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Objective To investigate the incidence,treatment and outcome of mid-and long-term biliary complications after liver transplantation.Methods Clinical data of 651 patients who underwent liver transplantation at General Hospital of Armed Police Forces from April 2002 to February 2012 were retrospectively studied to analyze the incidence, treatment and outcome of mid-and long-term biliary complications after liver transplantation.Results Among 651 liver transplant cases,47 patients (7.2%) developed mid-and long-term biliary complications.The mean time of onset was 21 months.Forty seven patients underwent 48 cases of treatment in total.Nine cases received anti-inflammatory therapy alone.Fourteen cases were treated with choledochoscope lithotomy,choledochoscope biliary cast or placing the biliary support tube.And 13 cases underwent endoscopic retrograde cholangiopancreatography (ERCP)nephrolithotomy, expanding the bile duct or placing the biliary support tube,including 1 patient was switched to percutaneous transhepatic cholangial drainage (PTCD)due to ERCP failure.Seven cases received drainage by PTCD and 5 cases were treated with anti-inflammatory therapy combined with choledochoscope or PTCD. The total efficacious rate was 92% . Among 3 invalid patients, two patients were treated with secondary liver transplantation and one died.Conclusions The mid-and long-term biliary complications probably occur after liver transplantation.Individualized therapies should be chosen based upon the types and severity of biliary complications,which yields relatively high efficacious rate.Secondary liver transplantation should be performed as necessary.
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Objective To evaluate patterns and timing of management for hepatic artery complications after orthotopic liver transplantation. Methods Between October 2003 and March 2007, the clinical data of 25 patients diagnosed as hepatic artery thrombosis (HAT) and hepatic artery stenosis (HAS) were retrospectively analyzed. Treatment patterns included liver retransplantation and interventional therapy including thrombelysis, pereutaneous transluminal angioplasty and stent placement. Results There were 5 HAT cases, 3 patients were treated with thrombolysis, one patient recovered, one suffered from recurrent HAT and underwent retransplantation, and died of multiple organ failure, the third one died after thrombolysis. The remaining two HAT cases were treated with retransplantation because of liver failure and recovered. Among the 12 patients presented with HAS within 1 month posttransplantation, 2 patients received liver retransplantation because of graft failure and 10 patients were treated with interventions. 7 patients recovered after stent placement and 4 patients received late liver retransplantaton due to ischemic bile duct lesion. Two patients died of intraeranial hemorrhage and infection respectively among 6 liver retransplantations. Among the 8 patients suffering from late HAS (after 1 month postoperatively), 5 patients were treated with stent placement,and liver function improved. Two patients were treated conservatively and liver function was stable. The remaining one patient receiving late liver retransplantation due to ischemic bile duct lesion died postoperatively. Conclusion Individualized therapeutic regimens should be adopted in treating hepatic artery complications after orthotopic liver transplanatation, according to their periods, types and whether ischemic bile duct lesion exists. Liver retransplantation is the best treatment for HAT patients.Percutaneous interventional management is the first-line therapy for patients without irreversible graft dysfunction due to HAS, but liver retransplantation is the only option for patients with ischemic bile duct lesion due to HAS.
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Objective To assess the safety and efficacy of transcatheter closure of congenital coronary artery fistulas(CAFs).Methods Retrospective analysis was performed on 19 patients mean age of(5.5?4.1) years treated from February 1995 to December 2005 with transcatheter closure of CAFs using transcatheter spring coil embolization,Amplatzer PDA occluder or Amplatzer plug.One case had a residul fistula postoperatively associated with patent duetus arteriosus(PDA).Results The abnormal parameters included mean fistula diameter(3.7?1.6)mm(2.5-8.2 mm),pulmonary mean pressure(28.0?5.0)mmHg(25.0-67.0 mmHg)and pulmonary to systemic shunt(Qp/Qs)1,6?0.8(1.0-2.3).The sites of the fistulas were originated in right coronary artery 11,left anterior descending coronary artery or left circumflex coronary artery 8. Abnormal communication sites of these fistulas were to right ventricle in 14 and right atrium in 5.Various occlusion devices used to close these fistulas included one Giantureo coil in 10,2-4 Gianturco coils in 3, Duct-Occlud in 3,Amplatzer duct occluder in 2 and Amplatzer plug in 1.The post-operative residul fistula with PDA was treated successfully with PDA occlusion.The immediate,one month and one year complete occlusion rates were 55.6%(10/18),88.9%(16/18),100%(18/18),respectively.The coil slipped into the left pulmonary artery in 1 case and correction was obtained by retrieving with forceps.Follow-up studies at 3 months to 4.3 years showed complete abolition of shunt in all patients with no evidence of recanalization leading to recurrences of shunt.Conclusion Transcatheter closure of CAFs is a safe and effective alternative to surgical repair.
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Objective To describe our follow-up results of interventional management in 20 patients with subclavian artery stenosis. Methods This study involved in 20 symptomatic patients with an average age of 63.4 years,a mean stenose severity of 86.2% and a mean systolic arterial pressure difference of 116 mm?Hg between both upper limbs. Percutaneous transluminal angioplasty (PTA) in the first 8 patients and stenting in the last 12 patients were performed via a right femoral or radial artery. Results Both PTA and stenting were successfully archived in all patients with normalization of radial pulses and a mean systolic arterial pressure difference of 24 mm?Hg between both upper limbs. No major complications occurred. In the follow-up for an average of 18.5 months,19 patients were free of adverse events except one with symptom recurrence. Conclusion As effective,simple and safe procedures,PTA and stenting can be used as a first-line treatment modality for the symptomatic patients with subclavian artery stenosis.
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Arterial stenotic and occlusive disorders of low limb are commonly the most important factors associated with the prognosis of diabetic foot.The effect of traditional bypass operation is unpredictable for lack of runoff artery.On the other hand,the contributions of special interventional devices and techniques targeted at infrapopliteal artery show unique therapeutic outcomes of interventional management;together with furthermore stem cell thansplantation would present a promising future for the treatment of diabetic foot.