional therapy.Interventional medicine is defined from the perspective of clinical application,while interventional radiology is defined from the technical characteristics of diagnosis and treatment.《of Interventional Radiology》 and the upcoming 《Journal of Interventional Medicine (English version)》 will become the professional sister journals in interventional academic field,which will provide important support for promoting the development of interventional medicine in China and for enhancing the international influence power of Chinese interventional medicine.
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Objective To study the significance of treating advanced primary hepatic carcinoma by using the different methods combined with chemotherapy. Methods One hundred and fifteen cases with advanced primary hepatic carcinoma were divided into 5 groups by accepting different chemotherapy: the groups of interventional-chemotherapy (group A, 40 cases), whole body hyperthermia combined with chemotherapy (group B, 16 cases), only chemotherapy (group C, 9 cases), local heat chemotherapy (group D, 26 cases), symptomatic supportive (group E, 24 cases) for comparing response rate (RR) and survival time between each other. Results The RR in group A,B,C were 30.5 % (12/40), 12.5 % (2/16), 11.1 % (1/9) respectively, and there was no significant difference among three groups (P>0.05). The mid-survival time of five groups were 7.7, 9.2, 7.9, 6.0, 4.7 months, and there was significant difference between group B and group E (P<0.05). The 0.5-, 1-, 2-year survival rate in group B were higher than those in group E with significant difference (81.2%vs. 29.1%, 37.5%vs. 12.5%, 12.5%vs. 0, all P<0.05). Conclusions The RR of only routine chemotherapy is low, while the RR of interventional-chemotherapy and local heat chemotherapy is high with non-prolonged survival time. Whole body hyperthermia combined with chemotherapy have active effects in helping to improve the efficacy and prolong the survival time in retreatment patients with advanced hepatic tumor.
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Objective To compare the clinical efficacy of transdorsal-to-plantar (TDP) or transplantar-to-dorsal (TPD) retrograde endovascular angioplasty in treating below-the-knee arterial occlusion diseases, and to compare it with conventional anterograde endovascular angioplasty. Methods A total of 96 patients with below-the-knee arterial occlusion diseases (112 diseased lower extremities in total), who were admitted to authors’ hospital during the period from Oct. 2009 to July 2011 to receive conventional anterograde endovascular angioplasty, were enrolled in this study. The clinical data were retrospectively analyzed. Among the 112 diseased lower extremities, conventional anterograde endovascular angioplasty failed in 27, and TDP or TPD retrograde endovascular angioplasty had to be carried out. A total of 71 patients (85 diseased lower limbs) were successfully treated with conventional anterograde endovascular angioplasty (routine group), while 20 patients (22 diseased lower limbs) were successfully treated with retrograde endovascular angioplasty (retrograde group). The preoperative ankle-brachial index(ABI), the coronary angiography-based thrombolysis in myocardial infarction (TIMI) flow score, the dorsal or plantar arterial pulse score, the postoperative limb salvage rate and target vessel patency rate were calculated, and the results were compared between the two groups. Results The technical success rate in the retrograde group and the routine group was 75.9% and 74.0%respectively (P>0.05). Preoperative ABI value of the retrograde group and the routine group was 0.55± 0.21 and 0.56±0.14 respectively, after the treatment which increased to 0.93±0.19 and 0.89±0.18 respectively (P>0.05). Preoperative TIMI score of the retrograde group and the routine group was 0.1 ±0.5 and 0.8 ±0.8 respectively, which significantly increased to 2.5±0.6 and 1.8±0.8 respectively (P0.05). Twenty-four months after endovascular angioplasty Kaplan-Meier analysis indicated that the limb salvage rate of the retrograde group and the routine group was 95.5%and 96.5%respectively (P>0.05). Conclusion Compared with conventional anterograde endovascular angioplasty for the treatment of below-the-knee arterial occlusion diseases, retrograde endovascular angioplasty via TDP or TPD path can immediately improve the blood flow with obvious improvement of ABI score, primary target vessel patency rate as well as the limb salvage rate. Therefore, retrograde endovascular angioplasty should be regarded as an effective supplementary technique when anterograde angioplasty fails.
