ABSTRACT
OBJECTIVE: The purpose of this study is to investigate the long-term safety and efficacy of a small-diameter expandable transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension. MATERIALS AND METHODS: This single-center retrospective study included 28 patients (12 women and 16 men; mean age, 56.9 years) who underwent small-diameter expandable TIPS creation between 2008 and 2010 for refractory ascites (n = 15; mean [± SD] model for end-stage liver disease [MELD] score, 15.5 ± 5.3) or gastrointestinal variceal bleeding (n = 13; mean MELD score, 15.2 ± 8.4). An expandable TIPS was created by deploying a covered stent inside a balloon expandable stent. For patients with recurrent symptoms, TIPS adjustment was made by balloon expandable stent balloon dilation. The TIPS diameter was defined as the diameter of the final angioplasty balloon. TIPS patency and efficacy and the rate of post-TIPS hepatic encephalopathy were evaluated. RESULTS: The median diameter of the initial TIPS was 8 mm in the group with variceal bleeding compared with 6 mm in the group with ascites (p = 0.003). The primary patency rate at 1 and 5 years was 90.8% and 73.3%, respectively. Eighty percent of patients with ascites required no or less-frequent large-volume paracentesis. The clinical success rate for patients with acute variceal bleeding was 92.3%. Six patients with ascites (initial TIPS diameter, 6 mm) and two patients with variceal bleeding (initial diameter, 6 mm and 8 mm) required subsequent TIPS adjustment. Of the 22 patients with no prior history of enecphalophy, seven patients (31.8%) experienced new hepatic encephalopathy within 90 days. CONCLUSION: A small-diameter expandable TIPS is technically feasible and safe, with efficacy falling within the range of that of conventional TIPS. This technique offers the possibility of individualizing the degree of portal decompression.
Subject(s)
Ascites/surgery , Esophageal and Gastric Varices/surgery , Gastrointestinal Hemorrhage/surgery , Hypertension, Portal/surgery , Liver Failure/surgery , Portasystemic Shunt, Transjugular Intrahepatic , Ultrasonography, Interventional , Adult , Aged , Aged, 80 and over , Ascites/diagnostic imaging , Contrast Media , Esophageal and Gastric Varices/diagnostic imaging , Female , Fluoroscopy , Gastrointestinal Hemorrhage/diagnostic imaging , Humans , Hypertension, Portal/diagnostic imaging , Liver Failure/diagnostic imaging , Male , Middle Aged , Polytetrafluoroethylene , Retrospective Studies , Treatment OutcomeABSTRACT
Computed tomography angiography (CTA) of the extremities offers a noninvasive, rapid means of evaluation of the extremities in vascular emergencies. CTA is now the first-line investigation for this purpose, offering high sensitivity and specificity in diagnosis. The learning objectives of this review article include reviewing normal arterial anatomy and variants of the upper and lower extremity, illustrating CTA findings in traumatic vascular injuries, and exploring the range of vascular pathologies that may cause acute ischemic symptoms in the extremities.
Subject(s)
Computed Tomography Angiography/methods , Emergency Service, Hospital , Extremities/blood supply , Extremities/diagnostic imaging , Vascular Diseases/diagnostic imaging , Emergencies , HumansABSTRACT
We present a case of ovarian torsion in pregnancy with demonstration of vascular flow on sequential Doppler ultrasonography. Magnetic resonance imaging demonstrated ovarian enlargement and edema. Mild symptoms and low clinical suspicion, in addition to risks associated with pregnancy prevented early laparoscopic examination, though torsion was considered. Progressive ovarian enlargement supported surgical intervention, which confirmed the presence of torsion. This case report reviews multimodality imaging characteristics of ovarian torsion, re-emphasizing the significance of ovarian morphology.
