Objective To assess the clinical efficacy of TIPS in the treatment of patients with refractory ascites and investigate the clinical factors associated with TIPS. Methods 21 consecutive patients with refractory ascites, 16 men and 5 women with mean age of 45 years (range 22-69 years) were followed up for an average of 337 days (range 50-1323 days). Asites/ abdomen circumference, serum parameters, stents function, time of followed up and survival rate were analized. Results The ascites was significantly reduced as compared with basal values (P

Objective To assess the clinical value of pre-operative embolization for nasopharyngeal angiofibroma. Methods 13 patients with nasopharyngeal angiofibroma confirmed by surgery and biopsy were retrospectively analysed. Bilateral carotid artery angiograpy was perfomed for demonstration of the arterial supply of tumor. According to the size and different caliber of arteries, embolization were seperately undertaken by different types of coil via 4.1or 5F Head-Hunter catheter. The embolization efficacy, embolization was evaluated by amount of blood loss. Results After coil embolization , no complication happened ranging 1～4 days (mean 2 days) in all 13 patients and then all the tumor masses were totally resected with mean blood loss of (584.6?379.4) ml (range 250～1500 ml). Conclusions Preoperative coils embolization is safe, reliable with less complication especially for reducing intraoperative blood loss and promoting the prognosis.

0.05). The most frequent side-effects were abdominal pain and fever. The degree and duration of abdominal pain were higher and longer in group B than those in group A, but the occurrance rate of fever was lower in group B. The occurrance rate of severe complications showed no significant differences for both groups. The increase of embolization degree may aggravate post-embolization side-effects and raise the incidence of complications. Conclusions PVA may be used as the embolic material of PSE with embolization degree ranging from 50% to 70% which may alleviate hypersplenism in patients with cirrhosis, relieve post-embolization syndrome and decrease the incidence of severe complications.

Objective To study the therapeutic effect, side-effect and safety of uterine artery embolization of hysteromyoma with pinyangmycin and lipiodol emulsion. Methods Embolization carried out selectively through uterine artery with pinyangmycin and lipiodol emulsion of 158 hysteromyoma was followed up for 3-18 months with observation of the size of hysteromyoma, the change of corpus uteri and the degree of reactions. Results All cases were embolized successfully including 150 cases of bilateral and 8 cases of unilateral uterine arterial embolization. The appearance of uterine arteries showed obvious arterial enlargement with spiral hypervasculature, tumor staining and prolonged opacification. Six patients underwent hysteroectomy 1 week after the embolization. The specimens demonstrated flaky necrosis with small bloody specks under pathologic examination. The alleviation rate of symptoms were 90.5% with recovery of normal menstrual cycle as 89.4%. The compressive symptoms of hypogastric pain and abdominal distention disasppeared in 91.3%. The reduction in size of hysteromyoma and corpus utei were 80% and 48% on average respectively. Conclusion The primary results demonstrates that uterine artery embolization of hysteromyoma is safe and effective, with low complication rate and more advantage over surgical approach.

Objective To discuss the perioperative nursing norm for patients who are suffering from biliary complications occurred after liver transplantation and who will receive interventional management to treat the complications.Methods Interventional therapies were performed in 20 patients with biliary complications due to liver transplantation.The interventional procedures performed in 20 cases included percutaneous biliary drainage(n = 13), percutaneous biliary balloon dilatation(n = 5) and biliary stent implantation(n = 7).The clinical results were observed and analyzed.Results Biliary tract complications occurred after liver transplantation were seen frequently.Proper interventional management could markedly improve the successful rate of liver transplantation and increase the survival rate of the patients.In accordance with the individual condition, proper nursing measures should be taken promptly and effectively.Conclusion Conscientious and effective nursing can contribute to the early detection of biliary complications and, therefore, to improve the survival rate of both the transplanted liver and the patients.

