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Multimodal MRI diagnosis and transvenous embolization of a basicranial emissary vein dural arteriovenous fistula: A case report 颅底发射静脉硬脑膜动静脉瘘的多模式MRI诊断和经静脉栓塞:一例报告。
Q3 Medicine Pub Date : 2023-02-01 DOI: 10.1016/j.jimed.2022.07.003
Xi Chen , Liang Ge , Hailin Wan, Lei Huang, Yeqing Jiang, Gang Lu, Jing Wang, Xiaolong Zhang

A dural arteriovenous fistula (DAVF) is an abnormal linkage connecting the arterial and venous systems within the intracranial dura mater. A basicranial emissary vein DAVF drains into the cavernous sinus and the ophthalmic vein, similar to a cavernous sinus DAVF. Precise preoperative identification of the DAVF location is a prerequisite for appropriate treatment. Treatment options include microsurgical disconnection, endovascular transarterial embolization (TAE), transvenous embolization (TVE), or a combination thereof. TVE is an increasingly popular approach for the treatment of DAVFs and the preferred approach for skull base locations, due to the risk of cranial neuropathy caused by dangerous anastomosis from arterial approaches. Multimodal magnetic resonance imaging (MRI) can provide anatomical and hemodynamic information for TVE. The therapeutic target must be precisely embolized in the emissary vein, which requires guidance via multimodal MRI. Here, we report a rare case of successful TVE for a basicranial emissary vein DAVF, utilizing multimodal MRI assistance. The fistula had vanished, pterygoid plexus drainage had improved, and the inferior petrosal sinus had recanalized, as observed on 8-month follow-up angiography. Symptoms and signs of double vision, caused by abduction deficiency, disappeared. Detailed anatomic and hemodynamic assessment by multimodal MRI is the key to guiding successful diagnosis and treatment.

硬脑膜动静脉瘘(DAFF)是连接颅内硬脑膜内动脉和静脉系统的异常连接。颅底发射静脉DAVF流入海绵窦和眼静脉,类似于海绵窦DAVF。术前准确识别DAFF的位置是进行适当治疗的先决条件。治疗选择包括显微外科断开、血管内经动脉栓塞(TAE)、经静脉栓塞(TVE)或其组合。TVE是一种越来越流行的治疗DAVFs的方法,也是颅底定位的首选方法,因为动脉入路的危险吻合会导致脑神经病变的风险。多模式磁共振成像(MRI)可以为TVE提供解剖学和血液动力学信息。治疗目标必须在发射静脉中精确栓塞,这需要通过多模式MRI进行指导。在这里,我们报告了一例罕见的利用多模式MRI辅助的TVE成功治疗颅底发射静脉DAFF的病例。在8个月的随访血管造影中观察到,瘘管已经消失,翼丛引流得到改善,岩下窦已经再通。外展缺乏引起的复视症状和体征消失了。通过多模式MRI进行详细的解剖和血液动力学评估是指导成功诊断和治疗的关键。
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引用次数: 0
Predictors of liver failure after transarterial chemoembolization in patients with spontaneously ruptured hepatocellular carcinoma: A retrospective study 自发性破裂肝细胞癌患者经动脉化疗栓塞后肝功能衰竭的预测因素:一项回顾性研究。
Q3 Medicine Pub Date : 2023-02-01 DOI: 10.1016/j.jimed.2022.10.003
Zhuofan Deng, Yunbing Wang

Background

Spontaneously ruptured hepatocellular carcinoma (rHCC) is a life-threatening condition. Transarterial chemoembolization (TACE) is a widely accepted treatment; however, it can lead to serious complications, especially liver failure. We sought to identify preoperative predictors of liver failure in patients with rHCC undergoing TACE.

Methods

Patients with rHCC who received TACE as the initial therapy were retrospectively studied at our institution between January 2016 and December 2021. Based on the occurrence of liver failure after TACE, the patients were divided into liver failure and no-liver failure groups. Predictors of liver failure after TACE were analyzed using univariate and multivariate regression analyses. The predictive performance was assessed using the area under the curve (AUC). Delong's test was used to compare predictive efficiency.

