Construction of Transjugular Intrahepatic Portosystemic Shunt: Bare Metal Stent/Stent-graft Combination versus Single Stent-graft, a Prospective Randomized Controlled Study with Long-term Patency and Clinical Analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Balanced adjustment of the portal vein shunt volume during a transjugular intrahepatic portosystemic shunt (TIPS) is critical for maintaining liver perfusion and decreasing the incidence of liver insufficiency. A stent-graft is proved to be superior to a bare metal stent (BMS) for the construction of a TIPS. However, the clinical results of the combination application of stents and stent-grafts have not been determined. This study aimed to compare the technique of using a combination of stents and stent-grafts with using a single stent-graft to construct a TIPS.</p><p><b>METHODS</b>From April 2011 to November 2014, a total of fifty patients were randomly assigned to a stents-combination group (Group I, n = 28) or a stent-graft group (Group II, n = 22). Primary patency rates were calculated. Clinical data, including the technical success rate, bleeding control results, incidence of encephalopathy, liver function preservation, and survival rate, were assessed.</p><p><b>RESULTS</b>Technically, the success rate was 100% for both groups. The primary patency rates at 1, 2, and 3 years for Group I were 96%, 84%, and 77%, respectively; for Group II, they were 90%, 90%, and 78%, respectively. The survival rates at 1, 2, and 3 years for Group I were 79%, 74%, and 68%, respectively; for Group II, they were 82%, 82%, and 74%, respectively. The incidence of hepatic encephalopathy was 14.3% for Group I and 13.6% for Group II. The Child-Pugh score in Group I was stable at the end of the follow-up but had significantly increased in Group II (t = -2.474, P = 0.022).</p><p><b>CONCLUSIONS</b>The construction of a TIPS with either the single stent-graft or BMS/stent-graft combination is effective for controlling variceal bleeding. The BMS/stent-graft combination technique is superior to the stent-graft technique in terms of hepatic function preservation indicated by the Child-Pugh score. However, considering the clinical results of the TIPS, the two techniques are comparable in their primary shunt patency, incidence of encephalopathy and patient survival during the long-term follow-up.</p>

Efficacy of anticoagulation on patency post-permanent inferior vena caval filter placements / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the efficacy of anticoagulation on patency post-permanent inferior vena caval filter (IVCF) placements.</p><p><b>METHODS</b>The patients with deep vein thrombosis (DVT) of the lower extremity who were accepted permanent IVCF placement from December 2001 to December 2007 were reviewed retrospectively. Data on vital status, filter thromboembolism, anticoagulation time, and so on were obtained through follow-up. One hundred and thirty eight patients (75 male and 63 female) with a mean age of 65 years were enrolled in the study. All the patients were divided into non-anticoagulation group, anticoagulation group A with taking warfarin less than 6 months, or anticoagulation group B with taking warfarin more than 6 months. chi(2) test, t test, Kaplan-Meier survival curve, Log-rank test were used for statistics analysis.</p><p><b>RESULTS</b>Sixteen patients died, and 1 of them died of pulmonary embolism. Including the 1 patient mentioned before, there were 19 patients (13.8%) suffered from filter thromboembolism. Upon chi(2) test, there were no significant differences (P = 0.288) on the patency rates between non-anticoagulation, anticoagulation group A and anticoagulation group B (87.8%, 75.0%, and 88.3% respectively). Upon Kaplan-Meier survival analysis, there were still no significant differences (P = 0.227) on the mean patency time and the cumulate rates of patency at the 1st or 3rd year between the 3 groups (87.1%, 80.0%, 94.8% and 87.1%, 74.3%, 85.4% respectively).</p><p><b>CONCLUSION</b>Anticoagulation has no efficacy on patency post-permanent IVCF placements.</p>

Surgical treatment of Cockett's syndrome in patients with deep vein thrombosis of lower extremity / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the surgical treatment of Cockett's syndrome in patients with deep vein thrombosis of lower extremity (DVT).</p><p><b>METHODS</b>Ninety-five patients were diagnosed as Cockett's syndrome among 160 patients with DVT who received surgeries in our hospital from February 1991 to September 2005. Among these 95 patients, pathological changes included left common iliac vein (LCIV) occlusion (n = 20), > 50% stenosis of the LCIV (n = 53), < 50% stenosis (n = 22). All patients received thrombectomy. In patients with LCIV occlusion, resection and reconstruction were performed in 10 patients, iliocaval bypass for 3 patients, and Palma procedures for 3 patients. In patients with > 50% stenosis of LCIV, 5 patients received stent placement, 8 patients received percutaneous transluminal angioplasty (PTA) by dilation balloon catheter, 4 patients received iliac angioplasty, and the other 36 patients received PTA by F8-10 Fogarty thrombectomy catheter. Territorial anticoagulant and lytic therapy were performed through the catheter inserted into the great saphenous vein intraoperatively for 3 days and then venography was performed for all the patients postoperatively. Warfarin was administered for more than 6 months.</p><p><b>RESULTS</b>Eighty-two patients (86.3%) were cured. One patient died of myocardial infarction, and the others were improved.</p><p><b>CONCLUSIONS</b>Management of Cockett's syndrome is essential to increase the cure rate of DVT. Resection and reconstruction is useful for occlusive LCIV, while PTA or stent placement if preferred for severely stenotic vessels.</p>