Non-selective versus highly selective partial splenic embolization in treating patients with hypersplenism secondary to liver cirrhosis: a comparative study / 中华肝胆外科杂志

Objective:To compare the clinical outcomes of treatment using non-selective versus highly selective partial splenic embolization in patients with hypersplenism secondary to liver cirrhosis.Methods:The clinical data of patients with hypersplenism secondary to hepatitis B cirrhosis who underwent splenic embolization at the Department of Hepatobiliary and Pancreatic Surgery of Leshan People's Hospital from July 2017 to July 2020 were analyzed retrospectively. Of 65 patients with hypersplenism, there were 42 males and 23 females, with age of (58.5±9.8) years. Twenty-six patients underwent splenic artery non-selective partial splenic embolization (the non-selective group) and 39 patients underwent partial splenic embolization using highly selective intubation (the highly selective group). The postoperative peripheral hematological indexes, liver function, operation-related complications and portal vein color Doppler ultrasonography were compared between the two groups.Results:The white blood cell count and platelet count of patients in the 2 groups were significantly higher than those before operation. The white blood cell count at 4, 12 and 24 weeks after operation and the platelet count at 12 and 24 weeks after operation in the highly selective group were significantly higher than those in the non-selective group ( P<0.05). Compared with the non-selective group, the total bilirubin, ICG-R15, portal vein diameter and portal vein blood flow in the highly-selective group significantly lower ( P<0.05). The incidences of 0/Ⅰ/Ⅱ/Ⅲ pain in the non-selected group was significantly higher when compared with that in the highly selected group (5/10/11/1 vs. 12/22/7/0), ( P<0.05). There were no significant differences in the incidences of postoperative complication between the two groups ( P>0.05). Conclusion:Compared with non-selective partial splenic embolization, highly selective partial splenic embolization gave more stable and lasting treatment outcomes in patients with hypersplenism caused by liver cirrhosis with better recovery of blood-related indicators, better improvement in postoperative liver function and relief of portal hypertension symptoms.

Short-term Therapeutic Effect of Elemene Combined with Interventional Therapy for Moderate and Advanced Liver Cancer / 广州中医药大学学报

Objective To evaluate the short-term effect of elemene combined with transcatheter hepatic arterial chemoembolization (TACE) interventional therapy for the treatment of moderate and advanced liver cancer.Methods A total of 63 patients with moderate and advanced liver cancer were randomized into test group(31 cases) and control group(32 cases). Both groups were given TACE, and additionally, the test group was given intra-arterial infusion of Elemene Emulsion(400-600 mg/m2)together with MAO(Mitomycin C 4-6 mg/m2 , adriamycin 20-40 mg/m2, Oxaliplatin 50-85 mg /m2), and the control group was given intra-arterial infusion of MAO. Short-term effect was evaluated by the clinical outcomes of tumor size, progression-free survival(PFS), total survival rate and adverse reactio n. Results(1)The overall response rate(ORR) in the test group was superior to that in the control group, and the difference was statistically significant(P0.05).(3) No severe toxic or side effect was found in t he twogroups, the difference being not significant(P>0.05). The test group tended to have milder adverse reaction. Conclusion Intra-arterial infusion Elemene Emulsion combined with TACE interventional therapy is effective in increasing ORR, prolonging PFS, promoting adverse reaction endure and relieving symptoms of weakness, abdominal distension and pain.

The Efficacy and Long-Term Outcome of Microcoil Embolotherapy for Acute Lower Gastrointestinal Bleeding

OBJECTIVE: To evaluate the clinical efficacy as well as long-term clinical outcomes of superselective microcoil embolization for lower gastrointestinal bleeding (LGIB). MATERIALS AND METHODS: Between 1997 and 2009, 26 patients with intended transcatheter embolotherapy for LGIB were retrospectively reviewed. Embolization was performed only when the catheter could be advanced to or distal to the mesenteric border of the bowel. The main purpose of our study was to assess technical success, recurrent bleeding rate and complications. We also evaluated the long-term clinical outcome, including late recurrent LGIB, bowel ischemia and the survival rate. RESULTS: Twenty-two bleeding sources were in the territory of superior mesenteric artery and four in the inferior mesenteric artery. Technical success was achieved in 22 patients (84.6%). The target vessel of embolization was vasa recta in seventeen patients and marginal artery in the remaining five patients. Early rebleeding occurred in two patients (7.7%) and bowel ischemia in two patients, of whom the embolized points were both at the marginal artery. Delayed recurrent bleeding (> 30 days) occurred in two angiodysplasia patients. Five patients (19.2%) died within the first 30 days of intervention. Long-term follow-up depicted estimated survival rates of 58.2 and 43.1% after one, and five years, respectively. CONCLUSION: Transcatheter embolotherapy to treat LGIB is effective with low rebleeding and ischemic complications. Considering the advanced age and complex medical problems of these patients, the minimal invasive embolotherapy may be used as both a primary and potentially definitive treatment of LGIB.