Objective To investigate the imaging characteristics of different biliary strictures after liver transplantation and their relationship with causes. Methods Forty-six patients with jaundice and biliary stricture were enrolled in this study.The diagnosis was confirmed by percutaneous transhepatic cholangiography (PTC).All the patients had hepatic arteriography with DSA or CTA and underwent liver biopsy.Their imaging characteristics were analyzed and the related statistic analysis was conducted.Results Anastomosis biliary stricture (ABS) was demonstrated in 21 cases,and non-anastomosis biliary stricture (NBS) with hepatic artery thrombosis (HAT) occurred in 13 cases,and there were 12 cases of NBS without HAT.PTC examination confirmed there were 26 cases of biliary stricture at hepatic hilum,and the incidence of biliary stricture in NBS group was significantly higher than that in ABS group (92％ vs.14.35％,P＜0.05).There were 31 cases of intrahepatic bile duct stricture,and the incidence in NBS group was significantly higher than that in ABS group ( 100％ vs.28.6％,P＜0.05).There were 33 cases of dilatation of intrahepatic bile duct,and the incidence in NBS without HAT group was significantly lower than that in ABS group and NBS with HAT group (16.7％,100％ and 76.9％ respectively) (P＜0.05).There were 21 cases of extrahepatic biliary dilatation,and the incidence in ABS group was significantly higher than that in NBS group (85.7％ vs. 12％,P＜0.05). There were 18 cases of stricture and dilatation in intrahepatic bile duct,and the incidence in NBS with HAT group was significantly higher than that in ABS group and NBS without HAT group (76.9％,28.6％ and 16.7％ respectively,P＜0.05).The results of the liver biopsy were accorded with the diagnosis of biliary stricture,Conclusion The different biliary strictures carry different imaging characteristics,including location of biliary stricture,and location and type of secondary biliary dilatation.

Objective To investigate the diagnosis and treatment of isolated celiac artery (CA) dissection and superior mesenteric artery (SMA) dissection.MethodsIntegrating clinical data of 119 cases with isolated dissection of the visceral arteries ( IDVA ) reported in literature and 2 patients with spontaneous isolated dissections of both CA and SMA treated in the Third Affiliated Hospital of Sun Yat-sen University,the diagnosis and treatment of IDVA were analyzed retrospectively.Results Among 119 cases reported in the literature,69 cases were symptomatic.All of the cases were diagnosed by contrast-enhanced abdominal CT or MRI.After IDVA was discovered,surgical treatment and endovascular stent placement was performed in 8 and 5 patients respectively,although the remaining 106 patients were managed conservatively with good results.In our 2 cases,the diagnosis of CA and SMA dissection was established by contrastenhanced CT and confirmed by conventional angiograghy.One patient was treated with anticoagulation and antihypertension,and the other patient was treated with endovascular stenting.Both of the patients didn't have discomfort during the follow-up period of 12 and 3 months respectively.ConclusionsContrastenhanced abdominal CT is the main tool for detection of IDVA.Most of the patients with IDVA can be managed conservatively,but close surveillance with imaging studies is necessary for early recognition of dissection progression.Patients with persistent or relapsed symptoms,and dissection progression,should undergo surgical or endovascular treatment.

Objective To investigate the prognosis and prognostic risk factors of hepatic artery complications after orthotopic liver transplantation (OLT) treated with the interventional techniques.Methods The clinical data of 21 patients with hepatic artery complication after liver transplantation receiving thrombolysis, PTA, and stent placement in our institute from November 2003 to April 2007 were retrospectively analyzed. Based on the prognosis of grafts, 21 patients were divided into poor-prognosis group and non-poor-prognosis group. Fifteen variables (including biliary complication, hepatic artery restenosis,early or late artery complication, and so on) were analyzed in both groups with binary logistic regression analysis to screen out the risk factors related to prognosis of percutaneous interventional treatment for hepatic artery complications after OLT. Results Twenty-one patients were followed for mean 436 days, median 464 days (3-1037 days). The poor-prognosis group included 11 patients (5 cases received retransplantation, and 6 died). The mean survival time of grafts in poor-prognosis group was 191 days, and median survival time was 73 days (3-616 days). The mean survival time of grafts in non-poor-prognosis group which included 10 patients was 706 days, and median survival time was 692 days (245-1037 days).Univariate analysis showed there were significant difference in biliary complication, total bilirubin and indirect bilirubin between the two groups. The binary logistic regression analysis showed the risk factor related to prognosis was with biliary complication before the interventional management (P = 0.027, OR =22.818). Conclusion Biliary complication before interventional management is the risk factor related to poor prognosis of patients with hepatic artery stenosis or thrombisis receiving interventional treatment.

