The majority of complications due to orthotopic liver transplantation (OLT)need interventional treatment. For arterial and venous complications after OLT, we have established clear and definite interventional therapeutic mode. However, it has been the difficult point as well as the weak point for interventional radiologists to treat the biliary complications. With the technical improvement and deep-going understanding, a part of biliary complications of OLT can be relieved or even finally be cured with percutaneous biliary drainage(PTBD) and endoscopic nasobiliary drainage(ENBD). For some patients, PTBD and ENBD seem to be the main palliative therapeutic means, which might accompany the patients for a lifetime. Now, it is an urgent demand to formulate the clinical therapeutic guidelines for the treatment of biliary complications after OLT.

Objective To advocate the importance of central venous access(CVA), and compare the technical characteristics and clinical values of central venous access constructed trans right subclavian vein (TSCV) and trans the right internal jugular vein (TIJV). Methods Between March 1999 and June 2001, we operated 348 cases of CVA, including 270 TSCV and 78 TIJV. The durations of reserving the accesses were 13～75 day, average 23 days. Results In 270 TSCV, 268 cases were successful, the successful rate was 99%. 11 cases had critical complications, including: 2 cases of pneumothorax, 1 access was constructed into subclavian artery, 3 accesses obstruction, 3 accesses of anomalous transfusion caused by catheter shift, infection of puncture site 2 cases. In 78 TIJV, 75 cases were successful, the successful rate were 96%. The critical complications occurred in 1 case.Conclusions The CVA is safe, easy, and practical, which would provide the special and immediate medical therapy for the tumorous and critical patients. In emergency, the TSCV procedure would be the choice.

Objective To discuss the technical skills and the contraindication of transjugular intrahepatic portosystemic shunt stent (TIPSS) in portal vein cancercous thrombosis (PVCT) complicated with portal hypertension. Methods There were 16 cases of PVCT with portal hypertension, and average age of 53.6 yr. There were 9 cases with complete occlusion of portal vein trunk and 7 cases with incomplete thrombosis. There were 5 cases with cavernous transformation of the portal vein(CTPV). 1 case of simple upper gastro intestinal tract (GIT) massive bleeding, 4 with refractory ascites and 11 with upper GIT massive bleeding and refractory ascites. Results The procedure of TIPS was successful in 11 cases, the successful rate reached about 68.8%. The mean portal vein pressure was reduced from 4.9kPa to 2.4kPa with average 2.5kPa reduction. Ascites decreased, bleeding stopped and the clinical symptoms disappeared. The average survival period was 136 days. The procedure failed in 5 cases. Conclusions TIPSS is an effective method to control the bleeding and ascites caused by PVCT. The PV cavernous transformation was the contraindication of TIPSS.

0.05, but the duration of pain was different in group A and B, P

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 explore the prognostic risk factors of low level malignant obstructive jaundice treated with transhapetic biliary drainage.Methods The clinical data of 142 patients with low level malignant obstructive jaundice received percutaneous transhapetic biliary drainage management from January 2010 to June 2013 were retrospectively analyzed.The study parameters included gender,age,tumor type,preoperative obstructive time,preoperative infection,drainage method,Child-Pugh grade,serum total bilirubin (TBIL),albumin (ALB),serum creatinine (SCr),the postoperative declining degree of bilirubin and postoperative antineoplastic therapy.The prognostic risk factors were evaluated.Results Single variable analysis showed that preoperative infection (P =0.006),Child-Pugh grade (P =0.004),SCr (P =0.043),the postoperative declining degree of TBIL (P =0.001) and postoperative antineoplastic therapy (P =0.015) were the related factors for survival time.The further Logistic regression analysis showed that preoperative infection (OR =3.729,95％ CI 1.332-6.363,P =0.040),Child-Pugh grade ≥ 10 scores (OR =0.513,95％ CI 0.375-1.276,P =0.018) and postoperative antineoplastic therapy (OR =0.668,95％ CI 0.210-2.026,P =0.038) were the related factors for survival time.Conclusion In treating of low level malignant obstructive jaundice with transhapetic biliary drainage,the preoperative infection,Child-Pugh grade and postoperative antineoplastic therapy may be the important related factors that affect the patient's survival time,to evaluate the prognosis of these patients has important reference meaning.

