Endovascular embolization of the hepatolienal vessels in the treatment of portal hypertension.

PURPOSE: to study the characteristics and variants of changes in the structure of celiac trunk and portal vein pool vessels, to define the tactics of most effective use of endovascular interventions in the treatment of portal hypertension. MATERIAL AND METHODS: the immediate and long-term results of angiographic studies and endovascular interventions are analyzed in 329 patients with portal hypertension induced by liver cirrhosis. The compensated stage of portal hypertension was identified in 62, subcompensated in 93 and decompensated in 174 patients. The patients underwent embolization of the splenic, left gastric and gastro-omental arteries, varices of the esophagus and cardial part of the stomach. In the long-term period, appropriate corrective medical endovascular interventions were performed in the event of the identification of recanalization of the previously embolized vessels and occurrence of the collateral pathways. RESULTS: after embolization of the splenic artery the positive shifts in blood readings, reduction of the splenic size, and abatement of ascites were revealed in the majority of cases. In the long-term period, the efficacy of the procedure diminished as a result of restoration of the lumen of the previously embolized vessels or development of the collaterals which demanded repeat endovascular intervention. The hospital lethality among patients with portal hypertension who had been provided endovascular interventions because of esophageal bleeding accounted for 29.8%, with the incidence of early recurrences being equal to 4.8%. The best results were obtained in a group of patients who had undergone embolization of bleeding gastroesophageal varices coupled with occlusion of the splenic artery for decompression and intraportal infusion therapy.

[Choice of approach for transhepatic endovascular and biliary procedures]. / Vybor dostupa dlia vypol'neniia chrespechenochnykh éndovaskuliarnykh i éndobiliarnykh vmeshatel'stv.

Results of diagnostic and therapeutic transhepatic procedures in 185 patients with portal hypertension and 292 patients with obstructive jaundice are analyzed. Optimal angles for introduction of instruments, optimal intercost and the most convenient for manipulation biliovascular structures of the liver were determined. These principles permitted to reduce the failure rate in endovasculary procedures from 10.5 to 3.8%, in endobiliary--from 13.2 to 0.97%.