Results

Sixty patients (19 and 41 in the liver failure and non-liver failure groups, respectively) were included. Multivariate analysis showed that preoperative prothrombin activity (PTA) level (odds ratio [OR], 0.956; 95% confidence interval [CI], 0.920–0.994; P ​= ​0.024) and Child-Pugh grade B (OR, 6.419; 95% CI, 1.123–36.677; P ​= ​0.037) were independent predictors of liver failure after TACE in patients with rHCC. The AUCs of the preoperative PTA levels and Child-Pugh grade B for predicting liver failure after TACE in patients with rHCC were 0.783 and 0.764, respectively.

Conclusion

Preoperative PTA level and Child-Pugh grade B were significant independent risk factors for liver failure after TACE in patients with rHCC. These can be used to predict liver failure after TACE in patients with rHCC for individual decision-making regarding treatment planning.

背景:自发性肝细胞癌(rHCC)是一种危及生命的疾病。经动脉化疗栓塞(TACE)是一种广泛接受的治疗方法;然而,它会导致严重的并发症,尤其是肝衰竭。我们试图确定接受TACE的rHCC患者肝功能衰竭的术前预测因素。方法:对2016年1月至2021年12月在我院接受TACE作为初始治疗的rHCC患者进行回顾性研究。根据TACE后肝功能衰竭的发生情况,将患者分为肝功能衰竭组和无肝功能衰竭对照组。TACE后肝功能衰竭的预测因素采用单变量和多变量回归分析进行分析。使用曲线下面积(AUC)评估预测性能。德龙检验用于比较预测效率。结果:纳入了60名患者(肝衰竭组和非肝衰竭组分别为19名和41名)。多因素分析显示术前凝血酶原活性(PTA)水平(比值比[OR],0.956;95%置信区间[CI],0.920-0.994;P​=​0.024)和Child-Pugh分级B(OR,6.419;95%CI,1.123-36.677;P​=​0.037)是rHCC患者TACE后肝功能衰竭的独立预测因素。rHCC患者术前PTA水平和Child-Pugh B级预测TACE后肝功能衰竭的AUC分别为0.783和0.764。结论:术前PTA水平和Child-Pugh分级B是rHCC患者TACE后肝功能衰竭的重要独立危险因素。这些指标可用于预测rHCC患者TACE后的肝功能衰竭,以便对治疗计划做出个人决策。
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引用次数: 2
Evaluation of using a double helical, closed-cell stent-retriever (Skyflow) for thrombectomy procedures in acute arterial occlusion: A preclinical study and a clinical trial 评价在急性动脉闭塞中使用双螺旋闭细胞支架(Skyflow)取栓:临床前研究和临床试验
Q3 Medicine Pub Date : 2022-11-01 DOI: 10.1016/j.jimed.2022.09.003
Huan Liu , Yanyan He , Tengfei Zhou , Liangfu Zhu , Yao Zhao , Yonghong Ding , Yingkun He , Tianxiao Li

Background and purpose

Stent retriever thrombectomy is the standard therapeutic approach for ischemic stroke with acute large-vessel occlusion. This study evaluated the safety and efficacy of a new thrombectomy device (Skyflow) in the treatment of acute ischemic stroke.

Methods

After an arterial occlusion model was established, stent-retriever thrombectomy was performed. Digital subtraction angiography (DSA) and autopsy were carried out immediately after thrombectomy in six animals in the acute experimental group. Simulated stent-retriever thrombectomy was performed for three animals in the subacute experimental group, and follow-up angiography and vascular pathological examination were assessed 90 days after the operation. In the clinical trial, 192 patients with intracranial anterior circulation large vessel occlusion, within 8 ​h of symptom onset, were included to undergo thrombectomy with either Skyflow or Solitaire FR stent retriever. Efficacy and safety endpoints were recorded (including successful reperfusion, favorable clinical outcomes, time from puncture to reperfusion, instrument operation success rates and National Institutes of Health Stroke Scale (NIHSS) scores at 7 days for efficacy endpoints, and symptomatic intracranial hemorrhage (sICH), subarachnoid hemorrhage (SAH) and all-cause mortality rates for safety endpoints).

Results

All blood vessels achieved successful recanalization in the animal models. In the clinical trial, successful recanalization was attained in 88.4% of patients of the Skyflow group, which was comparable to that of the Solitaire FR group (82.5%) in the full analysis set of the clinical trial. There were no severe complications on DSA, an animal autopsy, or vessel pathological examination in animal experiments. Additionally, no statistically significant difference was observed between the Skyflow and Solitaire FR groups in the clinical trial regarding the safety endpoints.