Hereditary Hemorrhagic Telangiectasia Combined with Pulmonary Arteriovenous Malformation Treated with Transcatheter Embolotherapy / 대한피부과학회지

No abstract available.

Embolotherapy for Pulmonary Arteriovenous Malformations in Patients without Hereditary Hemorrhagic Telangiectasia

OBJECTIVE: To evaluate the clinical and radiological outcomes of transcatheter embolotherapy for treating sporadic pulmonary arteriovenous malformations (PAVMs) that were not associated with hereditary hemorrhagic telangiectasia. MATERIALS AND METHODS: Between January 2001 and June 2008, thirty-five sporadic PAVMs were detected in 23 patients. The clinical follow up consisted of assessing the changes of the signs and symptoms of the PAVMs, and radiological evaluation with chest radiographs or chest CT scans. RESULTS: The lower lung regions (63%) and peripheral locations (86%) were the common locations of the PAVMs. Thirty-four PAVMs (97%) had simple architecture (one arterial feeder within a single pulmonary segment). Technical success was achieved in 33 PAVMs (94%); two cases of technical failure were due to catheterization failure (n = 1) and too large a feeding artery (17 mm) that disabled embolotherapy (n = 1). Coils and Amplatz vascular plugs were used in 30 and three PAVMs, respectively. Inadvertent placement of one coil (n = 1) and pulmonary infarction (n = 1) occurred, but no relevant symptoms developed. For the 13 patients with available data, the mean arterial O2 saturation changed significantly from 92% to 98%. Complete or near-complete involution of the sac was observed in 30 of the 33 embolized PAVMs (91%). In these 33 embolized PAVMs, the mean sac diameter significantly decreased from 17.83 mm to 0.68 mm. CONCLUSION: Sporadic PAVMs are mostly the simple type with predominance in the lower lobe and peripheral locations. Transcatheter embolotherapy with coils or Amplatz vascular plugs is a safe and effective treatment for sporadic PAVMs and this provides excellent functional and radiological improvement.

Advance and application of interventional embolic agents / 医学研究生学报

The development and application of embolic agents is a very important step to vascular embolotherapy and many studies about it have been done at home and abroad.We must know their characteristics very well and choose situable embolic agents and interventional methods.Besides we also need to manufacture even ideal embolic agents.This text reviews the advance and application of many kinds embolic agents.

A case of bleeding from the accessory pancreatic duct associated with aneurysmal dilatation of pancreaticoduodenal artery / 대한내과학회지

Gastrointestinal bleeding through the pancreatic duct especially from the minor papilla through the accessory duct is a very rare event. It has rarely been demonstrated to be associated with pancreatic pseudocyst, arteriovenous malformation, pancreas divisum, and duodenal duplication cyst. We have experienced a 51-year old man having sudden onset melena. He had been recovered from a recent myocardial infarction and was on the aspirin treatment. Upper gastrointestinal endoscopic examination revealed bleeding through minor papilla from the accessory duct but no bleeding was observed through the ampulla of Vater. Angiogram demonstrated two sites of aneurysmal dilatation of pancreaticoduodenal artery and these were obliterated by selective embolization. Thereafter the bleeding was controlled and patient was recovered.

A case of bleeding from the accessory pancreatic duct associated with aneurysmal dilatation of pancreaticoduodenal artery / 대한내과학회지

Gastrointestinal bleeding through the pancreatic duct especially from the minor papilla through the accessory duct is a very rare event. It has rarely been demonstrated to be associated with pancreatic pseudocyst, arteriovenous malformation, pancreas divisum, and duodenal duplication cyst. We have experienced a 51-year old man having sudden onset melena. He had been recovered from a recent myocardial infarction and was on the aspirin treatment. Upper gastrointestinal endoscopic examination revealed bleeding through minor papilla from the accessory duct but no bleeding was observed through the ampulla of Vater. Angiogram demonstrated two sites of aneurysmal dilatation of pancreaticoduodenal artery and these were obliterated by selective embolization. Thereafter the bleeding was controlled and patient was recovered.

