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Objective:To investigate the current situation of the use of transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension, which should aid the development of TIPS in China.Methods:The China Portal Hypertension Alliance (CHESS) initiated this study that comprehensively investigated the basic situation of TIPS for portal hypertension in China through network research. The survey included the following: the number of surgical cases, main indications, the development of Early-TIPS, TIPS for portal vein cavernous transformation, collateral circulation embolization, intraoperative portal pressure gradient measurement, commonly used stent types, conventional anticoagulation and time, postoperative follow-up, obstacles, and the application of domestic instruments.Results:According to the survey, a total of 13 527 TIPS operations were carried out in 545 hospitals participating in the survey in 2021, and 94.1% of the hospital had the habit of routine follow-up after TIPS. Most hospitals believed that the main indications of TIPS were the control of acute bleeding (42.6%) and the prevention of rebleeding (40.7%). 48.1% of the teams carried out early or priority TIPS, 53.0% of the teams carried out TIPS for the cavernous transformation of the portal vein, and 81.0% chose routine embolization of collateral circulation during operation. Most of them used coils and biological glue as embolic materials, and 78.5% of the team routinely performed intraoperative portal pressure gradient measurements. In selecting TIPS stents, 57.1% of the hospitals woulel choose Viator-specific stents, 57.2% woulel choose conventional anticoagulation after TIPS, and the duration of anticoagulation was between 3-6 months (55.4%). The limitation of TIPS surgery was mainly due to cost (72.3%) and insufficient understanding of doctors in related departments (77.4%). Most teams accepted the domestic instruments used in TIPS (92.7%).Conclusions:This survey shows that TIPS treatment is an essential part of treating portal hypertension in China. The total number of TIPS cases is far from that of patients with portal hypertension. In the future, it is still necessary to popularize TIPS technology and further standardize surgical indications, routine operations, and instrument application.
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Objective To study the efficacy and safety of bronchial artery embolization(BAE)with tris-acryl gelatin microspheres(TAGM)combined with platinum spring coil with fiber(microcoils)in the treatment of acute severe hemoptysis caused by bronchiectasis.Methods A retrospective analysis of 48 patients with bronchiectasis was performed.After the lesion vessels were confirmed by angiography,the distal capillary bed was embolized with TAGM(300-500 μm),the middle blood flow was embolized with microcoils according to the diameter of the small artery,and then the proximal vessels were embolized with TAGM(500-700 μm)again.In patients with pulmonary artery/vein fistula,appropriate TAGM(500-700 μm)was selected according to the size of the fistula and the blood flow velocity,followed by dense embolization with multiple microcoils.The complete occlusion of the lesion vessel was confirmed again by arteriography after embolization.Results The overall success rate of operation was 95.83％.There were 36 patients with immediately stopped bleeding,6 cases with effective treatment,4 cases with improved treatment,1 case with invalid treatment due to the leakage of the responsible blood vessel,which was improved after the second embolization.There was 1 case died in surgery due to sudden massive hemoptysis,choking and suffocation.During the 3-51 months follow-up,1 patient died due to sudden massive hemoptysis;4 patients had recurrent hemoptysis due to poor control of infection and collateral circulation,which were controlled after reemboliza-tion,and 1 patient with bronchiectasis and pulmonary tuberculosis had repeated hemoptysis caused by multiple pulmonary lesions and severe pulmonary infection,performing on four times embolization.There was no patient with recurrent hemoptysis occurring recanalization of primary embolized vessel.During the follow-up,the overall survival rate was 97.87％,and the hemoptysis control rate was 87.23％.Conclusion TAGM combined with microcoils is safe and effective in the treatment of acute massive hemoptysis,which has good short-term effect and long-term prognosis.