Conclusion

This study showed that the new Skyflow stent retriever is safe and effective for the treatment of acute large vessel occlusion, as demonstrated in our animal study and human trial.

背景与目的支架取栓是缺血性脑卒中合并急性大血管闭塞的标准治疗方法。本研究评估了一种新型取栓装置(Skyflow)治疗急性缺血性脑卒中的安全性和有效性。方法建立动脉闭塞模型后,行支架取栓术。急性实验组6只动物取栓后立即行数字减影血管造影(DSA)及尸检。亚急性实验组3只动物模拟支架取栓,术后90 d随访血管造影及血管病理检查。在临床试验中,192例颅内前循环大血管闭塞患者,在症状出现8小时内,使用Skyflow或Solitaire FR支架取栓器进行血栓切除术。记录疗效和安全性终点(疗效终点包括再灌注成功、良好的临床结果、穿刺至再灌注时间、器械操作成功率和美国国立卫生研究院卒中量表(NIHSS) 7天评分,安全性终点包括症状性颅内出血(sICH)、蛛网膜下腔出血(SAH)和全因死亡率)。结果动物模型血管再通均成功。在临床试验中,Skyflow组88.4%的患者成功再通,与Solitaire FR组(82.5%)在临床试验的完整分析集中相当。动物实验DSA、动物解剖、血管病理检查均无严重并发症。此外,在临床试验中,Skyflow和Solitaire FR组在安全性终点方面没有统计学上的显著差异。结论我们的动物实验和人体试验表明,新型Skyflow支架回收器治疗急性大血管闭塞是安全有效的。
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引用次数: 0
Valvuloplasty of fetal pulmonary atresia with intact ventricular septum and hypoplastic right heart: Mid-term follow-up results 胎儿肺动脉闭锁伴完整室间隔和右心发育不全的瓣膜成形术:中期随访结果
Q3 Medicine Pub Date : 2022-11-01 DOI: 10.1016/j.jimed.2022.04.001
Gang Luo , Shuai Gao , Hongxiao Sun , Zhixian Ji , Dunliang Wang , Yue Sun , Silin Pan

Objective

This study aimed to analyze and evaluate the results of mid-term follow-up after fetal pulmonary valvuloplasty (FPV) in fetuses with pulmonary atresia with intact ventricular septum (PA/IVS).

Methods

From August 31, 2018, to May 31, 2019, seven fetuses with PA/IVS and hypoplastic right heart were included in this study. All underwent echocardiography by the same specialist and were operated on by the same team. Intervention and echocardiography data were collected, and changes in the associated indices noted during follow-up were analyzed.

Results

All seven fetuses successfully underwent FPV. The median gestational age at FPV was 27.54 weeks. The average FPV procedural time was 6 ​min. Persistent bradycardia requiring treatment occurred in 4/7 procedures. Finally, five pregnancies were successfully delivered, and the other two were aborted. Compared to data before fetal cardiac interventions (FCI), tricuspid valve annulus diameter/mitral valve annulus diameter (TV/MV) and right ventricle diameter/left ventricle diameter (RV/LV) of all fetuses had progressively improved. The maximum tricuspid regurgitation velocity decreased from 4.60 ​m/s to 3.64 ​m/s. The average follow-up time was 30.40 ​± ​2.05 months. During the follow-up period, the diameter of the tricuspid valve ring in five children continued to improve, and the development rate of the tricuspid valve was relatively obvious from 6 months to 1 year after birth. However, the development of the right ventricle after birth was relatively slow. It was discovered that there were individual variations in the development of the right ventricle during follow-up.

Conclusion

The findings support the potential for the development of the right ventricle and tricuspid valve in fetuses with PA/IVS who underwent FCI. Development of the right ventricle and tricuspid valve does not occur synchronously during pregnancy. The right ventricle develops rapidly in utero, but the development of tricuspid valve is more apparent after birth than in utero.