Objective To investigate the technique,efficacy,and safety of percutaneous interventional treatments for biliary complications (BC) after liver transplantation (LT).Methods The clinical and imaging data of 127 patients with BC after LT,who received percutaneous interventional treatments in the Third Affiliated Hospital of Sun Yat-sen University from January 2006 to December 2015,were analyzed retrospectively.On the basis of the cholangiographic appearance,patients were classified into 5 groups:biliary leakage group (n =11),anastomotic biliary strictures group (n=28),hilar biliary strictures group (n =30),multifocal biliary strictures group (n =51),and bilomas group (n =7).The modality of interventional treatments was percutanous transhepatic biliary drainage (PTBD),PTBD combined with balloon dilation,PTBD combined with balloon dilation and stent implantation.The methods of biliary drainage included external drainage and external-internal drainage.All the patients were followed up after treatment.The curative effect and operation-correlated complications were observed.Results The first successful rate of PTBD was 97.6％ (124/ 127).The total curative rate,improvement rate and inefficacy rate of interventional treatments were 37.8％ (48/127),44.9％ (57/127) and 17.3％ (22/127) respectively.In biliary leakage group,all the patients were cured by percutaneous interventional treatments with the curative rate being 100％.In anastomotic biliary strictures group,the cure and improvement rates were 64.3％ (18/28) and 35.7％ (10/28) respectively.The efficacy rate was 100％ (28/28).In hilar biliary strictures group,the cure,improvement and inefficacy rates were 40％ (12/30),53.3％ (16/30) and 6.7％ (2/30) respectively.The efficacy rate was 93.3％ (28/30).In multifocal biliary strictures group,the cure,improvement and inefficacy rates were 13.7％ (7/51),54.9％ (28/51) and 31.4％ (16/51) respectively.The efficacy rate was 68.6％ (35/51).In bilomas group,3 cases (3/7) obtained improvement and treatment of 4 cases was inefficative.The efficacy was the best for the patients with bilary leakage,and it was the worst for the patient with bilomas (P＜0.001).The main operation-correlated complication was bile tract infection during drainage.The rates of bile tract infection were 32.4％ (34/105) and 81.8％ (18/22) in patients with external drainage and external-internal drainage,respectively.There was statistically significant difference between these two items (P＜ 0.001).Conclusion PTBD combined with balloon dilation and biliary stent implantation is a safe and effective therapeutic modality for BC after LT,which can improve patients' clinical symptoms,improve patients' quality of life.The patients with bilomas should be treated by retransplantation as soon as possible.The biliary external drainage can decrease the rate of biliary tract infection significantly.

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 describe the technique, efficacy, and safety of percutaneous interventional therapy for anastomotic biliary strictures after orthotopic liver transplantation (OLT).Methods From May 2004 to December 2009, 25 patients with anastomotic biliary strictures afte OLT were enrolled in our study. The modalities of biliary drainage included external drainage in 22patients, and external-internal drainage in 3 patients who underwent re-transplantation. All patients accepted percutaneous interventional therapy in our hospital, including single PTBD in 4 patients,PTBD combined with balloon dilation in 14 patients, balloon dilation and plastic stent implantation in 5 patients, balloon dilation and metallic stent implantation in 2 patients. The drainage catheters were exchanged every 1 to 3 months. Results The success rate of PTBD was 100%. Of the all 25patients, 15 (60 %) patients were cured, and 10 (40 %) patients were improved. The effective rate was 100 %. The drainage catheters failed to pass through the narrow bile duct when initial PTBD in 7 patients, and success was achieved in 3 patients by operation again after biliary drainage for one week.In the other 4 patients, anastomotic bile ducts were occluded, which was confirmed by cholangiography after biliary drainage for 4 to 8 weeks. The rate of biliary tract infection was 24 % (6/25). No serious procedure-related complications occurred in the all 25 patients. Conclusion PTBD combined with balloon dilation and biliary stenting is a effective and safe therapeutic modality for anastomotic biliary strictures after OLT, which can improve the patients' clinical symptoms and elevate patients' quality of life. To avoid bile duct occlusion, the drainage catheters should be passed through the narrow segments of bile duct when initial PTBD.

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.