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With the continuous innovation and development in the field of interventional therapy, the complexity of surgery has been gradually increased, meanwhile, the psychological expectation from patients for a minimally invasive surgery has also become higher and higher. Patients expect not only to be safe to complete the surgery, but also to maintain the comfort during operation process. For ensuring these demands, anesthesia plays a key role. This paper aims to discuss the current situation, problems and development direction of anesthesia application in interventional surgeries in order to help promote the anesthesia management concepts in performing interventional procedures.
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Objective To compare the clinical efficacy of transdorsal-to-plantar (TDP) or transplantar-to-dorsal (TPD) retrograde endovascular angioplasty in treating below-the-knee arterial occlusion diseases, and to compare it with conventional anterograde endovascular angioplasty. Methods A total of 96 patients with below-the-knee arterial occlusion diseases (112 diseased lower extremities in total), who were admitted to authors’ hospital during the period from Oct. 2009 to July 2011 to receive conventional anterograde endovascular angioplasty, were enrolled in this study. The clinical data were retrospectively analyzed. Among the 112 diseased lower extremities, conventional anterograde endovascular angioplasty failed in 27, and TDP or TPD retrograde endovascular angioplasty had to be carried out. A total of 71 patients (85 diseased lower limbs) were successfully treated with conventional anterograde endovascular angioplasty (routine group), while 20 patients (22 diseased lower limbs) were successfully treated with retrograde endovascular angioplasty (retrograde group). The preoperative ankle-brachial index(ABI), the coronary angiography-based thrombolysis in myocardial infarction (TIMI) flow score, the dorsal or plantar arterial pulse score, the postoperative limb salvage rate and target vessel patency rate were calculated, and the results were compared between the two groups. Results The technical success rate in the retrograde group and the routine group was 75.9% and 74.0%respectively (P>0.05). Preoperative ABI value of the retrograde group and the routine group was 0.55± 0.21 and 0.56±0.14 respectively, after the treatment which increased to 0.93±0.19 and 0.89±0.18 respectively (P>0.05). Preoperative TIMI score of the retrograde group and the routine group was 0.1 ±0.5 and 0.8 ±0.8 respectively, which significantly increased to 2.5±0.6 and 1.8±0.8 respectively (P0.05). Twenty-four months after endovascular angioplasty Kaplan-Meier analysis indicated that the limb salvage rate of the retrograde group and the routine group was 95.5%and 96.5%respectively (P>0.05). Conclusion Compared with conventional anterograde endovascular angioplasty for the treatment of below-the-knee arterial occlusion diseases, retrograde endovascular angioplasty via TDP or TPD path can immediately improve the blood flow with obvious improvement of ABI score, primary target vessel patency rate as well as the limb salvage rate. Therefore, retrograde endovascular angioplasty should be regarded as an effective supplementary technique when anterograde angioplasty fails.
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Objective To investigate the clinical effects of two different partial splenic embolization (PSE) methods in treating portal hypertension due to cirrhosis, and to statistically analyze the difference between the two PSE methods. Methods Sixty-two patients with cirrhotic portal hypertension complicated by hypersplenism were divided into group A (peripheral embolization group) and Group B (lower- pole embolization group). Partial splenic embolization with sponge was carried out in all patients of both groups. Before and after PSE color Doppler ultrasoundgraphy was performed to determine the inner diameter of the portal vein and splenic vein, the velocity and rate of flow, the length and thickness of spleen, etc. The results were compared between the two groups. Results The splenic embolization area within 60% - 80%was obtained in 42 patients, and the embolization area>80%was seen in 20 patients. After PSE, decreased flow velocity as well as flow rate was detected in all patients, and both the length and thickness of the spleen were also significantly reduced when compared with the data determined before PSE. The differences between the two groups were statistically significantly (P < 0.05). Conclusion Partial splenic embolization can effectively relieve the portal hypertension caused by cirrhosis, and selective peripheral arterial embolization is superior to splenic lower-pole embolization in decreasing the portal pressure.