目的分析和评价完整室间隔肺闭锁(PA/IVS)胎儿肺动脉瓣成形术(FPV)后的中期随访结果。方法2018年8月31日至2019年5月31日,选取7例PA/IVS伴右心发育不全的胎儿作为研究对象。所有患者都接受了同一专家的超声心动图检查,并由同一团队进行手术。收集干预和超声心动图资料,分析随访期间相关指标的变化。结果7例胎儿均成功行FPV。FPV的中位胎龄为27.54周。FPV手术时间平均为6 min。持续性心动过缓需要治疗的病例有4/7。最后,有5人成功分娩,另外2人流产。与胎心干预(FCI)前的数据相比,所有胎儿的三尖瓣瓣环直径/二尖瓣环直径(TV/MV)和右心室直径/左心室直径(RV/LV)逐渐改善。三尖瓣最大反流速度由4.60 m/s降至3.64 m/s。平均随访时间30.40±2.05个月。随访期间,5例患儿三尖瓣环直径持续改善,出生后6个月至1年三尖瓣发育速度较为明显。然而,出生后右心室的发育相对缓慢。在随访中发现右心室的发育存在个体差异。结论本研究结果支持PA/IVS胎儿接受FCI后右心室和三尖瓣发育的可能性。在怀孕期间,右心室和三尖瓣并不是同步发育的。右心室在子宫内发育迅速,但三尖瓣的发育在出生后比在子宫内更明显。
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引用次数: 3
Impact and the delivery of loco-regional treatment for hepatocellular carcinoma during the COVID-19 pandemic COVID-19大流行期间肝细胞癌局部区域治疗的影响和交付
Q3 Medicine Pub Date : 2022-11-01 DOI: 10.1016/j.jimed.2022.09.004
Guo Yuan How, Uei Pua

Hepatocellular carcinoma (HCC) is the second most lethal tumour, with therapies broadly divided into curative and palliative intent. Unfortunately, the majority of HCCs were found to be unresectable at diagnosis. Advances in novel loco-regional therapies have given patients with unresectable HCC a vital chance for disease control and survival. However, the COVID-19 pandemic has greatly shaped and impacted treatment protocols and delivery for HCC patients. This review article aims to describe the impact of the COVID-19 pandemic on the delivery of loco-regional treatment modalities for HCC and compare treatment trends between the pre -pandemic and pandemic eras. Treatment of HCC involves complex collaboration between clinical professionals within their local and global healthcare institutions. The COVID-19 pandemic has had a profound impact on the treatment of HCC. The delivery of loco-regional treatment for HCC will need to adapt to each healthcare system's unique structure.

肝细胞癌(HCC)是第二大致死性肿瘤,其治疗方法大致分为治疗性和姑息性两种。不幸的是,大多数hcc在诊断时发现是不可切除的。新的局部-区域治疗方法的进展为不可切除的HCC患者提供了疾病控制和生存的重要机会。然而,COVID-19大流行极大地塑造和影响了HCC患者的治疗方案和交付。这篇综述文章旨在描述COVID-19大流行对HCC局部-区域治疗方式的影响,并比较大流行前和大流行时期的治疗趋势。HCC的治疗涉及当地和全球医疗机构的临床专业人员之间复杂的合作。COVID-19大流行对HCC的治疗产生了深远影响。肝癌局部-区域治疗的提供将需要适应每个医疗保健系统的独特结构。
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引用次数: 0
Primary balloon angioplasty for chronic occlusion of intracranial internal carotid artery: A case report 原发性球囊血管成形术治疗颅内颈内动脉慢性闭塞:一例报告。
Q3 Medicine Pub Date : 2022-11-01 DOI: 10.1016/j.jimed.2022.07.001
Tianli Li, Zhaolong Zhang, Chengjian Sun, Guoping Liu, Xiaolong Zhao, Liming Shao, Xuan Zheng, Yixing Xie, Changxin Wang, Rui Xu

Chronic occlusion of large intracranial arteries is the main cause of ischemic stroke in China. Patients with symptomatic intracranial artery occlusion and hemodynamic impairment are at high risk of recurrent stroke. Chronic occlusion of the intracranial segment of the internal carotid artery is a common type of intracranial artery occlusion. Medical management is regarded as the standard treatment for this disease. With the development of endovascular treatment, some patients with chronic cerebral artery occlusion have achieved satisfactory results with endovascular therapy. We reported a patient with symptomatic chronic occlusion of the ophthalmic segment of the internal carotid artery. Simple balloon angioplasty was performed, and the occluded ophthalmic segment of the internal carotid artery was successfully recanalized without perioperative complications. At 4 months follow-up, the internal carotid artery remained patent and perfusion of the right cerebral hemisphere improved dramatically. In addition, we briefly reviewed the relevant literature.

