Survival and clinical success of endovascular intervention in patients with Budd-Chiari syndrome: A systematic review.

Budd-Chiari syndrome is a complex clinical disorder of hepatic venous outflow obstruction, originating from the accessory hepatic vein (HV), large HV, and suprahepatic inferior vena cava (IVC). This disorder includes both HV and IVC obstructions and hepatopathy. This study aimed to conduct a systematic review of the survival rate and clinical success of different types of endovascular treatments for Budd-Chiari syndrome (BCS). All participant studies were retrieved from four databases and selected according to the eligibility criteria for systematic review of patients with BCS. The survival rate, clinical success of endovascular treatments in BCS, and survival rates at 1 and 5 years of publication year were calculated accordingly. A total of 3398 patients underwent an endovascular operation; among them, 93.6% showed clinical improvement after initial endovascular treatment. The median clinical success rates for recanalization, transjugular intrahepatic portosystemic shunt (TIPS), and combined procedures were 51%, 17.50%, and 52.50%, respectively. The median survival rates at 1 and 5 years were 51% and 51% for recanalization, 17.50% and 16% for TIPS, and 52.50% and 49.50% for combined treatment, respectively. Based on the year of publication, the median survival rates at 1 and 5 years were 23.50% and 22.50% before 2000, 41% and 41% in 2000‒2005, 35% and 35% in 2006‒2010, 51% and 48.50% in 2010‒2015, and 56% and 55.50% after 2015, respectively. Our findings indicate that the median survival rate at 1 and 5 years of recanalization treatment is higher than that of TIPS treatment, and recanalization provides better clinical improvement. The publication year findings strongly suggest progressive improvements in interventional endovascular therapy for BCS. Thus, interventional therapy restoring the physiologic hepatic venous outflow of the liver can be considered as the treatment of choice for patients with BCS which is a physiological modification procedure.

Influencing factors and prevention and treatment progress of vascular restenosis after interventional treatment of lower extremity arteriosclerosis obliterans / 国际外科学杂志

Lower extremity arteriosclerosis obliterans is a clinical manifestation of atherosclerosis in the lower extremities.At present, the main treatment methods include stent implantation, balloon angioplasty.However the incidence of restenosis after interventional surgery is high, which seriously affects the effect of surgical treatment and the prognosis of patients.This article reviews the mechanism, influencing factors and the latest progress in the prevention and treatment of vascular restenosis after arteriosclerosis obliterans of the lower extremity orteriosclerosis obliterans intervention, which is of important clinical significance to the early prevention and treatment of instent restenosis.

Ruptured Bronchial Artery Aneurysm Treated With Aortic Stent Graft and Aneurysm Embolization.

BACKGROUND: Mediastinal bronchial artery aneurysms are uncommon, with fewer than 40 published case reports. This study objective was to evaluate the short term follow up of two cases ruptured Bronchial Artery Aneurysm (rBAA) treated with aneurysm embolization and subsequent aortic stent graft. METHODS: Two cases of rBAA were treated with a combination of an aortic stent-graft and aneurysm embolization. With rBAA, aneurysm embolization could be performed with sodium polymannuronate until the aneurysm was almost completely packed. One of the limitations of aneurysm embolization is spontaneous recanalization of previously occluded aneurysm. So a stent-graft was deployed to isolate the feeding artery of the rBAA from the descending aorta. The 3 months follow- up after the procedure included chest or back pain and computed tomographic angiography. RESULTS: The hospital stays of the 2 cases were 5 and 7 days. Chest or back pain was disappeared. There were no hospital deaths and late deaths. Computed tomographic angiogram showed no recanalization and no hemothorax. These 2 patients have not reported any complications up to now. CONCLUSION: Aortic stent graft combined with aneurysm embolization is a minimally invasive, effective and safe method for rBAA.

LVIS stent-assisted endovascular embolization therapy for intracranial aneurysms: analysis of the safety and efficacy / 介入放射学杂志

Objective To evaluate the clinical safety and efficacy of LVIS stent (a low profile knitting designed self-expandable stent) in assisting endovascular embolization for intracranial saccular aneurysms.Methods A total of 127 patients with intracranial saccular aneurysm,who were admitted to authors' hospital during the period from April 2014 to June 2016 to receive LVIS stent-assisted endovascular embolization,were retrospectively analyzed.The safety of the operation,the immediate postoperative outcomes,the recurrence rate,and the clinical and radiographic follow-up results were analyzed.Results A total of 130 LVIS stents were successfully implanted in the 127 patients with intracranial saccular aneurysm,implantation failure was seen in one patient,the technical success rate was 99.2％.During or after the endovascular embolization process in-stent thrombosis was observed in 7 patients (7/127,5.5％).Neither perioperative bleeding nor death occurred.Immediately after the operation,complete occlusion of the aneurysm was obtained in 112 aneurysms (88.1％) and neck remnant was observed in 15 aneurysms (11.9％).The patients were followed up for a mean period of 8 months.Follow-up angiography was performed in 37 patients,which showed that complete occlusion of the aneurysm was obtained in 33 patients (89.1％),and visualization of the aneurysm was seen in 4 patients (10.9％),including 3 patients who had aneurysm visualization immediately after embolization and one patient who had aneurysm recurrence.No death occurred.Conclusion The use of LVIS stent to assist endovascular embolization for intracranial saccular aneurysms is safe and effective,although its long-term effect needs further observation.

