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 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 discuss dosimetric advantage,compliance,efficacy and prognostic factors of whole brain conformal intensity-modulated radiotherapy ( IMRT ) combined with synchronous dosage for treatment of brain metastases.Methods Forty-one patients with metastatic tumor to the brain were confirmed by computed tomography (CT) or magnetic resonance imaging (MRI).They received whole brain irradiation and simultaneous integrated boost to bulky metastases by IMRT.Gross tumor volume(GTV) DT 4994-6990 cGy/ 22-30 fractions/4.4-6.0 weeks,whole brain DT 3990-5000 cGy/22-30 fractions/4.4-6.0 weeks.Results The median follow-up time was 6.4 months.The overall response rate,the median survival time and the overall survival at 1 year were 65.8 ％,8 months,24.4 ％.The brain-stem,spinalcord,lens,opticnerves were in the limited dose.In 21 patients,radioactive brain edema was happened,the rest did not appear early and late radiation reaction.Conclusion Whole brain irradiation using simultaneous integrated boost to bulky lesion by IMRT show an improvement in dose distribution and significant effect to patients with brain metastases.The therapy is well-tolerated and effective.

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 evaluate combination multiple interventional therapies for acute lower extremity deep venous thrombosis (DVT).Methods From January 2008 to October 2014,96 patients with acute unilateral proximal or mixed DVT received interventional treatments including 74 DVT cases of the left lower extremity,and 22 patients in the right.Procedures undertaken included catheter-directed thrombolysis (CDT) only (n =7),CDT combined with thrombolysis (n =89),balloon angioplasty (n =32),and stent implantation (n =6).Results The mean circumference difference between the normal and affected thighs dicreased from (6.7 ± 1.8) cm to (0.8 ± 0.3) cm,t =13.48,P ＜ 0.001.That between the normal and affected calves decreased from (5.9 ± 1.6)cm to (0.7 ±0.4)cm,t =12.84,P ＜0.001.After intervention the Porter's score reduced from (9.7 ± 2.4) points to (1.1 ± 0.6) points,t =15.46,P ＜0.001,and the venous patency rate was (90 ± 8)％.Conclusion CDT combined with thrombolysis through dorsal vein,PTA,and stent implantation is a safe and effective therapeutic modality for acute lower extremity DVT.

Objective To investigate the nursing of traumatic carotid-cavernous fistula(TCCF)by intervention.Methods 18 patients with TCCF by intervention were given nursing measures including psychological preparation,eye care,disease observation and complications care.Results All patients gained successful embolization,and the symptoms of proptosis and vascular murmur in patients were alleviated.One case received spring embolism because of balloon rupture.The symptoms of vascular spasm in two patients were alleviated with timely treatment.Hyperperfusion syndrome was relieved after lowering blood pressure in two patients.Conclusions The intervention embolization is an effective treatment of TCCF.Good nursing could improve the efficacy and reduce the incidence of complications.

Objective To study the feasibility and efficacy of percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS) in patients with portal hypertension due to chronic portal vein occlusion after splenectomy.Methods 27 patients who had portal hypertension due to chronic portal vein occlusion after splenectomy underwent PTIPS between December 2010 and March 2015.These patients were enrolled in this retrospective study.The success rates,efficacy,and complications were evaluated.Significance in the differences in the portosystemic pressure gradient (PPG) as measured before and after PTIPS procedure was assessed.Results PTIPS was successfully carried out in 25 patients but failed in 2.No fatal procedural complications were observed.The mean PPG dropped from (22.3 ± 5.7) mmHg to (12.4 ± 3.1) mmHg after successful PTIPS (1 mmHg =0.133 kPa,P ＜0.05).The median follow-up in the 25 patients with successful PTIPS were 22 months and there were 3 (12.0％) deaths from liver failure due to severe cirrhosis,and 1 death (4.0％) from stroke during the follow-up period.Shunt dysfunction happened in 4 (16.0％) patients.The original symptoms reoccurred in 2 patients (8.0％) and the remaining patients were diagnosed by routine CT or US examination.Three patients recovered after shunt revision with stent implantation or balloon angioplasty,while one patient refused any further therapy except oral medication.This patient suffered from the first episode of rebleeding 36 months after PTIPS.Hepatic encephalopathy developed in 2 (8.0％) patients,1 patient recovered after medical treatment,while the other who developed Grade 3 hepatic encephalopathy recovered after implanting a smaller cover stent.The remaining patients were asymptomatic with patent shunts.Conclusion PTIPS was a feasible,safe,and efficacious treatment for portal hypertension due to chronic portal vein occlusion after splenectomy.

