Assuntos
Aneurisma/diagnóstico por imagem , Aneurisma/patologia , Veia Porta/diagnóstico por imagem , Veia Porta/patologia , Idoso , Aneurisma/cirurgia , Angiografia , Feminino , Seguimentos , Humanos , Artérias Mesentéricas/diagnóstico por imagem , Veia Porta/cirurgia , Tomografia Computadorizada por Raios XRESUMO
The transjugular intrahepatic portosystemic shunt has recently become widely used for portal decompression. Shunt stenosis resulting from pseudointimal hyperplasia and hepatic encephalopathy are emerging as important midterm complications of the procedure. Bile extravasation caused by bile duct transection by the stent wires has been suggested as a cause of the pseudo-intimal hyperplasia. The present case report describes a 6 1/2-month-old transjugular intrahepatic portosystemic shunt in which apparent biliary epithelial proliferation had formed large cyst-like spaces within the pseudo-intima at the site of shunt stenosis. We hypothesize that secretory products from these biliary epithelial cells may have contributed to shunt stenosis by creating expansile cysts or by stimulating pseudointimal hyperplasia. In addition, we found a large, recent Zahn's infarct adjacent to the stent. Pseudointimal hyperplasia had extended from the stent wires into the orifices of contiguous small portal and hepatic vein branches. The resulting stenosis of these small veins may have contributed to the Zahn's infarct.
Assuntos
Sistema Biliar/patologia , Infarto/etiologia , Fígado/irrigação sanguínea , Derivação Portossistêmica Cirúrgica/efeitos adversos , Doenças Biliares/etiologia , Divisão Celular , Epitélio/patologia , Humanos , Fígado/patologia , Fígado/cirurgia , Masculino , Pessoa de Meia-Idade , Derivação Portossistêmica Cirúrgica/métodosRESUMO
The bird's nest inferior vena cava filter, in clinical trial since 1982, has been placed in 568 patients at risk for pulmonary embolism. Of the 481 patients in whom the filter had been in place for 6 months or more, 440 were followed up clinically. The prevalence of clinically suspected recurrent pulmonary thromboembolism was 2.7% (12 patients) and that of inferior vena cava filter occlusion was 2.9% (13 patients). With the initial filter design, filter migration occurred in five patients. No migrations have occurred in the 147 patients treated with the filter after its modification to improve the anchoring system for greater stability. The bird's nest filter has proved safe and effective in the prevention of pulmonary embolism.
Assuntos
Filtração/instrumentação , Embolia Pulmonar/prevenção & controle , Veia Cava Inferior , Ensaios Clínicos como Assunto , Seguimentos , Migração de Corpo Estranho , Humanos , Radiografia , Aço Inoxidável , Fatores de Tempo , Veia Cava Inferior/diagnóstico por imagemRESUMO
A filter for the inferior vena cava has been devised for treatment of pulmonary embolism. Percutaneous insertion of the filter is accomplished with the use of a sheath and an 8-F catheter. Therapeutic results involving 28 patients have been excellent. No embolism has recurred; no vena cava thrombosis has developed. Since minor surgery is unnecessary, the procedure saves time and is cost-effective.