Objective To discuss the management, complication and effectiveness of establishing a prolonged hemodialysis access with a long-term venous indwelling catheter. Methods During the penod of July 2007-February 2009, a total of 64 long-term venous indwelling catheters for hemodialysis were placed in 62 patients with terminal chronic renal insufficiency. Results Of the total 64 catheter-placements, 62 were pereformed under DSA guidance and 2 at bed-side. Because of blocked flow, adjustment of the catheter was carried out in 4 cases, replacement of catheter in 2 cases and thrombolytic therapy in one case. In 62 patients, the arterial flow rate after the procedure reached to 230-300ml/min. In 57 cases the indwelling catheter remained in working condition so far. Five cases died within 6 months. Conclusion For establishing a prolonged hemodialysis access. The placement of a long-term venous indwelling catheter is feasible. The main complication is the blocked flow. Which is mainly related to the disposition of the catheter itself or its tip. The right intemal jugular vein is the indwelling site of choice, the tip of double-lumen catheter should be within the superior vein cava. With the help of DSA guidance, the procedure can be performed accurately, safely and easily.

Objective To evaluate the patency rate of two types of metallic biliary stent in treating malignant biliary stenosis, and to discuss the patient’s survival rate. Methods A total of 126 patients with malignant biliary stenosis were treated with percutaneous implantation of biliary stent. The clinical data were retrospectively analyzed. A total of 167 metallic biliary stents were used in 126 patients. Ninety - two metal stents of mesh type were employed in 70 cases, while 75 metal stents of laser engraving type were adopted in 56 cases. After the treatment all patients were followed up, and the stent patency time as well as the median survival time was determined. The results were analyzed and compared between the two types of stents. Results Technical success rate was 100% (126/126). The median patency rate time of mesh type and laser type was 182 days and 196 days respectively, the patient’s median survival time of mesh type group and laser type group was 179 days and 186 days respectively. No statistically significant differences in the stent patency time and in the median survival time existed between the two groups (P > 0.05). Conclusion In treating malignant biliary obstruction with stenting, the mesh type stent and the laser type stent have quite same therapeutic effect. Therefore, in clinical practice the two types of stent can be replaced with each other to a certain degree.

Objective To investigate the early outcome of cutting balloon (PCB) in the management of hepatoenterostomy stricture.Methods The clinical data of 12 cases of supposed benign anastomotic strictures after hepatoenterostomy were retrospectively studied.Hepatic duct jejunal anastomotic stricture was confirmed by MRI or PTC,and patients underwent anastomosis plastic repair by CB.Biliary drains tube were removed when free flow of the contrast material through the anastomosis was observed by cholangiography at least 2 weeks postoperative.The follow-up period was 1 year.Results Cutting balloon procedures were successful in all the 12 cases.The symptoms of jaundice and infection were abated.3 cases suffered from postoperative transient complications.On follow up,1 patient died of tumor recurrence,2 patients reported biliary calculi associated with actue cholangitis which were relieved after corresponding treatment.Conclusions Cutting balloon repair of the biliary-enteric anastomotic strictures is a safe,reliable and minitraumatic procedure.

ObjectiveTo evaluate the safety and feasibility of the tracheal stent implantation for treatment of malignant tracheal stenosis under general anaesthesia. Methods Eighteen patients with malignant tracheal stenosis underwent preoperative 64-slice spiral CT scan and airway reconstruction. The stenotic sites were located in main tracheal trunk(5 patients),in right main bronchus( 1 patient),in trachea and left main bronchus (4 patients),in trachea and right main bronchus (3 patients),in main tracheal trunk and bilateral main bronchus(5 patients).The degree of stenosis was rated 51％ to 70％ in 7 cases,71％ to 90％ in 11 cases.All patients,17 patients of ASA grade 1V and 1 patient of grade Ⅲ,presented with severe dyspnea. Under general anaesthesia,implantation of metallic stent was performed through the sputum aspiration hole of the connecting tubing with DSA guidance.The NBP,ECG,RR,SaO2 of the patients were recorded and compared with t test during the entire procedure. At the end of the procedure,relief of dyspnea,complications related to anesthesia and operation were recorded. Results The success rate of stent placement was 18/18,and dyspnea was significantly relived in all patients. Slightly bloody sputum occurred in 7 cases.The stent was obstructed by sputum in 1case,and the patient was treated with medication.There were no severe complications.The operative course were rated 11 to 9 in 17 cases,and 6 to 8 in 1 case.All 18 patients were cooperative during the procedure.Sixteen patients rated the procedure as very comfortable and 2 rated the procedure as comfortable.Respiratory rate (RR) and heart rate (HR) decreased in all patients after the operation [ ( 37.1 ± 2.8 )/min and ( 106.5 ± 14.2 ) bpm before the operation respectively,( 18.6 ± 1.4)/min and ( 73.2 ± 7.6) bpm after the operation respectively ],t =17.81 and 3.80,P ＜ 0.01.Pulse oxygen saturation ( SaO2 ) during the operation [ ( 91.2 ± 1.8 ) ％ ]increased [ (76.3 ± 8.6 )％ before the operation ] and increased further after the operation [ (94.5 ±4.3 ) ％ ],t =2.06 and 2.26,P ＜ 0.01.Blood pressure (BP) showed no changes throughout the operation (P ＞ 0.05 ).The conprehensive assessment of operation were favorable in all patients. Conclusion With careful preoperative evaluation and planning, tracheal stent implantation under general anaesthesia in patients with malignant tracheal stenosis is feasible and safe.