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Objective To explore the recyclability and safety of Celect retrievable filter placement in the prevention of pulmonary embolism in patients with deep venous thrombosis(DVT).Methods The data of 120 DVT patients with Celect retrievable filter were collected from the Second Hospital of Shanxi Medical University from August 2015 to March 2017 and analyzed retrospectively. The Celect filter was placed in the inferior vena cava(IVC)at the inferior margin of the renal vein for 1 to 2 cm by puncturing the contralateral femoral vein or right internal jugular vein.The filter retrieve risk was assessed within 8 weeks after being implanted. The filters would be recovered through the right jugular vein when meeting the recovery standard, and the retrieve methods included conventional method, removing the guide wire into a loop trap method and guiding wire into a loop combined with balloon assisted method.The perforation of the vena cava was observed and the tilt angle of the filter was measured.The success rate of Celect filter retrieve was evaluated by the Kaplan-Meier method. Results Celect filters were successfully implanted in 120 patients with DVT.The IVC filters were implanted through femoral vein in 111 patients and 2 cases via right internal jugular vein.No complications,asymptomatic pulmonary embolism and related death was found in all patients.Twenty four patients did not reach the standard of filter retrieve,and were follow-uped.Ninety six cases were treated with Celect retrievable filter,among which,93 cases were successfully recovered with the filter indwelling time ranging from 7 to 144 days and the median being 50 days.The failure of the filter retrieve occurred in 3 cases because of the serious tilt of the filter or the encapsulation of filter by inferior vena cava thrombus.Perforation of vena cava with no clinical symptoms occurred in 21 cases.Filter tilt was found in 35 cases,among which,15 cases had inclined angle>15 degrees or the recovery hook closed to the IVC wall.Thirteen cases with filter tip or recovery hook attached to the wall were successfully removed by using the guide wire into a loop or trap guide wire into a loop combined with balloon assisted method instead of routine removal method.The retrieve rate was 100% when the retention time of Celect filter in the body was within 106 days. Conclusion Celect retrievable filter can be implanted in DVT patients with long retrieve time window and high retrieve rate,but the filter inclination rate and vena cava perforation rate are high.
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Objective To analyze the survival and prognostic factors in the treatment of angiosarcoma. Methods A retrospective study was performed on clinical data of 30 patients pathologically diagnosed with angiosarcoma who were admitted to our hospital from 1988 to 2015 and had complete follow?up data. In those patients, 18 patients received comprehensive treatment, containing 9 patients treated with surgery plus radiotherapy, 4 patients with surgery plus chemoradiotherapy, and 5 with surgery plus chemotherapy;12 patients received non?comprehensive treatment, containing 11 patients treated with surgery alone and 1 patient radiotherapy alone. The survival rates were calculated using the Kaplan?Meier method and analyzed using the log?rank test. The Cox regression model was used for multivariate prognostic analyses. Results The 1?, 2?, and 5?year sample sizes were 29,26, and 18, respectively. The 1?, 2?, and 5?year overall survival ( OS) rates were 70?1%, 49?1%, and 40?9%, respectively;the 1?, 2?, and 5?year local relapse?free survival rates were 52?8%, 44?0%, and 35?2%, respectively;the 1?, 2?, and 5?year distant metastasis?free survival rates were 81?6%, 68?0%, and 56?7%, respectively. The multivariate analysis showed that tumor site, tumor size, staging, and visible tumor residue after initial treatment were prognostic factors for OS ( P= 0?027, 0?027, 0?011, 0?000 );In the patients with stage Ⅰ or Ⅱ disease, the comprehensive treatment achieved a significantly lower local?relapse rate than the individual treatment ( P=0?006);gender, age, staging, and tumor site were prognostic factors for distant metastasis ( P=0?028, 0?011, 0?015, 0?022 ) . Conclusions Early diagnosis and early treatment are recommended for angiosarcoma, which has high local recurrence and distant metastasis rates. Comprehensive treatment ( surgery plus radiotherapy and/or chemotherapy) is recommended for patients with stage Ⅰ or Ⅱ disease. Tumor site, tumor size, staging, and visible tumor residue after initial treatment are prognostic factors.
