Purpose: To study the incidence of new or worsened hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic stent shunts (TIPSS) and to identify periprocedural factors influeneing patients at risk. Materials and methods: Between March 1993 and March 1997, 264 patients were treated with TIPSS. 212 patients were possible to assess the development of encephalopathy comprising the wholersome study data, 148 men and 64 women with age ranging from 18 to 74 years old. All patients underwent more than 3 months of clinical follow-up (3~45 months). 118 patients (55.66%) were categorized as Child's class A, 69 patients (52.55%) as Child's class B, 25 patients (11.75%) as Child's C. The diametes of the stent were 8mm im 41(18.87%) patients and 10 mm in 171(81.13%). We analyzed the following factors: age, sex, Child's classification the degree of liver atrophy, TIPSS in emergency or not, and size, the curvature of the shunt tract, portacaval gradient (PCG) before and after TIPSS, embolization of the gactric varices, blood ammonia level, derection of portal vein flow detected with color Doppler imageng after shunt. Statistical methods were used with Student's test, X~2 test, rand sum tets, linear regression and correlation, and multeple limear regressin. Results: The overall incidence of nwe and worsened HE was 16.03% (33/212). Of these, 27 patients were claigced as minimal (grade Ⅰ) and 6 advanced (grade Ⅱ). By Child's classification, new or worsening HE was seen in 8.47% of class A, 11.59% of class B, 60.0% of class C. TIPSS- related HE was correlated to Child's classification (r=0.86). As regard to shunt siza, the HE rate of 8mm stent was 7.31% (3/41), 10mm stent was 17.54%(30/171), and the difference between the two groups wss statistically significance (P

Objective To investigate the factors that may affect the prognosis of patients with moderate-advanced hepatocellular carcinoma (HCC) who are receiving sorafonib therapy.Methods The clinical data of 38 HCC patients,whose diagnoses were confirmed by pathology or clinical imaging and were in accord with the Barcelona Clinic Liver Cancer (BCLC) staging criteria,were retrospectively analyzed.Sorafenib 400 mg was orally given twice everyday,and according to modified RECIST criteria the tumor response was evaluated once every 4-6 weeks,the adverse events were recorded,and the drug toxicity was evaluated by grading standard 3.0 edition for common adverse reactions formulated by American National Cancer Institute.Results Among the 38 patients,one patient developed hepatic encephalopathy after took sorafenib for two weeks,and medication had to be stopped.Of other 37 patients,14 patients developed pancreatic atrophy in different degrees (positive group),the median progression free survival (mPFS) was 9.0 months,and the median overall survival (mOS) was 25.8 months;pancreatic atrophy didn't occurred in the remaining 23 patients (negative group),the mPFS was 3.3 months,and the mOS was 8.4 months.The differences in mPFS and in mOS between the two groups were statistically significant (P＜0.01 and P=0.025respectively).The main adverse events included hand-foot skin reaction,diarrhea,fatigue and weight loss,which were relieved after symptomatic treatment,and no severe untoward effect occurred.Conclusion Certain correlation exists between pancreatic atrophy and the curative effect of sorafenib.For patients who develop severe diarrhea associated with pancreatic atrophy,a longer survival time as well as a longer stable state of disease can be expected.(J Intervent Radiol,2017,26:258-262)