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Objective To discuss the feasibility and short-term clinical effectiveness of DSA-guided percutaneous vertebroplasty (PVP) for the treatment of painful osteoblastic metastatic spinal lesions. Methods During the period from Jan. 2010 to Dec. 2011 at authors’ hospital PVP was carried out in 23 patients with osteoblastic spinal metastases (34 lesions in total). Coexisting osteoblastic pathological fracture was found in twelve patients. The WHO standards, visual analogue scale (VAS) and karnofsky-KPS score were used to evaluate the therapeutic results. Results Technical success was achieved in all patients. All patients were followed up for at least 3 months. Of 20 patients who had complete clinical data, complete remission (CR) was obtained in 6, partial remission (PR) in 10, mild remission (MR) in 3 and no remission (NR) in one. The clinical effectiveness (CR+PR) was 80%. The mean VAS scores dropped from preoperative (7.0 ± 1.6) to (2.2 ± 1.9) at 24 hours after the treatment, and to (2.4 ± 2.1) and (2.5 ± 2.1) at one and three months after the treatment respectively. The mean KPS scores rose from preoperative (76.5 ± 10.4) to (86.5 ± 11.8), (88.0 ± 12.0) and (89.0 ± 10.8) at 24 hours and one, three months after the treatment respectively. Small amount leakage of PMMA was observed in 4 cases (17.4%) with no obvious clinical symptoms. Conclusion DSA-guided PVP is a feasible and effective treatment for painful osteoblastic spinal metastases. This therapy can immediately relieve pain and reinforce spine, besides, it can remarkably improve the living quality and decrease the incidence of paraplegia.
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Objective To discuss the clinical value of percutaneous vertebroplasty (PVP) in treating severe vertebral compression fracture. Methods During the period from June 2012 to March 2013, PVP was carried out in 30 patients with severe vertebral compression fracture (30 diseased vertebrae in total). The clinical data were respectively analyzed. According to the shape of compressed vertebra , the fractures were divided into three types: wedge-shaped, double concave and oblong-shaped. For wedge-shaped fracture, PVP was performed via the pedicle access of the healthy side. For double concave type , unilateral pedicle access was used, while for oblong-shaped type unilateral or bilateral access was adopted to conduct PVP according to the distribution of the injected PMMA. The therapeutic results were evaluated by using VAS and pain degree classification standard of WHO. The preoperative and postoperative vertebral height was estimated on the lateral projection. All patients were followed up for six months at out-patient clinic or by telephone. Results The success rate of puncturing was 100%. The preoperative mean VAS was 6.9 ± 0.9. The postoperative VAS at one day, one, 3 and 6 months after the procedure was 5.0 ± 0.9, 3.5 ± 0.7, 2.5 ± 0.8 and 1.6 ± 0.7 respectively. Based on WHO pain degree classification standard, complete remission (CR) was obtained in 25 cases, partial remission (PR) in 3 cases, and invalid in 2 cases. The effective rate (CR +PR) was 93.33%. The mean preoperative height of the compressed vertebrae was (5.77 ± 1.09) mm and the mean postoperative height of the compressed vertebrae was (14.33 ± 2.03) mm. Conclusion For the treatment of severe vertebral compression fractures, percutaneous vertebroplasty is clinically feasible with reliable short-term effect.