Risk factor analysis of intervention for the treatment of neurological complications in the elderly patients with ruptured intracranial aneurysm / 中国脑血管病杂志

Objective To evaluate the risk factors for interventional treatment of neurological complications in elderly patients with rupture intracranial aneurysms.Methods Form December 2004 to December 2014,520 consecutive old patients (≥ 60 years) with ruptured intracranial aneurysm treated at the Department of Neurosurgery,Changhai Hospital,the Second Military Medical University were enrolled retrospectively.The imaging and clinical follow-up results at day 30 after procedure were documented.According to whether the occurrence of interventional therapy-related neurological complications (including intraoperative aneurysm rupture,interventional therapy-related thromboembolic events,early postoperative aneurysm rebleeding,new postoperative subdural hemorrhage or intraparenchymal hemorrhage),they were divided into a complication group (n =68) and a non-complication group (n =452).Univariate statistical analysis and multivariate Logistic regression analysis were used to screen the independent risk factors for the occurrence of neurologic complications after interventional therapy.Results The incidence of neurological complications in 520 patients with aneurysm was 13.1％ (n =68).Multivariate Logistic regression analysis showed that the history of hypertension (OR,2.207,95 ％ CI 1.149-4.240,P ＜ 0.05),Hunt-Hess grade Ⅳ-Ⅴ (OR,4.287,95％ CI 2.048-8.971,P ＜ 0.01),Fisher grade Ⅲ-Ⅳ (OR,2.686,95％ CI 1.483-4.865,P ＜ 0.01),wide-neeked aneurysm (OR,2.884,95 ％ CI 1.511-5.505,P ＜ 0.01),aneurysm bleb (OR,4.560,95 ％ CI 2.500-8.321,P ＜ 0.01),and aneurysm ＜ 3 mm (OR,5.748,95 ％ CI 2.122-15.570,P ＜ 0.01) were the independent risk factors for treatment-related neurological complications in the interventional treatment of intracranial ruptured aneurysms in the elderly.Conclusion The history of hypertension,high Hunt-Hess grade,high Fisher grade,wide-neck aneurysm,aneurysm bleb,and micro-aneurysm are the independent risk factors for treatment-related neurological complications in interventional treatment of intracranial ruptured aneurysms in the elderly.

Long-term prognostic analysis of early interventional therapy for lower extremity deep venous thrombosis.

The aim of the present study was to observe the long-term prognostic value of early interventional therapy for lower extremity deep venous thrombosis (LDVT). In total, 85 patients diagnosed with LDVT for the first time were consecutively selected (identified course of disease was <3 months), and were divided into the control group with 43 cases and the observation group with 42 cases according to different therapeutic methods. The control group received anticoagulation therapy and thrombolysis, or integrated surgical thrombectomy, a conventional open operation, while the observation group received comprehensive treatment, combining endovascular catheter-directed thrombolysis and thrombectomy. The therapeutic effects were compared. After treatment, the differences in circumference of the thigh and shank between the affected and unaffected extremities, and vein dysfunction score of the two groups were decreased compared with before treatment. In addition, the above indexes of the observation group were significantly lower than in the control group (P<0.05). The clinical effective rate and effective extent of the observation group were higher than those of the control group, and the differences were statistically significant (P<0.05). The occurrence rate of post-thrombotic syndrome in the observation group was lower than that of the control group, and there was no difference in comparison of grading. The recurrence rate and restenosis rate of the observation group were lower than in the control group, while the patency rate of the observation group was higher than that of the control group, and the differences were statistically significant (P<0.05). In conclusion, early catheter-directed invention of thrombolysis with thrombectomy for LDVT has good clinical effect in the short-term and long-term.

Endovascular interventional embolization for the treatment of aneurysms located at the bifurcation of middle cerebral artery / 介入放射学杂志

Objective To evaluate the therapeutic efficacy of endovascular embolism in treating aneurysms located at the bifurcation of middle cerebral artery. Methods During the period from Jan. 2009 to May 2013 at authors’ hospital, a total of 21 patients with intracranial aneurysms located at the bifurcation of middle cerebral artery were treated with interventional embolization. Of the 21 cases , steel coils were used in 7, stent-assistant embolization was adopted in 12, and dual-microcatheter technique was employed in 2. The results were analyzed. Results Postoperative angiography showed that complete embolization of the aneurysm was achieved in 14 patients, residual neck was detected in 2 patients and subtotal obliteration of the aneurysm was seen in 5 patients. Procedure-related complications occurred in 2 patients, including cerebral bleeding during operation (n = 1) and postoperative small area cerebral infarction. Seventeen patients were followed up for 6 months, and follow-up angiography showed that no recurrence of aneurysm was seen. Conclusion For un-ruptured, or ruptured with no big hematoma, intracranial aneurysms located at the bifurcation of middle cerebral artery, endovascular interventional embolization is the treatment of choice.

Hydrocoil for the treatment of intracranial aneurysms / 介入放射学杂志

In the recent few years,apart from the development of interventional technology,the development of new kinds material for packing intracranial aneurysms has hastened the promotion of endovascular interventional treatment greatly. Microvention company introduces lately Hydrocoil,a kind of hydro-agglutinated microspring coil which adopts a special hydrolink detachment technology,enriching the methods of endovascular treatment for cerebral aneurysms. Hydrocoil is a traditional platinum coil coated with expandable,unabsorble hydrogel material,which can improve the filling volume proportion of the aneurysm. At present it has been initially applied in clinic. This article summarizes the characteristics,the preclinical study,and the clinical application of Hydrocoil.(J Intervent Radiol,2007,16: 710-713)