颅内大动脉慢性闭塞是中国缺血性脑卒中的主要病因。有症状的颅内动脉闭塞和血液动力学受损的患者有复发性中风的高风险。颈内动脉颅内段的慢性闭塞是一种常见的颅内动脉闭塞类型。医疗管理被认为是治疗这种疾病的标准方法。随着血管内治疗的发展,一些慢性脑动脉闭塞患者的血管内治疗取得了满意的效果。我们报告了一名有症状的颈内动脉眼段慢性闭塞患者。进行了简单的球囊血管成形术,成功地将闭塞的颈内动脉眼段再通,没有围手术期并发症。在4个月的随访中,颈内动脉保持通畅,右脑半球的灌注显著改善。此外,我们还简要回顾了相关文献。
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引用次数: 0
Overview of multimodal MRI of intracranial Dural arteriovenous fistulas 颅内硬脑膜动静脉瘘的多模态MRI研究综述
Q3 Medicine Pub Date : 2022-11-01 DOI: 10.1016/j.jimed.2022.04.004
Xi Chen , Liang Ge , Hailin Wan, Lei Huang, Yeqing Jiang, Gang Lu, Xiaolong Zhang

Dural arteriovenous fistulas (DAVFs) include a wide range of pathological conditions that are associated with intracranial vessel abnormalities. While some types of DAVFs present with typical neuroimaging characteristics, others share overlapping pathological and neuroimaging features that can hinder accurate differentiation. Hence, misclassification of the various types of DAVFs is common. Thorough knowledge of DAVF imaging findings is essential to avoid such misinterpretations. Traditional digital subtraction angiography (DSA) is considered the gold standard for diagnosing and evaluating DAVFs. However, angiography cannot detect changes in a patient's brain structure. Conventional magnetic resonance imaging (MRI) sequences, including MR angiography (MRA), allow the evaluation of DAVFs without ionizing radiation or invasiveness. Advanced MRI techniques, such as susceptibility-weighted imaging (SWI) and dynamic contrast-enhanced MRA, provide added value to real-time physio-pathological data regarding the hemodynamics of DAVFs. Beyond these techniques, new insights using high-resolution vascular wall MRI are incorporated for the noninvasive evaluation of DAVFs. This article reviews the pathophysiology of DAVFs, focusing on the specifics of MRI findings that facilitate their classification. The role of conventional and advanced MRI sequences for DAVFs was assessed using insights derived from the data provided by structured reports of multimodal MRIs to evaluate DAVFs.

硬脑膜动静脉瘘(davf)包括与颅内血管异常相关的多种病理情况。虽然某些类型的davf具有典型的神经影像学特征,但其他类型的davf具有重叠的病理和神经影像学特征,这可能会妨碍准确的鉴别。因此,各种类型的davf的错误分类是常见的。彻底了解DAVF成像结果是必要的,以避免这种误解。传统的数字减影血管造影(DSA)被认为是诊断和评估davf的金标准。然而,血管造影不能检测到患者大脑结构的变化。传统的磁共振成像(MRI)序列,包括磁共振血管造影(MRA),可以在没有电离辐射或侵入性的情况下评估davf。先进的MRI技术,如敏感性加权成像(SWI)和动态对比增强MRA,为davf血流动力学的实时生理病理数据提供了附加价值。除了这些技术之外,利用高分辨率血管壁MRI对davf进行无创评估的新见解也被纳入其中。本文回顾了davf的病理生理学,重点介绍了有助于其分类的MRI具体表现。利用多模态MRI结构化报告提供的数据来评估davf,评估常规和高级MRI序列对davf的作用。
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引用次数: 0
Dynamic changes in liver function after transjugular intrahepatic portosystemic shunt in patients with cirrhosis 肝硬化患者经颈静脉肝内门体分流术后肝功能的动态变化
Q3 Medicine Pub Date : 2022-11-01 DOI: 10.1016/j.jimed.2022.09.001
Chaoyang Wang , Jinghong Yao , Huanzhang Niu , Chongtu Yang , Jiacheng Liu , Yaowei Bai , Shuguang Ju , Bin Xiong

Purpose

To evaluate the dynamic changes in liver function after transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with cirrhosis and to explore its association with clinical outcomes.