Objective To investigate the feasibility of gadopentetate dimeglumine as contrast agent for arteriography and interventional procedures.Methods Nine patients received gadopentetate dimeglumine as contrast agent during interventional procedures. Gadopentetate dimeglumine was used in 2 patients with contraindications to iodinated contrast media. In addition to the standard injection sequences with iodinated contrast media, arteriograms were obtained after administration of gadopentate dimeglumine in seven patients. Diagnostic arteriographies were performed in thoracic aorta, common carotid artery, bronchial artery, intercostal artery, hepatic artery, iliac artery and uterine artery. The doses of gadopentetate dimeglumine used in this series were≤0.3 mmol/kg. Vital signs and arterial oxygen saturation were monitored during the procedures. The blood and urine routine examinations, the hepatic and renal functions tests were done after the procedure. Results There were no significant differences between the gadopentetate dimeglumine and the iodinated contrast media examinations for illustrating the main trunk of these arteries. Angiograms obtained with the iodinated contrast media appeared to be better than that of with gadopentetate dimeglumine for visualizing the distal branches of these arteries and the tumor stain. The interventional procedure was completed successfully in the two patients using gadopentetate dimeglumine alone. No patient suffered from complication related to the use of gadopentetate dimeglumine, and also no worsened renal function was shown after the procedure. Conclusions Diagnostic arteriograms can be achieved safely and successfully by using gadopentetate dimeglumine, especially in patients with allergy to iodinated contrast media and chronic renal insufficiency.

Objective To evaluate the safety and efficacy of the interventional techniques for the management of hepatic artery stenosis (HAS) after orthotopic liver transplantation (OLT).Methods Seven patients diagnosed with HAS after OLT were treated with interventional procedures. Three (patients) presented with biliary ischemic complications, 1 with hepatic abscess, and 3 with elevation of liver enzymes and bilirubin levels. Interventional techniques included transcatheter hepatic arterial thrombolysis with a low dose of urokinase (UK), and stent placement in the stenotic segment of the hepatic artery. All patients were followed up regularly by duplex ultrasound scan after discharge.(Results) HAS with over 70 % degree at the anastomosis was found in 3 patients. Complete occlusion of the proper hepatic artery was found in 4 patients, and the hepatic artery flow was re-established in these patients at 3 to 7 days after transcatheter hepatic arterial thrombolysis. However, an over 90 % degree of stenosis at the anastomosis was seen in 4 cases. Stent placement in the stenotic segment of the hepatic artery was performed successfully in 7 patients, and significant improvement of liver (function) was seen in these patients at 2 weeks after the procedures. No complications related to the procedure occurred. The 7 patients had a good clinical course with normal graft function during a mean follow-up of 9 months (4 to 18 months), and patent hepatic artery flow was identified by follow-up Doppler ultrasonography.Conclusion Transcatheter endovascular interventional techniques are safe and effective methods for treatment of HAS after OLT.

Objective To evaluate the efficacy and safety of thrombolysis treatment of mesenteric and portal venous thrombosis by TIPSS pathway. Methods Six patients with thrombosis of the PV and SMV were treated by transjugular intrahepatic portosystemic shunt (TIPSS) pathway. All 6 patients presented abdominal pain, distention, and anorexia etc. No clinical signs of peritonitis were seen. The diagnosis was established by Doppler ultrasound scan and contrast enhanced CT. Control PV-SMV venography was performed after access to the PV branch. As soon as the diagnosis was established the thrombus in the PV and SMV was aspirated and fragmented. After the majority of the clot was cleared away with restoration of blood flow in the main trunk, a 4-French catheter with multiple side-holes was passed into the SMV, and urokinase (UK) was continuously infused for 3 to 13 days. Anticoagulants were given for 6 months therefter. Results The majority of the thrombus in PV and SMV was cleared away resulting in flow restoration in all patients after the procedure. Clinical improvement was seen in 5 patients, characterized by progressive alleviation of abdominal pain, distention, and diarrhea. Prior to removal of the infusion catheter from the SMV, venography revealed a complete resolution of the thrombosis in 3 patients, and residual thrombus in the PV branches in 3 cases without showing clinical symptoms. Follow-up Doppler ultrasound scan performed during 4-36 months after the procedure confirmed patency of the PV and SMV. The symptoms did not recur. Conclusions Through the TIPSS pathway, catheter-directed thrombolysis is safe and effective in the treatment of PV and SMV thrombosis.