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Objective To discuss the feasibility and clinical application of percutaneous internal fixation (PIF) combined with pecutaneous osteoplasty (POP) for the treatment of metastasis of proximal femur with impending pathological fracture. Methods Six consecutive patients with metastases of the proximal femur, who could not be able to tolerate conventional surgery, underwent PIF together with POP. The results were analyzed. Results The procedure was successfully accomplished in all six patients. Neither pulmonary embolism nor death occurred in all patients during and after the operation. No fracture at operated area was observed during follow-up period. Conclusion For stabilization of proximal femoral metastatic lesion with impending pathological fracture, percutaneous internal fixation combined with pecutaneous osteoplasty is a safe and effective technique.
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Objective To study the defects of bone marrow-derived endothelial progenitor cells (EPCs) in number ratio and biological abilities (proliferation, adhesion and migration) in diabetic rats. Methods (1) Establishment of diabetic rat model:1%STZ solution was quickly injected into the abdominal cavity of the male SD rats with the dose of 60 mg/kg. (2). Isolation, culture and identification of bone marrow-derived EPCs in diabetic and normal rats. Bone marrow mononuclear cells were isolated from diabetic and normal rats by density gradient centrifugation methods and cultured by EGM-2 MV medium. The cells were identified by morphological observation, FITC-UEA-1 binding and Dil-Ac-LDL uptake assay, and fluorescent immunocytochemistry was used for detection of CD34 , CD133 and VEGFR-2 expression. CCK-8 method and Transwell kit method were used to determine biological activities of EPCs. Results (1) When cultured in vitro, both bone marrow-derived EPCs in diabetic and normal rats were fusiform in shape, the cells snuggled up to the wall. The expression of CD34, CDl33, VEGFR-2 could be detected in these cells, and the cells could uptake Dil-Ac-LDL and bind FITC-UEA-1, which proved that these cells were EPCs. (2) No significant difference in the number of EPCs derived from bone marrow existed between diabetic rats and normal rats, but the proliferation ability, migration ability and adhesion ability of bone marrow-derived EPCs in diabetic rats were obviously lower than those in normal rats. Conclusion The number of bone marrow-derived EPCs in diabetic rats is not obviously different from that in normal rats, but the biologic activity of EPCs derived from bone marrow in diabetic rats is degraded, which is manifested as weakened abilities of the proliferation, adhesion and migration.
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The coronary covered stents have been more and more used to treat intracranial arterial diseases for recent years,and the hot point in study has gradually changed from clinical application of coronary covered stents to the fundamental and clinical trial of specially-designed intracranial covered stentsThe covered stents are mainly employed for the treatment of intracranial arterial disorders,including giant,wide-necked or minute cerebral aneurysms,intracranial pseudoaneurysms caused by a variety of reasons,fusiform or dissecting aneurysms of vertebral-basic artery,and internal carotid cavernous fistula,etc.It is very difficult for current surgical or endovascular treatment,both materially and technically,to deal with the above mentioned intracranial disorders.The covered stent can restore the anatomic shape of artery by direct sealing the aneurysmal neck and the fistula.The complications of covered stent treatment include defect of cranial nerves,occlusion of parent artery or branches.This article aims to review the related medical literature published both at home and abroad,to make a retrospective analysis of the therapeutic results,and to put forward some issues of common interest.
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Implantation of radioactive seeds is an effective therapeutic option for the treatment of malignant tumors. With the development of imaging technique and the use of treatment planning system (TPS) it has been more and more employed in clinical settings. The technique has been widely practiced in various malignant tumors, such as prostate cancer, lung caner, pancreatic cancer, hepatocarcinoma, etc. In order to standardize the clinical application of this technology, the authors propose some suggestions concerning the management of radioactive seeds, the indications and contraindications as well as the method of operation as a technical guidance.
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Interventional radiology is a new and developing subject, and a good grasp of imaging knowledge, skilled manipulation and plenty of clinical experience are essential for physicians who are engaged in this special field. For this reason, all interventional physicians should make great efforts to unceasingly improve their theoretical levels and practical abilities. Many interventional physicians who used to be the diagnostic radiologists have solid foundation of medical imaging as well as rich manipulation ability.Nevertheless, what they usually lack is the special clinical knowledge, they are short of relevant clinical ability to confidently deal with the interventional perioperative events. The interventional perioperative performance is an important component of interventional therapy. Standard interventional preoperative preparations can effectively reduce the occurrence of postoperative complications and scientific postoperative managements will help obtain an optimal result.