Methods

This retrospective study included patients who underwent TIPS between August 2016 and December 2020. Liver function was primarily evaluated using the model for end-stage liver disease (MELD) score, which was analyzed at baseline, 1 week, 1 month, 3 months, 6 months, and 12 months using one-way repeated measures ANOVA. The Kaplan-Meier method, log-rank test, and multivariate analysis were used as appropriate.

Results

In total, 235 patients were included in this study. The MELD score was significantly higher at 1 week (11.8 ​± ​3.1 vs 13.5 ​± ​3.5, p ​< ​0.05) and 1 month (11.8 ​± ​3.1 vs 13.2 ​± ​4.6, p ​< ​0.05) than the baseline level and recovered at 3 months (11.8 ​± ​3.1 vs 11.9 ​± ​3.9, p ​> ​0.05). At 12 months, the MELD score was higher than the baseline level (11.8 ​± ​3.1 vs 12.4 ​± ​3.2, p ​< ​0.05). Patients with a recovery of the MELD score (n ​= ​151) at 3 months had a lower probability of overt and severe HE (log-rank p ​= ​0.015 and p ​= ​0.027, respectively) than those without recovery (n ​= ​84). Logistic regression analysis revealed that albumin (odds ratio [OR], 0.926; 95% confidence interval [CI], 0.863–0.992; p ​= ​0.029) and platelet count (OR, 0.993; 95% CI, 0.987–0.999; p ​= ​0.033) were independent predictive factors for non-recovery of the MELD score at 3 months.

Conclusions

Liver function after TIPS creation showed a trend of deterioration at first, followed by recovery. Recovery of liver function at three months was associated with reduced overt and severe HE.

目的评价肝硬化患者经颈静脉肝内门体分流术(TIPS)后肝功能的动态变化,并探讨其与临床预后的关系。方法本回顾性研究纳入了2016年8月至2020年12月期间接受TIPS治疗的患者。使用终末期肝病(MELD)评分模型主要评估肝功能,并在基线、1周、1个月、3个月、6个月和12个月使用单向重复测量方差分析进行分析。酌情采用Kaplan-Meier法、log-rank检验和多变量分析。结果本研究共纳入235例患者。MELD评分在1周时显著升高(11.8±3.1 vs 13.5±3.5,p <0.05)和1个月(11.8±3.1 vs 13.2±4.6,p & lt;0.05), 3个月恢复(11.8±3.1 vs 11.9±3.9,p >0.05)。12个月时,MELD评分高于基线水平(11.8±3.1 vs 12.4±3.2,p <0.05)。3个月MELD评分恢复的患者(n = 151)发生明显和严重HE的概率(log-rank分别为p = 0.015和p = 0.027)低于未恢复的患者(n = 84)。Logistic回归分析显示,白蛋白(比值比[OR], 0.926;95%置信区间[CI], 0.863-0.992;p = 0.029)和血小板计数(OR, 0.993;95% ci, 0.987-0.999;p = 0.033)是3个月MELD评分未恢复的独立预测因素。结论TIPS术后银功能呈先恶化后恢复的趋势。3个月时肝功能恢复与明显和严重HE减少相关。
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引用次数: 0
Portal vein embolization in the treatment of portal vein bleeding after percutaneous transhepatic biliary drainage: A case report and literature review 门静脉栓塞治疗经皮肝胆道引流术后门静脉出血1例报告并文献复习
Q3 Medicine Pub Date : 2022-11-01 DOI: 10.1016/j.jimed.2022.09.002
Hai Li , Naijian Ge, Chengjian He, Xiangdong Wang, Wei Xu, Jian Huang, Yefa Yang

Percutaneous transhepatic biliary drainage (PTBD) is an effective treatment for benign and malignant obstructive jaundice. Major bleeding complications occur in approximately 2–3% of patients after PTBD, which can result in death. A case involving a 63-year-old male with malignant obstructive jaundice, who experienced severe bleeding after PTBD, is reported. Emergency digital subtraction angiography, celiac trunk artery and superior mesenteric artery angiography were performed; however, no signs of arterial bleeding were found. To identify etiology, portal venography was performed under ultrasound guidance and portal vein bleeding was diagnosed. Ultimately, selective portal vein embolization successfully stopped the bleeding.

