Peng-Xu Ding

Initial Imaging Analysis of Budd-Chiari Syndrome in Henan Province of China: Most Cases Have Combined Inferior Vena Cava and Hepatic Veins Involvement

Aim To evaluate the type of venous involvement in Chinese Budd-Chiari syndrome (BCS) patients and the relative diagnostic accuracy of the different imaging modalities. Methods Using digital subtraction angiography (DSA) as a reference standard, color Doppler ultrasound (CDUS), computed tomography angiography (CTA), and magnetic resonance angiography (MRA) were performed on 338 patients with BCS. We analyzed the course of the main and any accessory hepatic veins (HVs) and the inferior vena cava (IVC) to assess the etiology of obstructed segments and diagnostic accuracy of CDUS, CTA and MRA. Results Among the 338 cases, there were 8 cases (2.4%) of isolated IVC membranous obstruction, 45 cases (13.3%) of isolated HV occlusion, and 285 cases (84.3%) with both IVC membranous obstruction and HV occlusion. Comparing with DSA, CDUS, CTA had a diagnostic accuracy of 89.3% and 80.2% in detecting BCS, and 83.4% of cases correctly correlated by MRA. Conclusion In Henan Province, most patients with BCS have complex lesions combining IVC and HV involvement. The combination of CDUS and CTA or MRI is useful for diagnosis of BCS and guiding therapy.

Microwave ablation treatment of liver cancer with a 2,450-MHz cooled-shaft antenna: pilot study on safety and efficacy.

To evaluate efficacy of microwave ablation in a primary clinical study, sixty patients (44 men, 16 women; mean age 53 years) with 96, 1-8 cm (mean 3.20 ± 0.17 cm) liver cancers were treated with 2,450-MHz internally cooled-shaft antenna. Complete ablation (CA) and local tumor progression (LTP) rates as well as complications were determined. CA rates in small (<3.0 cm), intermediate (3.1-5.0 cm) and large (5.1-8.0 cm) liver cancers were 96.4% (54/56), 92.3% (24/26) and 78.6% (11/14), respectively. During a mean follow-up period of 17.17 ∓ 6.52 months, LTP occurred in five (5.21%) treated cases. There was no significant difference in the CA and LTP rates between the HCC and liver metastasis patient subgroups (P<0.05). Microwave ablation provides a reliable, efficient, and safe technique to perform hepatic tumor ablation.

Agitation thrombolysis for fresh iatrogenic IVC thrombosis in patients with Budd-Chiari syndrome

Three patients with Budd-Chiari syndrome (BCS) and fresh inferior vena cava (IVC) thrombosis were treated by agitation thrombolysis as a mechanical thrombectomy procedure and followed up by duplex ultrasonography. Agitation thrombolysis was technically and clinically successful in all patients. Inferior vena cavagrams after the procedure showed complete resolution of the iatrogenic, fresh IVC thrombi without occurrence of pulmonary embolism. Duplex ultrasonography follow-ups after 12, 24, and 28 months, respectively, confirmed complete patency of the IVC without rethrombosis and reobstruction. The results indicate that agitation thrombolysis may be a safe and feasible approach for BCS patients with iatrogenic, fresh IVC thrombosis.

Treatment of Budd-Chiari syndrome with urokinase following predilation in patients with old inferior vena cava thrombosis.