ObjectiveTo investigate imaging features of the liver, portal vein and hepatic vein or transhepatic inferior venacava in patients with severe liver cirrhosisin multidetector row computed tomography ( MDCT), and assess the feasibility, safety and clinical significance of percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS). MethodsFifty patients with severe liver cirrhosis confirmed by clinical data and imaging examination were enrolled in this study. Simulation of intrahepatic portosystemic shunt by percutaneous transhepatic approch is as follows. The right midaxillary line (the eighth or ninth intercostal space) was selected as puncture point A the right branch of portal vein was puncture point B,transhepatic inferior vena cava was puncture point C, and the distal part of right portal vein was D. A-B-C connection is simulated as percutaneous transhepatic puncture tract, C-B-D connection is simulated as portosystemic shunt tract.After tri-phase contrast-enhanced CT scanning, postprocessing images through multiple planner reconstruction ( MPR ) were obtained. The data were indicated statistically by x ± s. And 95％ confidence interval for mean was calculated.Anatomic relationship among the right portal vein,transhepatic inferior vena cava, hepatic artery and bile duct were analyzed for all patients. ResultsThe length of the needle (A-B-C) is ( 145. 7 ± 14. 8 ) mm. The curvature of the needle ( the angle of A-B line and B-C line) is ( 145.0 ±9.9)°. The length of transhepatic shunt tract (B-C) is (42.7 ±7.2) mm. The length of the shunt tract (C-B-D) is ( 117. 7 ±11.6 ) mm; The angle of the shunt tract ( the angle of B-C line and B-D line) is (1O8.5 ± 5.9)°. In 24/50 patients, transhepatic inferior vena cava locate in the dorsal of the right portal vein, in 26/50 patients they are in the same plane.In all patients, the right branches of hepatic artery and bile duct locate in the ventral of the right portal vein.Conclusion The procedure of PTIPS is feasible and safe. To quantify the length and angle of the needle and the length and angle of the shunt tract provides the anatomic basis for clinical application.

Objective To evaluate the feasibility of percutaneous transsplenic portal vein catheterization (PTSPC). Methods Thirty patients with portal hypertension underwent gastroesophageal variceal embolization via PTSPC route, 2 of which simultaneously underwent portal vein stenting. This study included the patients with portal venous obstruction ( tumor embolus or thrombus) or the patients with serious liver atrophy caused by liver cirrhosis. The patients who had severe coagulation insufficiency (with prothrombin time ＞ 20 s) were excluded. Of the 30 patients, 17 had primary hepatocellular carcinoma with main portal venous tumor embolus, 13 had cirrhosis with severe liver atrophy and(or) slight or moderate ascite. Before this study, all of 30 patients had a history of variceal bleeding, and 16 patients had a normal coagulation level, 10 patients had a mildly prolonged prothrombin time (14-17 s), 4 patients had a moderately prolonged prothrombin time (18-20 s). All of 30 patients underwent upper abdomen CT enhanced scanning before this procedure, and the site, direction, and depth of splenic vein branch puncture were decided by CT images. The technology of PTSPC, procedure-related complications, and its clinical application were retrospectively analyzed. Results PTSPC was performed successfully in 28 of 30 patients. Two cases failed because of a small intrasplenic vein. Procedure-related complications occurred in 6 patients (20. 0% ), which had decrease of hemoglobin concentration ( 15-50 g/L). Four of them needed blood transfusion. In the six patients, one patient (3.3%) with abdominal cavity hemorrhage had a serious drop of blood pressure 2 hours after procedure, whose clinical symptoms were relieved after four units of packed RBC and a great quantity of fluid were transfused. Twenty-eight patients whose PTSPC were successfullyperformed underwent variceal embolization, 2 of them were placed with portal vein covered stents. During a median follow-up period of 6 months (range: one to forty-two months), 14 patients died of hepatocellular carcinoma 1 to 12 months after procedure, and 2 patients died of hepatic failure caused by liver cirrhosis at fourteen months and twenty-three months after procedure, respectively. Variceal rebleeding was observed in 4 patients, the cumulative rebleeding rate at 1 year was 14.3%. Conclusion PTSPC is a feasible procedure, which provides a useful route for endovascular treatment of portal vein. However, hemorrhage at the puncture site after procedure should be noticed.

Hepatic venous outflow obstruction is a severe complication after liver transplantation, often occurs after living donor liver transplantation (LDLT). In this article, the clinical and imaging data of two patients with hepatic venous outflow obstruction after LDLT were analyzed retrospectively, and the related literatures were reviewed to explore the diagnosis and the interventional therapy of this complication. Hepatic venous outflow obstruction can be confirmed with percutaneous transhepatic venography. Percutaneous interventional managements, including balloon angioplasty and stent implantation are safe, easy and effective for the treatment of hepatic venous outflow obstruction after adult-to-adult living donor liver transplantation (A-A LDLT).