经皮经肝胆道引流术是治疗良恶性梗阻性黄疸的有效方法。大约2-3%的PTBD患者发生大出血并发症,可导致死亡。报告一例63岁男性患恶性梗阻性黄疸,经PTBD后出血严重。急诊数字减影血管造影、腹腔干动脉及肠系膜上动脉血管造影;然而,没有发现动脉出血的迹象。为明确病因,在超声引导下行门静脉造影,诊断门静脉出血。最终,选择性门静脉栓塞成功止血。
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引用次数: 1
Percutaneous transcatheter super-selective renal arterial embolization with N-butyl cyanoacrylate for iatrogenic renal hemorrhage 氰丙烯酸正丁酯经皮肾动脉超选择性栓塞治疗医源性肾出血
Q3 Medicine Pub Date : 2022-11-01 DOI: 10.1016/j.jimed.2022.03.008
Xishan Li , Guodong Chen , Dongliang Zhu

Background

To evaluate the safety and efficacy of percutaneous transcatheter super-selective renal arterial embolization (SRAE) with N-butyl cyanoacrylate (NBCA) for iatrogenic renal hemorrhage.

Methods

Between January 2014 and December 2019, 45 patients (including 18 patients with coagulopathy), who underwent percutaneous transcatheter SRAE with NBCA for iatrogenic renal hemorrhage at our institution, were retrospectively reviewed. The technical success rate, clinical success rate, and embolization-related complications were analyzed. The values of estimated glomerular filtration rate (eGFR), serum creatinine (sCr), and serum urea (sUr) were analyzed at the time of pre-SRAE, post-SRAE, and last follow-up to evaluate the effects of NBCA-based SRAE on renal function.

Results

Diagnostic renal arteriography revealed contrast extravasation in 18 patients and pseudoaneurysms in 27 patients. NBCA mixed with iodized oil in a 1:2–1:4 ratio was the sole embolic agent. No procedure-related mortality or major complications occurred. The technical and clinical success rates were both 100%. The values of eGFR, sCr and sUr were not found to be significantly different between pre-SRAE, post-SRAE and last follow-up (eGFR: 91.52 ​± ​21.17 vs. 90.98 ​± ​22.11 vs. 92.14 ​± ​23.51 ​mL/min/1.73 ​m2, p ​= ​0.729; sCr: 74.73 ​± ​11.08 vs. 75.27 ​± ​12.43 vs. 73.95 ​± ​10.14 ​μmol/L, p ​= ​0.543; sUr: 5.69 ​± ​0.84 vs. 5.71 ​± ​0.96 vs. 5.70 ​± ​0.79, p ​= ​0.515, respectively).

Conclusions

Percutaneous transcatheter SRAE with NBCA is a safe and effective treatment modality for iatrogenic renal hemorrhage with no deterioration of renal function.

背景:评价经皮经导管超选择性肾动脉栓塞(SRAE)加氰丙烯酸正丁酯(NBCA)治疗医源性肾出血的安全性和有效性。方法回顾性分析我院2014年1月至2019年12月因医源性肾出血行经皮经导管SRAE联合NBCA治疗的45例患者(包括18例凝血功能障碍患者)。分析技术成功率、临床成功率及栓塞相关并发症。分析SRAE术前、术后及末次随访时肾小球滤过率(eGFR)、血清肌酐(sCr)、血清尿素(sUr)的测定值,评价基于nbca的SRAE对肾功能的影响。结果肾动脉造影显示造影剂外渗18例,假性动脉瘤27例。NBCA与碘化油按1:2-1:4的比例混合是唯一的栓塞剂。无手术相关死亡或主要并发症发生。技术和临床成功率均为100%。eGFR、sCr、sUr值在srae前、srae后及末次随访间无显著差异(eGFR: 91.52±21.17 vs 90.98±22.11 vs 92.14±23.51 mL/min/1.73 m2, p = 0.729;可控硅:74.73±11.08和75.27±12.43和73.95±10.14μmol / L, p = 0.543;苏尔:5.69±0.84和5.71±0.96和5.70±0.79,p = 0.515)。结论经皮经导管SRAE联合NBCA治疗医源性肾出血安全有效,且无肾功能恶化。
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Journal of Interventional Medicine
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