PurposeThis study was undertaken to evaluate the safety and feasibility of thrombolytic urokinase treatment after predilation in patients with Budd-Chiari syndrome (BCS) with chronic inferior vena cava (IVC) thrombosis.Materials and methodsBetween December 2006 and September 2009, 13 consecutive BCS patients with chronic IVC thrombosis were treated with continuous urokinase infusion after predilation and subsequent (i.e. after thrombus resolution) IVC dilation with a 30-mm dilator. The procedural technical and angiographic, and ultrasonic results, as well as mortality, morbidity and the final clinical outcome, were evaluated immediately after the treatment or at 1 week and 1, 3, 6 and 12 months and then annually thereafter.ResultsThe immediate and long-term procedural technical outcome was successful in all patients. Follow-up inferior vena cavagrams demonstrated complete resolution of the chronic IVC thrombi and full IVC patency, without occurrence of pulmonary embolism at any time during the study. Colour-Doppler ultrasound (US) follow-up for 16.92 months (±12.04) showed full patency of the IVC, without thrombosis, restenosis or reobstruction, in all patients and resolution of all clinical symptoms. All patients were alive at the time of this report.ConclusionsOur preliminary results indicate that thrombolysis with continuous infusion of urokinase after predilation is a safe and feasible approach for treating BCS patients with chronic IVC thrombosis.RiassuntoObiettivoQuesto studio è stato condotto per valutare la sicurezza e la fattibilità del trattamento trombolitico con urochinasi dopo pre-dilatazione in pazienti con sindrome di Budd-Chiari (BCS) con trombosi cronica della vena cava inferiore (IVC).Materiali e metodiTra il dicembre 2006 e il settembre 2009, 13 pazienti BCS con trombosi cronica dell’IVC sono stati trattati con infusione urochinasica continua dopo predilatazione e successiva (i.e. in seguito alla risoluzione del trombo) dilatazione dell’ IVC con un dilatatore di 30 mm. Le procedure tecniche ed angiografiche, e i risultati ecografici, cosi come la mortalità, la morbidità, e i risultati clinici finali, sono stati valutati immediatamente dopo il trattamento, a una settimana e a 1, 3, 6, e 12 mesi e infine annualmente.RisultatiI risultati immediati ed a lungo termine della tecnica procedurale hanno avuto successo in tutti pazienti. Le flebografie di follow-up della vena cava inferiore hanno dimostrato una completa risoluzione della trombosi cronica dell’ IVC e totale pervieta’ dell’ IVC, senza alcun caso di embolia polmonare durante lo studio. Il follow-up con ecografia Color-Doppler (US) a 16.92 mesi (±12.04) ha mostrato completa pervietà dell’ IVC, senza trombosi, restenosi o riostruzione, in tutti i pazienti e risoluzione di tutti i sintomi clinici. Ad oggi tutti i pazienti sono sopravvissuti.ConclusioniI nostri risultati preliminari indicano che la trombolisi con infusione continua di urochinasi dopo predilatazione è un approccio sicuro e fattibile per il trattamento dei pazienti BCS con trombosi cronica dell’ IVC.

Long-term safety and outcome of percutaneous transhepatic venous balloon angioplasty for Budd-Chiari syndrome.

The restenosis following percutaneous transluminal balloon angioplasty (PTBA) is high for Budd–Chiari syndrome (BCS) patients with hepatic venous obstruction (HVO). We aim to evaluate the safety and long‐term outcome of PTBA with a large balloon catheter in a large series of patients with HVO.

Outcome of a retrieval stent filter and 30 mm balloon dilator for patients with Budd–Chiari syndrome and chronic inferior vena cava thrombosis: a prospective pilot study

AIM To evaluate the mid-term safety and efficacy of a retrieval stent filter and 30mm balloon dilator in the treatment of Budd-Chiari syndrome (BCS) patients with chronic inferior vena cava (IVC) thrombosis. MATERIALS AND METHODS Twenty-three consecutive patients with BCS and chronic IVC thrombosis were treated with a retrieval stent filter and a 30mm balloon dilator, and subsequently underwent color Doppler ultrasound follow-up at our hospital. Data relating to the technical success, angiographic and ultrasound results, mortality, morbidity, and final clinical outcome were collected retrospectively and follow-ups were performed 1, 3, 6, and 12 months after placement of the stent, and annually thereafter. RESULTS Stent filter placement and balloon dilation were technically successful in all patients, with no procedure-related complications. Removal of the stent filter was technically successful in 22 of 23 attempts, yielding a technical successful rate of 95.7% (95% confidence intervals (CI): 87%, 105%). Inferior vena cavagrams performed immediately before stent removal demonstrated that the IVC thrombus had completely resolved in all patients without pulmonary embolism. The mean primary patency rate 3, 6, 12, and 24 months after venoplasty was 0.91 (95% CI: 0.79-1.04), 0.87 (95% CI: 0.72-1.02), 0.87 (95% CI: 0.72-1.02), and 0.87 (95% CI: 0.72-1.02), respectively. The secondary patency rates were 1.00 throughout the follow-up period. All patients are alive with resolution of the symptoms at the time of this report. CONCLUSIONS The preliminary results indicate that the retrieval stent filter and 30mm balloon dilator are a safe and effective treatment for BCS patients with chronic IVC thrombosis.

Outcomes of thrombolysis with and without predilation of the inferior vena cava (IVC) in patients with Budd-Chiari syndrome with old IVC thrombosis.

