Endovascular diagnosis and intervention in patients with isolated hyperammonemia, with or without ascites, after liver transplantation.

Hyperammonemia with or without ascites with normal synthetic liver functions after liver transplantation might indicate the presence of anastomotic stenosis of the portal or hepatic vein or the existence of a patent portosystemic shunt. The authors describe six patients, three children after split-liver transplantation and three adults after cadaver liver transplantation, who presented with hyperammonemia. Three patients had ascites. All lesions were successfully treated percutaneously; stents were placed in patients with anastomotic stenoses and coil embolization was performed in patients with patent portosystemic shunts--with either transhepatic or transjugular approaches according to the site of the abnormality. Ammonia levels returned to normal, and ascites had regressed completely for at least 3 months.

Peripheral cutting balloon in the management of resistant benign ureteral and biliary strictures: long-term results.

PURPOSE: To report the long-term follow-up results of peripheral cutting balloon incision and dilatation (PCBID) after failed high-pressure balloon dilatation in patients with benign ureteral and biliary strictures. MATERIALS AND METHODS: The study included 9 patients (5 males and 4 females) who underwent successful PCBID procedures. Of these, 4 patients had biliary strictures; 2 of them had choledocho-choledochal anastomosis after liver transplantation, one at the choledocho-jejunal anastomosis, and the other at the papilla of Vater after failed endoscopic papillotomy. Of the 5 patients with ureteral strictures, 2 occurred following kidney transplantation, one after local radiation, and 2 had pelvic metastases compressing the urinary tract. The duration of follow-up, both clinical and radiological, was 24 months. RESULTS: The 9 patients who underwent successful PCBID procedures represented 82% of the original group treated by PCBID, which we reported in a previous publication. There were no periprocedural complications. The rate of primary patency, which was confirmed clinically and ultrasonographically at the end of follow- up, was 55% (5/9), and the secondary patency rate was 78% (7/9). Choledocho-choledochal restenosis occurred in 2 patients, 5 and 9 months after liver transplantation, who were treated percutaneously; one by balloon angioplasty (secondary patency for 19 months) and the other by PCBID (patency for 15 months). The remaining 2 patients (both with pelvic metastases) had restenosis 5 and 6 months postprocedure and were successfully treated by the insertion of double-J ureteral stents. CONCLUSION: PCBID is a simple and safe option for the treatment of ureteral and biliary strictures after failed high-pressure balloon dilatation, which demonstrated a two-year primary patency rate of 55% and a secondary patency rate of 78%.

Use of peripheral cutting balloon in the management of resistant benign ureteral and biliary strictures.

PURPOSE: To report the initial and midterm results of percutaneous cutting balloon incision and dilation (PCBID) for the treatment of benign ureteral and biliary strictures in patients after failed high-pressure balloon dilation. MATERIALS AND METHODS: The study sample consisted of 11 patients: three with ureteric strictures after renal transplantation, three with biliary anastomotic strictures after liver transplantation, three with pelvic metastatic disease compressing the ureter, one after a failed endoscopic papilla of Vater sphincterotomy, and one with tight stenosis at the choledochojejunal anastomosis. All strictures were resistant to high-pressure balloon dilation. Four patients underwent PCBID immediately after failed high-pressure balloon dilation in the same session, and seven underwent the procedure in a separate session within the subsequent week. The width of the peripheral cutting balloons did not exceed the diameter of the normal lumen (7-8 mm). RESULTS: PCBID was successful in nine patients (82%). One failure occurred in a transplanted ureter and one occurred in a transplanted liver with a choledochocholedochal anastomosis. In both cases, PBCID was performed in the same session as failed high-pressure balloon dilation. There were no periprocedural complications. Patency was confirmed at the 3- and 6-month clinical and ultrasonographic follow-up. CONCLUSION: PCBID is a simple minimally invasive method for the treatment of benign ureteric and biliary strictures. The success rate is high and no complications occurred.