Objective To investigate the frequency, patterns of the angiographic findings and risk factors for development of complications after transcatheter arterial chemoembolization (TACE) via the inferior phrenic artery (IPA).Methods One hundred and sixty eight patients with hepatic tumor fed by the IPA underwent a total of 226 procedures of TACE of the IPA, with combined routine TACEO(88.7%) or without (11.3%) the combination of routine TACE of the hepatic artery. TACE of the malignancy was performed with an emulsion of iodized oil and anti-cancer agents and then followed by gelatin sponge particle injection. The complications were assessed on clinical observation, laboratory tests, and computed tomographic (CT) images after TACE of the IPA; and finally were correlated with the angiographic findings of the IPA. Results The tumor supplied by IPA was noted at initial TACE in 25 (14.9%), at successive TACE in 97 (57.8%), after percutaneous tumor ablation guided by ultrasound in 28 (16.7%), and after hepatic surgery in 18 (10.7%) cases. The abnormal findings on arteriography showed enlargement of the IPA with tumor staining in all cases, dense non-tumor staining in 61(36.3%), artery-to-artery anastomosis in 62(36.9%),arteriovenous shunts in 12(7.1%) cases. 96.4% of these patients complained of shoulder pain during TACE of the IPA. The cumulative complication rate after the procedure was 8.9%,including hiccup in 13 cases (5.8%), chest pain with cough and mild hemoptysis in 9 (4.0%), phrenoparalysis in 8 (3.5%), angina with abnormal ECG in 4 (1.8%), increasing of CPK, AST, and ALT significantly in 6 (2.7%), transient myeloparalysis in 2 (0.9%), and subphrenic abscess in 2 cases (0.9%). Two patients with the subphrenic abscess were successfully treated with percutaneous catheter drainage and antibiotics. The symptoms of these mild complications subsided with symptomatic treatment.Conclusions Complications of TACE via the IPA occur in about 9% of the patients and these complications do not worsen the patients survival. IAP angiographic abnormalities such as arteriovenous shunts, artery-to-artery anastomoses, dense non-tumor contrast staining,are important risk factors for complications of TACE of the IPA.

Objective To evaluate the efficacy and safety of the interventional radiological techniques for management of symptomatic portal vein (PV) occlusion. Methods Nine patients with PV trunk occlusion were treated using interventional procedures. Four patients presented with abdominal pain, distention, and malabsorption; five presented with portal hypertension and repeated bleeding from esophagogastric varices. The etiologic factors were identified in all 9 patients, including post-transplantation of the liver in 2, hepatocellular carcinoma (HCC) associated with PV tumor thrombus in 3, post abdominal operative state in 1, and PV thrombosis in 3 cases. The portal access was established via a percutaneous transhepatic route in 4, and via a transjugular intrahepatic portosystemic shunt (TIPS) approach in 5 patients. The interventional procedures included stent placement in 4, balloon angioplasty in 6, and catheter directed pharmacologic and mechanical thrombolysis in 7 patients. Results The technical success was achieved in all cases. No complications related to the procedure occurred. Portal flow was reestablished in all patients after the procedures. Clinical improvement was seen in 3 patients with symptomatic PV thrombosis, characterized by progressive reduction of abdominal pain, distention, and diarrhea. Follow-up time ranged from 4 to 36 months. One patient with HCC died of multiple organs metastases at 11 months after the treatment. One patient died of intraabdominal sepsis and multiple organs failure 12 days after the procedure even though the antegrade flow was re-established in the main trunk of the PV. Patency of the PV trunk was confirmed by follow-up color Doppler ultrasound scan in the rest 7 patients, without recurrence of variceal bleeding or PV thrombus. Conclusions Interventional minimally invasive procedures, including balloon angioplasty, stent placement, catheter directed local pharmacologic and mechanical thrombolysis, are safe and effective in the treatment of symptomatic PV trunk occlusion.

