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Objective To assess the efficacy and safety of different diameter covered stents used in transjugular intrahepatic portosystemic shunt (TIPS) for esophagogastric varices with bleeding (EGVB). Methods The clinical data of 68 patients with portal hypertension due to cirrhosis, who received TIPS for EGVB during the period from Desember 2010 to February 2015, were retrospectively analyzed. Among the 68 patients, covered stent with diameter of 7mm was used in 30 (small stent group) and covered stent with diameter of 8mm was employed in 38 (big stent group). Using Kaplan-Meier method, the cumulative digestive tract no-rebleeding rate, the patency rate of shunt and the survival rate of both groups were analyzed. Logrank test was used to make comparison between the two groups, and chi-square test was conducted to compare the incidence of hepatic encephalopathy between the two groups. Results The operative success rate was 100％ in 68 patients. The patients were followed up for 0.1-52.3 months, with a mean of (19.4±16.0) months. The 3-, 6-and 12-month cumulative digestive tract no-rebleeding rates were 86.54％, 79.30％ and 74.90％ respectively in the small stent group, which were 91.87％, 85.93％ and 81.63％ respectively in the big stent group, but the differences between the two groups were not statistically significantly (X2=0.05, P=0.83). The 3-, 6-and 12-month cumulative patency rates of shunt in the small stent group were 95.00％, 80.19％ and 70.17％ respectively, which in the big stent group were 96.15％, 91.97％ and 81.07％ respectively, and no statistically significant differences existed between the two groups (X2=0.40, P=0.53). The 3-, 12-, 24-and 48-month cumulative survival rates in the small stent group were 93.33％, 86.67％, 75.11％ and64.38％ respectively, while those in the big stent group were 97.37％, 94.23％, 88.68％ and 76.02％ respectively, and the differences between the two groups were not statistically significantly (X2=2.21, P=0.14). Postoperative hepatic encephalopathy occurred in 15 patients (15/68, 22.06％), the incidences of hepatic encephalopathy in the small stent group and in the big stent group were 20.00％ (6/30) and 23.68％ (9/38) respectively, the difference between the two groups was not statistically significantly (X2=0.13, P=0.72). Conclusion Compared with the use of 7mm covered stent, the use of 8mm covered stent in TIPS neither can improve the curative effect nor can reduce the incidence of hepatic encephalopathy.
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Objective To assess the efficacy and safety of transjugular intrahepatic portasystemic shunt (TIPS) with Viatorr covered stent in patients with portal hypertension-related complications.Methods Clinical data of 8 patients with por-tal hypertension-related complications were analyzed retrospectively.All the cases received TIPS with Viatorr covered stent.After the operation,the followed up was used to evaluate the therapeutic effect of TIPS by enhanced CT scan.Results All the operations of TIPS were technically successful.And all the cases were treated with Viatorr covered stents with diameter of 8 mm and covered segment length of 50-80 mm.For 1 case with cavernous transformation of portal vein,a 8 mm×40 mm E-Luminexx bare stent was implanted in the portal vein side.For 1 case with hepatic vein stenosis,a 8 mm× 40 mm Fluency covered stent was implanted in the hepatic vein side.After the operation,the portal pressure reduced from (33.08 [29.32,40.22])mmHg (preoperative) to (23.31 [21.43,26.51])mmHg (postoperative) with statistical difference (Z=-2.52,P=0.012).The patients were followed up for 1.1-7.7 months,and all the patients were alive without complications of portal hypertension.There were 2 cases with mild hepatic encephalopathy after operation.During the reexamination time of 1-7.7 months,all TIPS shunts remained patency.Conclusion TIPS with Viatorr stent is a safe and effective treatment for patients with portal hypertension-related complications.
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Objective To assess the efficacy and safety of transjugular intrahepatic portasystemic shunt (TIPS) with Viatorr covered stent in patients with portal hypertension-related complications.Methods Clinical data of 8 patients with por-tal hypertension-related complications were analyzed retrospectively.All the cases received TIPS with Viatorr covered stent.After the operation,the followed up was used to evaluate the therapeutic effect of TIPS by enhanced CT scan.Results All the operations of TIPS were technically successful.And all the cases were treated with Viatorr covered stents with diameter of 8 mm and covered segment length of 50-80 mm.For 1 case with cavernous transformation of portal vein,a 8 mm×40 mm E-Luminexx bare stent was implanted in the portal vein side.For 1 case with hepatic vein stenosis,a 8 mm× 40 mm Fluency covered stent was implanted in the hepatic vein side.After the operation,the portal pressure reduced from (33.08 [29.32,40.22])mmHg (preoperative) to (23.31 [21.43,26.51])mmHg (postoperative) with statistical difference (Z=-2.52,P=0.012).The patients were followed up for 1.1-7.7 months,and all the patients were alive without complications of portal hypertension.There were 2 cases with mild hepatic encephalopathy after operation.During the reexamination time of 1-7.7 months,all TIPS shunts remained patency.Conclusion TIPS with Viatorr stent is a safe and effective treatment for patients with portal hypertension-related complications.
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Objective To evaluate the treatment effect of balloon angioplasty and cryoplasty on iliac artery stenosis in canine model.Methods Canine models of iliac artery stenosis were established with surgical ligation and transfixion.Models were randomly divided into two groups:iliac artery stenosis treated by cryoplasty (n =8) and by balloon angioplasty (n =8).The degree of iliac artery stenosis of two model groups was assessed by digital subtraction angiography (DSA) immediately and two weeks after the angioplasties.Then all the dogs were executed for pathological observation of the target vessels.Results Sixteen canine models of iliac artery stenosis were established by surgical ligation and transfixion method with 100％ success rate.DSA showed there was (45 ± 12)％ of residual artery stenosis in the cryoplasty group immediately after surgery,while it was (39-12)％ in the balloon angioplasty group,and there was no significant difference between them(t =3.183,P ＞ 0.05).The artery stenosis of cryoplasty group was (48 ± 17) ％ after two weeks and not significantly different from that after surgery immediately (t =-1.271,P ＞ 0.05).The artery stenosis of balloon angioplasty group was (67 ± 13)％ after two weeks,and it was significantly higher compared with at after surgery immediately (t =-6.666,P ＜ 0.01).The degree of vascular stenosis in balloon angioplasty group was severer than that in cryoplasty group two weeks after angiography(P =0.041).The pathological examination showed artery intimal hyperplasia in cryoplasty group was milder than that in balloon angioplasty group and neointimal content of collagen in cryoplasty group was less than that in balloon angioplasty group.Conclusions The animal models of iliac artery stenosis were established successfully with surgical ligation and transfixion by damaging the intima and media of arterial wall.Compared with balloon angioplasty,the cryoplasty was able to inhibit proliferation of intimal and reduce collagen synthesis to prevent the iliac artery restenosis.