G. Ko

Early posttransplant hepatic venous outflow obstruction: Long‐term efficacy of primary stent placement

Although balloon angioplasty has been accepted as the safe and effective initial treatment to manage hepatic venous outflow abnormalities, it may induce rupture of the fresh anastomosis but also may be ineffective to eliminate various etiologies of venous outflow abnormalities in the early post‐transplant period. Therefore, we performed primary stent placement in 108 patients to treat early‐onset (≤4 weeks) post‐transplant hepatic venous outflow abnormality. The following parameters were documented retrospectively: technical success and complications: clinical success; recurrence; and patency of stent‐inserted hepatic veins.

Percutaneous transhepatic treatment of hepaticojejunal anastomotic biliary strictures after living donor liver transplantation

Endoscopic treatment has largely replaced surgery as the initial treatment for biliary strictures following living donor liver transplantation; however, this treatment is nearly impossible in patients who have previously undergone hepaticojejunostomy (HJ). We therefore retrospectively evaluated the efficacy of percutaneous transhepatic treatment in patients who developed HJ strictures following living donor liver transplantation. Percutaneous transhepatic biliary drainage and subsequent balloon dilation of biliary strictures were performed on 83 patients. Serial exchanges of drainage tubes with larger diameters up to 14 Fr were performed at 4‐week intervals. Drainage tubes were removed if follow‐up cholangiography revealed fluent passage of the contrast medium without recurrence of symptoms or changes in the biochemical findings. The clinical outcome, tube independence rate, and patency rate following drainage tube removal were retrospectively evaluated. Except for 2 patients who had failed negotiation of biliary strictures, clinical success was achieved in all 81 patients following percutaneous transhepatic treatment, and the drainage tubes were removed from 76 (93.8%) of these 81 patients. Tubes were removed 11.2 ± 7.4 months after initial percutaneous transhepatic biliary drainage. The recurrence rate at a mean of 36.0 ± 26.2 months following drainage tube removal was 15.8%. One‐ and three‐year primary patency rates were 95.3% ± 2.7% and 80.9% ± 5.2%, respectively. In conclusion, percutaneous transhepatic treatment is an effective alternative treatment for HJ strictures following living donor liver transplantation. However, further research will be required in order to minimize the duration of treatment and the stricture recurrence rate following tube removal. Liver Transpl 14:1323–1332, 2008.

Preoperative transcatheter arterial embolization of hypervascular metastatic tumors of long bones

Background: Complete resection of hypervascular metastatic tumors is often complicated by massive intraoperative blood loss. Purpose: To assess the technical success and clinical effectiveness of transcatheter arterial embolization (TAE) of hypervascular metastatic tumors of long bones to reduce blood loss during orthopedic surgery. Material and Methods: From January 2000 to September 2009, 25 patients (M:F=13:12; mean age 58.3 years) were treated with TAE of metastatic bone tumors before elective, orthopedic surgery. In all cases, the indication for TAE was preoperative devascularization. Technical success, defined as obliteration of tumor staining to 70% or more, requirement for red blood cell transfusion within 24 h following surgery, and hematologic parameters, i.e. the hemoglobin, hematocrit, and erythrocyte counts before and after surgery, were obtained. Results: The technical success rate was 96% (24/25 patients). Gelatin sponge particles (n=21) or polyvinyl alcohol particles (n=4) were used as embolic materials. The mean amount of red blood cell transfusion within the 24 h following surgery was 1.91 units (range 0–6) in the 23 patients with technically successful TAE and who underwent surgery within 3 days after TAE. In 22 patients with technically successful TAE and available hematologic data, the mean gaps in the hemoglobin, hematocrit, and erythrocyte counts before and after operation were 1.22 g/dl, 4.07%, and 0.45×106/mm3, respectively. Conclusion: Preoperative TAE is technically successful and clinically effective to minimize intraoperative and postoperative bleeding in patients with hypervascular metastasis to long bones.

Removal of retrievable self-expandable urethral stents: experience in 58 stents

The purpose of this study was to retrospectively evaluate the safety and efficacy of removing retrievable self-expandable urethral stents using a retrieval hook wire. Under fluoroscopic guidance, the removal of 58 polyurethane or PTFE (polytetrafluoroethylene)-covered stents was attempted in 33 patients using a retrieval hook wire. Indications for removal were elective removal (n=21), stent migration (n=19), formation of tissue hyperplasia around or inside of the stent (n=14), stent deformity (n=3), and severe pain (n=1). The mean time the stents remained in place was 64.8±42.9 days (range, 1–177 days). Fifty-six (97%) of the 58 stents were successfully removed using the retrieval hook wire despite the following difficulties; hook wire disconnection (n=2), untied drawstrings (n=3), and polyurethane membrane disruption/separation (n=4). The removal procedure using a retrieval hook wire failed in two stents (3%) which had migrated into the urinary bladder. One of the two stents with migration into the urinary bladder was removed using a snare through the cystostomy route. The overall complication rate was 14% (seven hematuria cases and one urethral tear case), and all were minor and spontaneously resolved without further treatment. In conclusion, removal of retrievable urethral stents using a retrieval hook wire was safe and effective despite some technical difficulties. It is a useful method for allowing temporary stent placement and solving various complications of stent use.