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Objective +o evaluate percutaneous intervetional therapy for portal vein anastomotic occlusion after liver transplantation.Method From July 2005 to July 2013,13 patients (9 male and 4 female; aged 25-65 years) with portal vein occlsion underwent interventional therapy.All patients accepted the imaging examation and 8 patients had typical clinical signs of portal hypertension.Percutaneous hepatic balloon venoplasty and stent placement was performed,trans-catherter urokinase infusion for thrombolysis and embolization for collateral pathways performed if necessary.+echnical success rate,complication rate and clinical symptoms were analyzed.Follow-ups including clinical course,stent patency and potal vein thrombosis which evaluated by imaging were performed.Result +echnical success was achieved in l1of 13 patients (84.6％) and 15 stents were deployed.Seven patients with localized portal vein occulsion accepted balloon dilation and stents deployment,4 patients with long segment cculsion also accept trans-catherter urokinase infusion for thrombolysis and embolization for collateral pathways.Portal vein flow recovered in all 11 patients.Procedure related complication occurred in 2 patient with hemothorax.During the follow-up period of 4-42 months,the clinical signs of portal hypertension were not observed in all patients.Stent stenosis was found in one patient with ultrasound in 23 months,but stent patency was proved by the percutaneous portal angiography.Conclusion Interventional therapy is effective for portal vein occulsion after liver transplantation,comprehensive interventional therapy should be performed in long segment portal vein cculsion.
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Objective In-hospital mortality rate in patients undergoing percutanous transhepatic biliary drainage for malignant obstructive jaundice remained high.This study aimed to assess pre-,intra-and post-procedure risk factors which were independently associated with increased in-hospital mortality.Methods One hundred and fifty-five consecutive patients with malignant obstructive jaundice received initial PTBD drainage.Twenty-five pre-procedure,4 intra-procedure and 6 post-procedure factors potentially related with in-hospital mortality were assessed by univariate and multivariate analysis.Results In-hospital mortality rate was 16.8％ (26/155).Of 25 pre-procedure variables analysed,Child-Pugh classification C,creatinine (≥ 6.93 μmol/L) and quality of life (≤ 30) were found to be significant in univariate and multivariate analysis.Increased mortality was seen in this study with two or more risk factors,significantly different from patients who had none or one risk factor(P ＜0.01).None of the intra-procedure factors were important in identifying patients at risk of death.Multivariate analysis indicated post-PTBD cholangitis and unsuccessful drainage as post-procedure risk factors that correlated with in-hospital death.Conclusions Three pre-procedure and two post-procedure risk factors were identified associated with in-hospital mortality.
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Objective To evaluate the long-term safety, efficacy and complications of placement vena cava filter in prevention of pulmonary embolism. Methods Seventy-three patients with proven diagnosis of deep venous thrombosis (DVT) and (or) pulmonary embolism (PE) by Doppler ultrasonography, DSA, CT or MRI, received percutaneous inferior vena cava filters (IVCF) from January 1994 to June 2005. The clinical data and imaging findings were evaluated retrospectively. The patients underwent telephone interview or questionnaire, abdominal X-rays, Doppler ultrasonography, computed tomographic pulmonary angiography (CTPA) or indirect CT venography (CTV) after a follow-up duration of 5 months to 11 years. Results Seventy-eight vena cava filters were used. There was 1 case of incomplete filter opening when placing filter. In follow-up, thrombi were trapped in the filter in 2 cases, filter tilting happened in 1 case, and there were no filter migration, filter disruption, filter perforation. Five of 73 cases were lost in follow-up visit, 14 patients died after implantation (5 days to 41 months, average 14.5 months). Among the 54 living patients, the identified recurrent PE was not noted. Three cases of recurrent DVT, 1 case of inferior vena caval thrombosis and 1 case of thrombosed filters were seen in follow- up. Conclusion Inferior veua cava filter is safe and effective for the long-term prevention pulmonary embolism, and the long-term major complications after filter placement are not frequent.