[Objective] To investigate X-ray and CT manifestations of tobereulosis of ankle joint and to discuss the differentiation with other diseases.[Method]The X-ray and CT findings in 5 cases with pathalogically proved tuberculosis of ankle joint were retrospectively analyzed.The differentiation with other diseases was discussed.[Result]The lesions involved entire right ankle joint in all 5 cases,The typical signs were as follows:(1)indistlnct and erosive joint surface,insect bitten-like of bony destruction ofjotht surface,digging-like shape of cancellous bone's destruction;(2)narrowed or irregular widened joint space;(3)ostooporosis of diseased region and surrounding;(4)extensive periostoal reaction of distal fibia and fibula;(5)to form cold abscess and sinus tract.[Conclusion]The tuberculosis of ankle joint earyies certain characteristic X-ray and CT signs,CT is better than X-ray in diagnosis.Highly alert of ankle joint tuberculosis is the key of early correct diagnosis.

Transcatheter internal iliac arterial embolization has become a first-choice treatment for control of life-threatened bleeding associated with pelvic tumors or obstetric disorders.Recently,uterine arterial embolization(UAE)has offered a successful alternative to surgery in the treatment of uterine fibroid.Clinical failure rates for this procedure was reported from 4% to 19% in literature,probably due to the existence of collateral flow to the pelvic lesions,especially the ovarian arteries(OA)being the most important source.Furthermore,the anastomosis between the ovarian and uterine arteries has been suggested as the pathway for nontarget embolization of the ovaries causing premature menopause.The OA are simple paired vessels and they usually arise from the anterolateral part of the abdominal aorta at the level of the second lumbar vertebra.Variations in origin of OA occur in 2%-10% with diameter smaller than 1.1 mm and routinely not identified on conventional aortography.However,in the presence of a uterine or other pelvic diseases,the OA become dilated as the result of pathologic blood supply demand.OA supply to the pelvic lesions are more frequently found in patients with large fundal fibroids,history of the pelvic surgery,post embolization of the uterine arteries,and dysplasia of uterine artery.In patient with one or more of these predisposing factors,the extent of OA supply to the pelvic lesions should be assessed using pigtail catheter pelvic aortography with the tip at the level of the renal arteries,followed by selective OA catheterization.In case of identified OA supply to the pelvic lesions,superselective embolization of the OA should be considered,using particles with diameters larger than 500 ?m.Proximal OA embolization,in combination with bilateral UAE,may significantly increase the risk of iatrogenic ovarian dysfunction.When necessary in a premenopausal patient,OA embolization should be performed unilaterally and as near as possible to the lesions,and the procedure is performed only with specific informed consent.

Objective To study the safety of transcatheter arterial chemoembolization(TACE)via the intercostal artery(ICA)for hepatic carcinoma.Methods A total of 24 patients with hepatic carcinoma(HCC)fed by the ICA underwent TACE via the artery in our hospital.Among the cases,15 were mass type and 9 were nodular type.Plain and enhanced CT or MRI scan were performed before the operation.During the procedure,we carried out intercostal arteriography.Selected catheterization of the feeding branch and then TACE were done.The ICA angiographic features,tumor location,clinical observation,laboratory tests,and imageology were evaluated after the surgery.Results In our cases,the HCCs supplied by the ICA collaterals were located at segments six and/or seven.Angiography showed that all the ICA collaterals originated from the right side at the levels of T8(7.5%,3/40),T9(15.0%,6/40),T10(47.5%,19/40),or T11(30.0%,12/40).The procedure was completed in 22 of the patients.CT scan performed after the procedure showed that the tumor was completely filled with lipiodol in 87.5%(21/24)of the cases.The serum level of AFP decreased significantly in 82.6%(19/23)of the patients.Three patients complained of severe pain at the shoulder after the operation,1 patient had skin itching during TACE,and 5 developed skin erythema after the procedure.Conclusions HCC supplied with ICA collaterals are often detected in the patients who have the tumor at the right posterior segment(S6 and S7)and had received TACE for several times.TACE via the ICA is safe but may leads to skin injuries.