Morphine prophylaxis alleviates pain in transjugular intrahepatic portosystemic shunt procedure: A randomized clinical trial.

BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) is an accepted minimal invasive procedure for the management of complications of portal hypertension. OBJECTIVE: This study aims to investigate the value of the preemptive administration of morphine, when compared with on-demand morphine, during TIPS. METHODS: The present study was a randomized control trial. A total of 49 patients were selected to receive 10 mg of morphine either before the TIPS procedure (group B, n= 26), or on demand when needed during the TIPS procedure (group A, n= 23). The patient's pain was scored using the visual analog scale (VAS) during the procedure. VAS, pain performance, HR, systolic pressure, diastolic pressure and SPO2 were recorded at four-time points: before the operation (T0), during the trans-hepatic puncture of the portal vein (T1), during the intrahepatic channel expansion (T2), and when the operation was finished (T3). The duration of the operation was also recorded. RESULTS: In group A, the proportion of severe pain at T1 was 4.3% (one case), two cases were combined with vagus reflex, and the proportion of severe pain at T2 was 65.2% (15 cases). No severe pain occurred in group B. The VAS score significantly decreased at T1, T2 and T3 in group B, when compared to group A (P< 0.05). HR, systolic pressure and diastolic pressure significantly decreased at T2 and T3 in group B, when compared to group A (P< 0.05). There was no significant difference between the two groups in terms of SPO2 (P> 0.05). CONCLUSION: Preemptive analgesia can effectively relieve severe pain during TIPS, improve patient comfort and compliance, ensure a routine procedure, and offer excellent safety, and is simple and effective.

Safety and efficacy of conservative, endovascular bare stent and endovascular coil assisting bare stent treatments for patients diagnosed with spontaneous isolated superior mesenteric artery dissection.

INTRODUCTION: Isolated dissection of visceral artery organs is very infrequently reported and when it occurs it mostly affects the superior mesenteric artery (SMA) with abdominal pain as the commonest presenting symptom. However, the best therapeutic strategy in symptomatic patients has not yet been established. AIM: To evaluate the safety and efficacy of conservative, endovascular bare stent and endovascular coil assisting bare stent treatments for patients diagnosed with spontaneous isolated superior mesenteric artery dissection (SISMAD). MATERIAL AND METHODS: We reviewed patients who had SISMAD and received conservative, bare stent and coil assisting bare stent as a primary treatment between 2014 and 2018. Patient demographics, symptoms, angiographic findings and treatment outcomes were analyzed. RESULTS: A total of 62 patients was found to have SISMAD among whom 83.9% (n = 52) were male and 16% (n = 10) were female with the mean age of 52.55 ±7.22 years, range 33-77. 22.6% (n = 14) received conservative, 62.9% (n = 39) endovascular bare stent and 14. Four percent (n = 9) endovascular coil assisting bare stent treatment. The success rate in primary treatment was conservative 78.5% (n = 11), bare stent 97.4% (n = 38), coil assisting bare stent 100% (n = 9). The mean follow-up duration (months) was 28.76 ±12.87. CONCLUSIONS: Endovascular bare stent placement is a safe, effective, and successful treatment in the management of symptomatic SISMAD. The diagnostic imaging result is a key point for planning appropriate treatment especially in patients with tapered vessels, longer dissection lesion, and dissection aneurysm where coil assisting bare stent shows good results. Conservative treatment should be given priority for the asymptomatic patient, but close monitoring is highly recommended.

Endovascular Treatment of Subclavian Artery Pseudoaneurysm.

BACKGROUND: In recent years, endovascular treatment of subclavian artery pseudoaneurysm (SAP) has been recommended by many experts. The aim of this study is to evaluate the safety and efficacy of the endovascular treatment of SAP, and to introduce our experience in the diagnosis and treatment of SAP. METHODS: A total of 8 consecutive patients with SAP were treated with endovascular treatment in our hospital between 2010 and 2018. We retrospectively reviewed the patients' clinical characteristics, physical examinations findings, diagnostic imaging results, endovascular treatment, clinical outcome, and follow-up results. RESULTS: All the 8 patients received endovascular treatment with covered stents initially. The technical success rate was 87.5% (7/8). In 1 patient with severe tortuosity of the proximal subclavian artery, the stent could not be released through the femoral artery approach in the primary operation but was successfully released via the brachial artery approach in the secondary operation. No complications occurred in the perioperative period. All the symptoms and signs were significantly relieved. During a follow-up of 4.5-84.5 months (average 31.5 months), 1 patient developed an endoleak 4 months after operation and reintervention was attempted but failed. No adverse events occurred in other patients during the follow-up period. CONCLUSIONS: Endovascular treatment of SAP is safe and effective, and should be used as a first-line treatment. Stent placement through the brachial artery approach is recommended for SAP with severe proximal vascular tortuosity.

Kissing stent management of stenosis of two branches of left renal artery bifurcation: a case report.

BACKGROUND: Secondary hypertension accounts for 5% of all cases of hypertension. Renal artery stenosis is one of the common causes of secondary hypertension. Atherosclerosis and fibromuscular dysplasia are the commonest types of stenosis associated with renal vascular hypertension, with the former accounting for 70-80% of all cases and the latter accounting for 10% of the incidence. The greatest incidence atherosclerosis is in men over the age of 40 years, mostly affecting the proximal part of the renal arteries, whereas fibromuscular dysplasia affects women ranging in age from 30 to 50 years. Currently, possible treatments are medical treatment using blood pressure-lowering drugs, balloon angioplasty with or without stent insertion, and surgery to reconstruct the artery. CASE PRESENTATION: We report a case of a 46-year-old Asian woman with stenosis of two branches of renal artery bifurcation treated by percutaneous balloon dilatation and stenting of both branches after referral to our department for a renal angiogram following 8 months of uncontrolled hypertension despite receiving medications. Initially, the patient presented with severe headache and fatigue. She was a known nonsmoker, was not diabetic, and had no history of diabetes in her family. She had no history of atherosclerosis. Apart from high blood pressure, the result of her physical examination was unremarkable. Laboratory investigations revealed normal serum cholesterol, lipid profile, and serum creatinine. She had been attending a hypertension clinic and receiving antihypertensive drugs for the past 8 months on a regular basis under close observation. Despite this treatment and care, her blood pressure remained high at 175/110 mmHg, which the attending doctor concluded to be uncontrolled blood pressure. Initial imaging indicated left renal artery stenosis, and the patient was referred to our department. CONCLUSIONS: For patients with uncontrolled hypertension despite receiving medications, renal Doppler ultrasound should be included in the diagnostic workup for secondary hypertension. Once renal artery stenosis is suspected, renal angiography is highly recommended because the technique is able to accurately diagnose stenosis in the branch arteries, unlike computed tomographic angiography and magnetic resonance angiography. Percutaneous transluminal renal angioplasty is the treatment of choice for renal artery stenosis in patients with renovascular hypertension or renal dysfunction.