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Objective To evaluate the multi-slice CT perfusion imaging in investigating whether edaravone can prevent and treat pulmonary thromboembolism ischemia-reperfusion injury(PTE-IRI).Methods Twenty mongrel canines were included.A Swan-Ganz catheter wag introduced into the right internal jugular vein using the Seldinger technique,and then was inserted into the pulmonary artery.Balloon occlusion of the right inferior lobe pulmonary artery for 4 h was followed by removing catheter and 4 h of reperfusion.Animals were divided into four groups of A(no edaravone during ischenmia and reperfusion),B(edaravone used only during ischemia),C(edaravone used during both ischemia and reperfusion)and D group(edaravone used only during reperfusion)(n=5 per group).Every group was divided into three time points including before ischemia,4 h after ischemia and 4 h after reperfusion.CT scan and CT perfusionwere performed at the three time points.The blood flow(BF),blood volume(BV)and mean transit time (MTT)of the bilateral inferior regional lung parenchyma were measured with the software of perfusion 3.Results CT examination showed pulmonary edema in the right inferior lung lobe at 4 h after reperfusion.(1)The BF and MTT of A,B,C and D group were[(259.4±15.7)ml·min-1·100 g-1,(293.7±7.9)ml·min-1·100 g-1,(379.4±14.5)ml·min-1·100 g-1,(382.5±16.6)ml·min-1·100 g-1]and[(3.1±0.2)s,(2.6±0.2)s,(2.2±0.1)s,(1.9±0.2)s]respectively at 4 h after reperfusion.The BF and MTT were statistically difierent(P＜0.01)between groups(A and B,A and C,A and D,B and C,B and D)except between group C and D(the P value＞0.05)at 4 h after reperfusion,but the BV was not statistically different between groups(P＞0.05).(2)The BF[(397.2±19.2)ml·min-1·100 g-1and(259.4±15.7)ml·min-1·100 g-1in group A,(393.2±16.1)ml·min-1·100 g-1and(293.7±7.9)ml·min-1·100 g-1 in group B]and MTT[(1.8±0.1)8 and (3.1±0.2)s in group A,(1.8±0.2)s and(2.6±0.2)s in group B]were statistically different(P＜0.01),but the BV[(12.0±0.9)ml/100 g and(12.2±1.0)ml/100 g in group A,(11.9±1.5)ml/100 g and(12.2±1.3)ml/100 g in group B]were not different(P＞0.05)between groups before ischemia and 4 h after ischemia.The BF.MTT and BV were not statistically significant between before ischemia and4 h after reperfusion in group C and D(P＞0.05).ConclusionsEdaravone can attenuate the degree of the PTE IRI.Multi-slice CT perfusion imaging can evaluate effect.
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BACKGROUND: Biliary tract complications are one of the most common postoperative problems after liver transplantation.Balloon dilation and percutaneous transhepatic biliary drainage (PTBD) has become an effective method to improve biliary complication after orthotopic liver transplantation (OLT).OBJECTIVE: To evaluate the balloon dilation and PTBD in the treatment of biliary stricture after OLT through case follow up.DESIGN, TIME AND SETTING: A total of 53 consecutive patients underwent interventional procedures to treat biliary stricture after OLT in the Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University from July 1999 to March 2007 and were recruited for this study. The series included 46 men and 7 women, with 17-64 years of age. After OLT transplantation, all patients had abnormally elevated serum bilirubin level, and confirmed to suffer from obstruction of biliary tract by CT or MRI examinations.METHODS: Of 50 patients who received PTBD treatment, 36 underwent PTBD through right bile duct, 14 underwent bilateral (right bile duct and left bile duct) PTBD with 6 patients through left bile duct in the second treatment. A total of 13 underwent balloon dilation, and 3 were subjected to balloon dilation alone.MAIN OUTCOME MEASURES: An averaged 9.6 months of follow up was performed in 53 patients to observe obstructive jaundice recurrence induced by abnormally elevated serum bilirubin level after percutaneous transhepatic biliary interventional procedures.RESULTS: Follow up results showed satisfactory clinical outcome with obstructive jaundice resolved in all patients, except one patient, who received treatment with T tube, died of acute rejection at month 1 during the follow up, and one patient with liver failure had extremely poor prognosis after discharge at month 1 during the follow up. Obstructive jaundice was recovered even healed and serum bilirubin level was decreased to normal level in 51 patients at the end of follow-up. Primary success rate was 79% (42 in 53 cases), and assisted success rate was 21%. The first interventional procedure failed to treat obstructive jaundice in 5 patients. Obstructive jaundice recurred after primary percutaneous procedure in other 6 cases. No procedure related severe complications happened.CONCLUSION: Balloon dilation and PTBD are safe to treat biliary tract complication after OLT, without complication.