Objective To evaluate the therapeutic effect of transarterial chemoembolization (TACE) combined with CT-guided 125I seed implantation in treating hepatocellular carcinoma (HCC) complicated by portal vein tumor thrombus(PVTT), and to discuss the technical points. Methods A total of 48 HCC patients with PVTT were enrolled in this study. TACE combined with CT-guided 125I seed implantation was carried out in all 48 patients. Based on the sites of PVTT, the lesions were classified into type A (PVTT within main portal vein), type B(PVTT within level-1 portal branch) and type C(PVTT within level-2 or more distal portal branch). According to whether the 125I seeds were directly implanted into the PVTT or not, the patients were divided into direct in-tumor thrombus implantation group (group A) and around tumor thrombus implantation group (group B; the 125I seeds were implanted in the liver parenchyma or in tumor tissue around the tumor thrombus within 1.7 cm region). The tumor thrombus control rate(TTCR), the disease control rate(DCR), the time to progress(TTP) and the overall survival rate of patients(OS) were determined, and the results were compared among different types and groups. Results TACE combined with CT-guided 125I seed implantation was successfully accomplished in all 48 patients. The median OS of type A, B and C was 8, 11.5 and 15 months respectively(P=0.003);the TTCR of type A, B and C was 61.5%, 70.8%and 72.7%respectively(P=0.548); the DCR of type A, B and C was 69.2%, 75%and 81.8% respectively (P=0.483); the median TTP of type A, B and C was 4.5, 8 and 11 months respectively(P=0.030);the median TTP of intra-hepatic tumor of type A, B and C was 5, 9 and 9.5 months respectively(P=0.012). The median OS in group A and group B was 10 and 11.5 months respectively (P=0.239); the TTCR in group A and group B was 69.2% and 68.2%respectively(P=0.591); the DCR of intra-hepatic tumor in group A and group B was 73.1% and 77.3%respectively(P=0.502); the median TTP of tumor thrombus in group A and group B was 7 and 10 months respectively(P=0.276); and the median TTP of intra-hepatic tumor in group A and group B was 8 and 9.5 months respectively(P=0.089). Conclusion For the treatment of hepatocellular carcinoma complicated by portal vein tumor thrombus, TACE combined with CT-guided 125I seed implantation can effectively control the progress of both the tumor thrombus and the intra- hepatic tumor and prolong patient’s survival time. Implantation of 125I seeds into the portal vein tumor thrombus and implantation of 125I seeds into the liver parenchyma around the tumor thrombus have the same therapeutic results. (J Intervent Radiol, 2015, 24:488-493)

Objective To investigate the clinical effect of percutaneous transluminal angiography in diabetic infrapopliteal arterial disease patients and the influence of post-procedural intraluminal small dose urokinase infusion on infrapopliteal arterial blood flow.Methods From January 2011 to September 2013,37 limbs (16 left and 21 right) in 28 diabetic patients inflicted with infrapopliteal critical limb ischemia underwent endovascular recannalization at our institution and were retrospectively analyzed.Stenotic or occlusive lesions were demonstrated in 74 infrapopliteal vessels,including 30 anterior tibial arteries (ATA),22 posterior tibial arteries (PTA),and 22 peroneal arteries (PA).In 30 limbs,tandem lesions in iliac-femoral arteries were also diagnosed.Antegrade ipsilateral femoral access,retrograde contralateral femoral or brachial arterial access had all been adopted as well as both angioplasty and stenting.Case specific decisions were made based on pre-procedural computed tomographic angiogram (CTA).Ankle-brachial index (ABI) was recorded before and after each procedure.Urokinase was continuously infused through arterial sheath catheter into vessels of target limb from a microinfusion pump at 200 000 to 300 000 units per 24 hour for 48 hours after procedure.Angiogram was performed before and after thrombolysis therapy aiming to ascertain the number of frames of images obtained during the period of time it took blood flow to carry contrast medium from the level of tibial plateau to ankle,which was recorded as index frame count (IFC).Patients were followed up for at least 3 months.ABI and ultrasound or CTA were performed on each follow-up visit to validate patency.Quantitative data such as ABI value and IFC were analyzed using paired samples t-test.Results Thirty two limbs were radiographically recanalized by angioplasty or stenting.Technical success rate was 86.4％ (32/37).Average ABI of all limbs increased significantly from 0.70±0.31 to 0.90± 0.21 (t=10.734,P＜0.05).Of the 32 limbs recanalized,IFC decreased significantly from 6.3 ± 1.6 before thrombolysis to 4.7± 1.4 after thrombolysis (t=12.136,P＜0.05).Six rest pain patients reported significantly alleviated symptoms.Fourteen limbs presented with feet ulcers or gangrene.Of these patients after endovascular treatment,1 underwent ankle level amputation,3 underwent toe amputation and 3 patients who did not seek further treatment reported spontaneous autoamputation and wound healing.The remaining 9 patients reported wound healing within 1 to 3 months.Secondary angioplasty was needed for symptom recurrence in 3 limbs of 3 patients 3 to 24 months after first procedure.Conclusions Endovascular treatment of diabetic infrapopliteal arterial diseases exhibited significant short term effect and was safe to perform.Small dose urokinase infusion after recanalization procedure was safe and effective in helping to improve infragenicular blood flow.