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Objective To explore main technical points and clinical efficacy of individualized stepwise multiple embolization treatment for refractory hemoptysis. Methods To retrospectively analyze materials of 103 patients treated by individualized stepwise multiple embolization. According to disease categories, individualized stepwise multiple embolization treatment with polyvinyl alcohol and loaded sodium alginate microspheres as basic embolization agent were performed, after the type, number, abnormal branches, pulmonary circulation and systematic pulmonary shunt of targeted vessels were confirmed through radiography. To judge short(less than 3 months), medium(3 to 6 months) and long term(more than 6 months) efficacy, resolution of hemoptysis after operation were assessed. To evaluate efficacy of individualized stepwise multiple embolization treatment for refractory hemoptysis, Kaplan-Meier survival curves were used. According to the features of target vessels to supply blood, patients were classified into with SPS and without SPS. By using Log-Rank test, the effective rates of one-year were compared between them. Results Out of 103 patients, 215 target vessels were demonstrated, among which individualized stepwise multiple embolization was for 196 target vessels, peripheral embolization for 8 vessels, and main trunk embolization in 11 patients. The visits after operation were made to 103 patients after 6 to 50 months, with the medium of 21 months. Hemoptysis was instantly resolved in 97.1%(100/103). The effective rates were 94.5%,93.2%, 89.7%,88.9%,85.2%and 76.6%for one, three, six months and one, two and three years after operation. In 103 patients, patients with SPS were 22 and without SPS were 81. One-year effective rates with and without SPS were (69.50 ± 0.11)% and (98.30 ± 0.03)% , respectively (χ2=11.662,P<0.01). Conclusion Individualized stepwise multiple embolization treatment shows excellent short-term and mid-long term efficacy in the treatment of refractory hemoptysis.
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Objective To emphasize the importance of embolization of nonbronchial systemic arteries in treatment of acute and life-threatening massive hemoptysis.Methods In a series of 146 patients with hemoptysis who underwent bronchial artery embolization,we found 12 cases whose blood supply were from 17 nonbronchial systemic arteries and hemoptysis was more than 300 ml blood within 24 hours.Embolic materials included absorbable gelatin sponge(GS),kelp micro gelatin(KMG),polyvinyl alcohol(PVA) particles and metal coils. Results In the 12 cases with 17 nonbronchial systemic arteries (4 were intercostal,3 internal mammary,3 thyrocervical trunk,3 inferior phrenic,1 left gastric,2 originated from the inferior aortic arch,and 1 originated from anterior abdominal aortic wall).Five cases were embolized by GS alone,2 cases by KMG,3 cases by GS+PVA,and 2 cases by GS+PVA+metal coils.Eight cases were performed embolization once,3 cases were performed twice and 1 case was performed three times.No significant complications developed related to embolization,except that 1 patient had transient eyesight decrease after embolization of thyrocervical trunk and 2 patients had chest pain after embolization of intercostal artery which resovled without any treatment.Conclusions During bronchial artery embolization for hemoptysis patients,all supplying artery should be searched and found.Even after successful embolization of bronchial arterys for hemoptysis patients,nonbronchial systemic arterial supply should still be taken into account.
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Objective To study the effect of thrombolysis of inta-arterial infusion of different concentrations of urokinase(UK) in dogs. Methods 25 healthy crossbreeding dogs were divided into five groups, with five dogs in each group. Every dog was injected with self-thrombus from carotis interna artery to embolize its distal part or branchers. Treatment with different concentrations of UK was initiated 2 hours after setting up the model of cerebral embolism by carotis interna artery. The dose of each group was: A(control group), 0.9% physiological sodium chloride solution; B,1 200U/ml UK; C,6 000U/mlUK; D, 12 000U/mlUK; E, 60 000U/mlUK. Angiography and CT scannings were performed before and after thrombolysis. Pathologic examination was performed 24 hours after embolism. Results The rate of recanalization of groups A,B were 0 but 100% for groups C,D and E, Judged by angiographies after thrombolysis, group C,D and E had significantly better reperfusion compared with group A,B(P