The diagnosis and treatment of acute lower gastrointestinal massive bleeding / 临床外科杂志

Objective To investigate the methods of diagnosis and treatment of acute lower gastrointestinal massive bleeding. Methods Retrospective analysis was made on diagnozing and treating of 21 patients with acute lower gastrointestinal massive bleeding Results Within a total of 21 cases,bleeding was controlled by conservative treatment in 6 cases(28.6%),supermesenteric angiography showe positive findings in 92.8% and the interventional therapy was applied successfully in 84.6%. no recurrence was observed after Ⅰ month to 4 year follow up. Conclusions Patients with acute lower gastrointestinal massive bleeding should be treated firstly by conservatie method,uncontrollable bleeding should be evaluated by selective supermesenteric angiography;after the bleeding artery was recongnized by angiography,the intervention embolotherapy should be taken;the patients whose angiography are negative and bleeding cannot be controlled should be operatded

Interventional therapy of hyperthyroidism / 介入放射学杂志

Objective To evaluate clinical application of arterial embolotherapy on hyperthyroidism. Methods 11 patients with hyperthyroidism were performed with thyroid superior and inferior arterial super selective arteriography and interventional embolization by polyvinyl alcohol(PVA),gelfoam particles and wool gianturco coil. Results The procedures were succeeded in 11 patients. After the embolotherapy , the thyroid function gradually returned to normal level in 10 patients. The symptom was not controlled satisfactorily in 1 patient, who underwent the right thyroid inferior arteries superselective arteriography and interventional embolization, and then the thyroid function gradually returned to normal level. No serious complications occurred in all patients. Conclusions Arterial embolotherapy is a safe, simple,symptomless, reliable and very effective for treatment of hyperthroidism.

A Clinical Analysis of Intracranial Arteriovenous Malformations

The author analyzed 66 cases of intracranial arteriovenous malformations treated in the Department of Neurosurgery of Yonsei University Hospital from 1977 to 1985. The results are summarized as follows : 1) The ratio of male to female was 2:1 and 75.8% or 50 cases were distributed between the 2nd and 4th decade. 2) The common presenting symptoms were either seizure alone(14%) or various symptoms resulting from hemorrhage(75%). 3) Arteriovenous malformations were suggested in 93.3% and were diagnosed in about half of the cases with the brain CT scan. Enhanced tubular shadow was the most important finding and hyperdensity of the lesion on precontrast brain CT scan was the most common finding. 4) The most common site of involvement was the supratentorial subcortical region with 75.4%, followed by the supratentorial deep region with 14.8%, and the infratentorial and dural region with 4.8%. 5) When compared to small( 4cm) lesions, there was less chance of hemorrhage in medium sized lesion(> 2cm to < 4cm). When the subcortical and deep regions of the supratentorial lesion were compared, there was no difference in incidence of hemorrhage. 6) According to angiographic findings, 46.6% was grade I lesions. The anterior cerebral artery and the middle cerebral artery were most commonly involved. 7) After craniotomy, total resection was performed in 34 of 43 cases or 79.1%. Due to either size or location, 14.4% or 7 of 43 cases were inoperable. 8) Immediate postoperative neurological deficits were noted in 12.5% or 6 of 48 cases. Non-hemorrhagic patients showed postoperative deficits more frequently than hemorrhagic patient did. 9) Regardless of treatment modality, there was a significant increase in number of patients who could be classified as grade I at discharge. 10) Long-term follow-up was carried out on 19 craniotomy cases. Neurological improvement was noted in 63.2% of these 19 cases. Among this group, there was no cases of neurological deterioration.

Percutaneous Transarterial Embolotherapy of Carotid-Cavernous Fistula

It is known that the percutaneous transarterial embolotherapy is the procedure of choice for the treatment of the carotid-cavernous fistula (CCF) ; The detachable balloons are utilized for the treatment of direct CCF, and particles or fluid materials for the indirect CCF (a kind of dural AV malformation) as embolic agents. We have experienced 14 cases of CCF over last 3 1/2 years. We present the results of our clinical experience including complications and technical problems. Eleven of 12 patients with direct CCF have been successfully treated with Debrun's latex detachable balloons, and 2 indirect CCF with PVA, Gelfoam particles or IBCA. In 6 (50%) of 12 direct CCF the only fistula was occluded with the preservation of internal carotid artery was originally occluded with the fistula. One patient underwent surgical ligation due to complication of embolotherapy. In two patients with indirect CCF the involved dural branches of external carotid artery were almost completely embolized ; One of both revealed recurrence 1 week after the procedure, producing symptoms and signs of original state. We encountered two cases of unexpected major complications during the procedures.