Objective To explore the clinical value of guide-wire shaping in subclavian vein catheter-ization.Methods Totally 400 patients requiring right subclavian vein catheterization were equally divided into two groups according to the clinic date: intervention group ( with guide-wire shaping , n =200 ) and control group (without guide-wire shaping, n=200).The catheterization was carried out by the same doctor .The rates of ectopic wire were compared between the two groups .Results The overall success rate of catheteriza-tion was 98.25%(393/400) [98.5% (197/200) in intervention group and 98.0% (196/200) in control group, P=0.500].The incidence of catheter displacement was 1.02%(2/197) in intervention group, which was significantly lower than that [7.14% (14/196)] in control group (P=0.002).Conclusion As a sim-ple procedure , guide-wire shaping can effectively prevent catheter displacement during catheterization .

Objective To evaluate the feasibility and safety of embedding the totally implantable venous access port (TIVAP) via the access of right brachiocephalic vein (BCV).Methods The clinical data of 493 patients,who underwent the placement of TIVAP by using right BCV route during the period from March 2013 to December 2015,were retrospectively analyzed.The patients included 137 males and 356 females,with a mean age of (47.3±13.2) years old (ranging from 29 to 78 years old).The puncture success rate and TIVAP indwelling procedure-related complications were analyzed.Results The technical success rate was 100％,the success rate of initial puncturing was 99％ (488/493).The mean operation time was (22.5± 8.3) minutes (range of 18-35 minutes).Mis-puncturing of artery happened in 3 patients (0.61％,3/493);and no severe complications such as hemothorax or pneumothorax occurred.After implantation,the patients carried TIVAP for 124-986 days,with a mean of (271.1±53.8) days.The incidence of complications was 2.25％ (11/488),including hemorrhage at port site (n=2),catheter-related infection (n=l),partial thrombosis (n=2),and formation of fibrous protein sheath (n=6).No serious complications such as displacement or rupture of catheter,or catheter pinch-off syndrome (POS),etc.were observed.Conclusion The implantation of TIVAP by using right BCV route has high puncturing success rate,the technique is safe and reliable,and it can provide another option of catheter access for the clinical performance of TIVAP implantation.

Objective To investigate the clinical efficacy and safety of transcatheter arterial chemoembolization(TACE) before percutaneous microwave ablation(MWA) on liver cancer in elderly patients.Methods Eighty elderly patients with primary liver cancer admitted into our hospital from January 2015 to December 2017 were randomly divided into the MWA group(n=32)and the MWA combined with TACE group(n=48).The MWA group received percutaneous microwave ablation,and the MWA combined with TACE group were treated with transcatheter arterial chemoembolization before percutaneous microwave ablation.The therapeutic effects were compared between groups.Results The total effective rate was increased in the MWA combined with TACE group vs.MWA group(79.2％ vs.56.3％,x2 =7.064,P =0.008).The proportion of patients who presented with serum AFP level ＞200 mg/L had no significant difference between the combination group and the MWA group(68.8％ vs.70.8％,x2 =0.040,P =0.842).While,after treatment,the proportion of patients who presented with serum AFP level decreased by ＞ 50％ was higher in the combination group than in the MWA group(79.2％ vs.56.3％,x2 =7.064,P =0.008).There was no significant difference in the incidences of adverse reactions between the two groups (P ＞ 0.05).Conclusions Compared with percutaneous microwave ablation,transcatheter arterial chemoembolization combined with percutaneous microwave ablation has a better efficacy and higher safety.

Objective To explore the value of C-arm CT in transjugular intrahepatic portosystemic shunt (TIPS).Methods Between June 2015 and October 2017,a total of 16 patients with cirrhosis complicated by upper gastrointestinal bleeding or massive ascites due to portal hypertention in our center were retrospectively enrolled in the study.Abdominal enhanced CT was routinely performed before surgery.Postprocessing images of portal vein were used as a guidance of TIPS in real time after integrated with intraoperative c-arm CT images during selective operations.Results The success rate of C-arm CT-guided TIPS was 100％.Portal vein angiography showed the position basically consistent with CT matched images reference position.No obvious abdominal hemorrhage,injury of biliary tract and other complications occurred in all patients.The mean number of needle passes was 2.1 ±0.9 passes(range of 1.0-4.0 passes),the mean time of portal vein entry was 4.3 ± 1.9 min (range of 2.0-8.0 min),the mean fluoroscopy period was 22.6 ± 4.8 min (range of 17.0-32.0 min),DAP was (256.2± 96.7)mGy/cm2.Conclusion C-arm CT-guided TIPS is technically feasible and safe.