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Objective To analyze the occurrence of infections relative to percutanous biliary drainage(PTBD)or stenting for malignant obstructive jaundice and explore the therapy and prevention. Methods 181 patients(130 male and 51 female; median age 64.5 years old)with malignant biliary obstructive jaundice were investigated including 81 hepatobiliary cancers,42 pancreatico-ampullae tumors,58 gestro-intestinal portal lymphatic metastasis. All cases accepted PTBD or placement of metallic stents and the perioperative complications were recorded and analysed including the occurance and treatment. Results All cases accepted PTBD or stenting successfully. The perioperative biliary infection was the major complication including 50 out of 62 preoperative infected cases(34.25%). 18 cases(15.13%)suffered from biliary infection after operation with 13 under control,5 without control,4 complicated with pulmonary infection and 17(9.39%)died of serious biliary infections. Gram-negative bacilli and endotoxin were the main cause of the severe biliary infection. Postoperative mild pancreatitis occurred in 65 cases(35.91%)without severe necrotic changes and were cured after anti-inflammatory treatment. Hepatic abscess due to biliary leak occurred in 1 case(0.55%),and was cured by CT-guided drainage. Conclusion Biliary infection is the most common complication after interventional therapy and should be promptly under control for preventing mortality and prolonging survival. Simultaneously,acute pancreatitis should also be on alert but good prognosis would be obtained with apt therapy.(J Intervent Radiol,2007,16: 693-695)
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<p><b>OBJECTIVE</b>To evaluate the method of palliative drainage by means of metallic indwelling stents or plastic tubes for patients with malignant biliary obstruction.</p><p><b>METHODS</b>From January 1995 to February 2001, 243 consecutive patients (161 men and 82 women; aged 26 - 91 years, mean of 61.3 years) with malignant biliary obstruction were treated with transhepatic placement of metallic stents and/or plastic tubes. Among them, 47 patients had pancreatic carcinoma, 98 cholangiocarcinoma, 28 metastatic carcinoma and 60 hepatic carcinoma. 169 stents of nine types were used in this series. After stenting, 47 patients were treated for local tumors. Procedure- and device-related complications were recorded. Patient survival and stent patency rates were calculated with Kaplan-Meier survival analysis.</p><p><b>RESULTS</b>One hundred and three patients underwent successfully stent placement for the first time. Others had their stents installed 1 - 2 weeks after catheterization. Stents were used in 132 patients. Ninety-five patients were treated with a single stent. Seventeen patients had two stents installed for bilateral drainage, 20 patients had two stents installed from top to bottom to create stenting of adequate length, and 12 patients had stents placed across the ampulla. The 2-month mortality rate was 8.64% (21/243). Major complications occurred in two patients (0.8%, 2/243). Minor complications included self-limited bleeding into the drainage tubes and fever. The average patency of the initial stent was 7.5 months and average survival was 9 months. Thirteen patients received brachytherapy in their stents, 15 extra radiation therapy, and 19 intra-arterial infusion chemotherapy. The 47 patients treated for local tumors had an average survival of 11.3 months (log rank 32.8, P < 0.001) with an average patency of 9.7 months (log rank 4.7, P < 0.05).</p><p><b>CONCLUSION</b>Percutaneous transhepatic bile drainage as a palliative procedure is well tolerated by patients. After stenting, treatment for local tumor may prolong the duration of stent patency and the survival of patients.</p>
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Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de los Conductos Biliares , Colangiocarcinoma , Colestasis , Diagnóstico por Imagen , Terapéutica , Drenaje , Neoplasias Hepáticas , Cuidados Paliativos , Neoplasias Pancreáticas , Radiografía Intervencional , StentsRESUMEN
Objective To report our experience of interventional procedure for arterial complications in post renal transplantation and to evaluate its clinical value.Methods In a retrospective analysis of renal transplantations in our center,52 cases of renal allograft artery abnormalities had taken angiography.Interventional procedure included transluminal angioplasty of arterial stenoses,treatment of arterial occlusion,and embolization of pseudoaneurysm.Results Renal allograft artery abnormalities included artery stenosis (n=21),artery thrombosis (n=13) and embolision (n=1),renal artery pseudoaneurysms (n=2),and decrease of renal artery flow (n=3).Of the 21 artery stenosis,2 grafts with artery stenosis were lost because the stenosis could not be corrected,and 3 with mild stenosis received no treatment.Another 16 accepted renal artery angioplasty (balloon dilation,n=12,and stent implantation,n=4).14 achieved long-term allograft function.1 graft was lost because renal function failed to recover.Restenosis occurred in one stent implantation,and lost the allograft function after secondary dilation.13 cases received thrombolytic therapy through artery catheter for thrombosis and 9 achieved long-term allograft function.Thrombolyses failed in 3 cases,and renal function failed to recover in 1 case.One pseudoaneurysm received stent implantation after embolization,and got a short-term allograft function.The other one received allograft excision.Conclusion Intravascular interventional therapy will be the first-line therapy for any indications of complication in post renal transplantation,and it can surely save the kidney in a majority of instances.