Purpose: To compare the efficacy of thrombolysis with and without predilation of the inferior vena cava (IVC) for Budd–Chiari syndrome (BCS) with old IVC thrombosis. Methods: We divided 40 patients with BCS with old IVC thrombosis into 2 groups, group A (n = 21), thrombolysis after dilation of the obstructed IVC and group B (n = 19), thrombolysis without predilation of the obstructed IVC. Thrombolysis was performed via urokinase administration through the dorsal vein of the foot. Results: Color Doppler ultrasonography at 30 days showed complete resolution of the thrombus in 21 (100%) group A patients and 6 group B patients (31.6%; P < .001). Thrombolysis was achieved using a lower dose of urokinase and within a shorter time frame in group A than in group B (P < .001). Conclusions: Thrombolysis after dilation was superior to thrombolysis alone and was safe and efficacious in patients with BCS with old IVC thrombosis.

Comparative study of predilation with stent filter for Budd-Chiari syndrome with old IVC thrombosis: a nonrandomized prospective trial.

PURPOSE To evaluate whether predilation approach yield intermediate-term results were better than those with stent filter approach. MATERIALS AND METHODS 59 BCS patients with old IVC thrombosis were selected for the treatment with a stent filter (n = 33, group A) or predilation (n = 26, group B) before thrombolysis, and subsequently underwent color Doppler ultrasound follow-up at our hospital. Data relating to the technical success, color Doppler ultrasound results, cost, mortality, morbidity, and final clinical results were collected prospectively and follow-ups were performed 1, 3, 6, and 12 months after the procedures, and annually thereafter. RESULTS Sent filter placement, thrombolysis and predilation were technically successful in all patients, with no procedure-related complications. Stent migration upward occurred in two patients, and removal of the stent filter was technically successful in 32 of 33 patients in group A. Inferior vena cavagrams performed before dilation with a 30-mm balloon catheter demonstrated that the IVC thrombus had completely resolved in all patients without pulmonary embolism. Reobstruction of the IVC without thrombosis was observed in three patients. Short of higher overall complications and costs in group A when compared to group B, there were no other differences in the clinical and color Doppler ultrasound findings, and primary patency rate between the two groups. All patients are alive with no recurrence of thrombosis at the time of this report. CONCLUSIONS BCS patients with old IVC thrombosis treatment with predilation approach yielded intermediate-term results that were better than those with the stent filter approach.

Portal, Mesenteric, and Splenic Vein Thromboses after Endovascular Embolization for Gastrointestinal Bleeding Caused by a Splenic Arteriovenous Fistula

We present an unusual case of portal, mesenteric, and splenic vein thromboses after endovascular embolization for gastrointestinal bleeding caused by a splenic arteriovenous fistula. The thromboses were successfully treated with anticoagulation therapy. The patient was a 37-year-old woman who presented with portal hypertension manifested by gastrointestinal bleeding with no evidence of liver disease. Splenic arteriography confirmed the presence of a high-flow arteriovenous fistulous communication from the splenic artery directly into the splenic vein. The arteriovenous fistula was successfully treated with percutaneous transarterial embolization by embolization coils and the patient achieved effective hemostasis. Low-molecular-weight heparin and warfarin were administrated to prevent thrombosis in the portal venous system after the procedure. Although anticoagulants were immediately administered, thromboses of the portal, mesenteric, and splenic veins were diagnosed by contrast-enhanced computed tomography after 10 days. Complete recanalization of the portal venous system confirmed by contrast-enhanced computed tomography was achieved by administering warfarin orally for 3 months.

Application of the Willis covered stent for the management of posttraumatic carotid-cavernous fistulas: an initial clinical study.

AIMS To evaluate the feasibility of using the Willis covered stent in the management of patients with traumatic carotid-cavernous fistulas (CCFs). MATERIALS AND METHODS Twelve consecutive patients with 14 post-traumatic CCFs referred for treatment with Willis covered stents were enrolled in this prospective study. Data on technical success, initial and final angiographic results, mortality, morbidity and final clinical outcome were collected. Follow- up was at one, three, six, and 12 months, and yearly thereafter. RESULTS Deployment of covered stents was technically successful in all the patients without complications. One covered stent was placed in eight patients and two covered stents in four. Angiographic results following stent placement showed a complete occlusion in nine patients with 11 CCFs, and an incomplete occlusion in three patients. Angiographic follow-up (mean, 14.00 ± 6.93 months; range, 6-24 months) revealed complete occlusion and no obvious in-stent stenosis in all the patients. Clinical follow-up (mean, 17.75 ± 7.05 months; range, 7-28 months) demonstrated full recovery in 11 patients, and improvement in one. CONCLUSION This initial experience indicates that the use of the Willis covered stent is a feasible procedure and may be an alternative treatment option for CCFs.