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Objective To discuss the technical points, safety and clinical effectiveness of DSA-guided percutaneous acetabuloplasty (PA) for the treatment of acetabular metastases. Methods Fifteen patients, including 6 males and 9 females, with acetabular malignant metastases were enrolled in this study.A total of 19 lesions were detected. The lesions were 13 - 25 mm in size (mean 19 ± 4 mm), the dose of PMMA used for per lesion was 5 - 13 ml (mean 8.2 ± 2.3 ml). All patients complained of greater or less degree of pain in their hips, 8 patients had to use walking stick, 4 patients showed limping although they could walk independently and three patients could not walk alone. DSA-guided percutaneous acetabuloplasty was performed in all patients and follow-up after the procedure was conducted for 1 - 12 months. Visual analogue score (VAS), walking state score and analgesic dosage taken by the patients were used for the evaluation of the clinical effectiveness. The complications were analyzed. All the data obtained were statistically analyzed with paired samples t test and analysis of variance by using SPSS12.0 statistical software.Results The procedure was technically successful in all patients. Pain rating evaluated by the VAS decreased from a mean of 7.8 before surgery to a mean of 4.2 in 24 hours after surgery (P < 0.01 ), which further decreased to 2.5 in one month (P < 0.01 ), while walking state score increased from a mean of 1.5before surgery to a mean of 2.5 in 24 hours after surgery (P < 0.01 ). The analgesic dosage taken by the patient was reduced in 14 patients and remained the same in one patient. The bone cement leakage into paraacetabular soft tissues occurred in three cases and peripheral vascular exudation of acetabulum was observed in three cases with no obvious clinical symptoms. Conclusion As a safe, reliable and minimally-invasive technique, DSA-guided percutaneous acetabuloplasty has excellent anti-pain effect in treating acetabular metastases. This therapy can markedlyimprove the patient's walking ability and the quality of life.
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Through the exploration and practice,the interventional nursing care has become an important part of Interventional Radiology,which bears a close relations to the pros and cons of the interventional therapeutic quality.The interventional nursing has been developing along the direction to become an independent nursing specialty.At the same time,various issues that affect the interventional nursing development start to emerge.At present,the setting up of a system to strengthen the establishment of the special care unit and human resources is urgently needed.The following measures are indispensable to promote the sustainable development of interventional care: to raise special awareness,to work out nursing routine and quality control standards,to explore the proficiency in order to stabilize nursing team,to pay attention to specialty education and to establish an integration mode for standardized training and professional development.
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The hypersplenism is a common disease caused by cirrhosis of different reasons. With the development of interventional radiology, partial splenic embolization (PSE) has been widely applied in clinical practice, especially in the treatment of secondary hypersplenism. There is a variety of embolization materials used in PSE, each has its own merits. Because of the anatomical characteristics of the splenic artery, the embolized volume and extent of the spleen will directly affect the therapeutic results. Peripheral blood test, immunological function, hemodynamics and hepatic function can be used to evaluate the effects of PSE. Owing to a variety of reasons, there are still some shortages of PSE in clinical practice, which are badly in need of being improved.
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During the past decades, interventional neuroradiology has become one of the most important modalities for treatment of cerebral vascular diseases. Chinese doctors have made great progress in this field, and their diagnosis and treament have also reached the international level in some territories. Following the need of specialized development for interventional neuroradiology,more and more problems have arisen and even caused argument in this field. To resolve the issue and promote the healthy and fast development of interventional neuroradiology,it is time for us to formulate the standard training and certification system for interventional neuroradiologist.