Yanhao Li

Gigantic Cavernous Hemangioma of the Liver Treated by Intra-Arterial Embolization with Pingyangmycin-Lipiodol Emulsion: A Multi-Center Study

AbstractPurpose: To evaluate the therapeutic effect and safety of pingyangmycin-lipiodol emulsion (PLE) intra-arterial embolization for treating gigantic cavernous hemangioma of the liver (CHL). Methods: Three hospitals (Nanfang Hospital, Inner Mongolia Autonomous Region’s Hospital and Huai He Hospital) participated in the study during 1997–2001. A total of 98 patients with CHL were embolized with PLE via the hepatic artery. The therapeutic effects including changes in tumor diameter, symptomatic improvement and occurrence of complications were evaluated for a period of 12 months after the procedure. Results: The tumor diameters decreased significantly from 9.7 ± 2.3 cm to 5.6 ± 1.6 cm 6 months after the treatment (P < 0.01), and then to 3.0 ± 1.2 cm at 12 months (P < 0.01). Transient impairment of liver function was found in 77 cases after embolization, 69 cases of which returned to normal in 2 weeks, and the other eight cases of which recovered 1 month later. The clinical symptoms were significantly relieved in all 53 symptomatic patients. Persistent pain in the hepatic region was found in two cases, and these two patients resorted to surgery eventually. Conclusion: Intra-arterial PLE embolization proves to be effective and safe in treating patients with CHL.

Fluoroscopic Intralesional Injection with Pingyangmycin Lipiodol Emulsion for the Treatment of Orbital Venous Malformations

OBJECTIVE The objective of our study was to evaluate the efficacy and safety of percutaneous intralesional injection under fluoroscopy with pingyangmycin Lipiodol emulsion (PLE) for the treatment of orbital venous malformations. MATERIALS AND METHOD . This study is a retrospective analysis of 19 consecutive patients with distensible orbital venous malformations. Of the 19 patients, two had diffuse lesions. These patients presented with proptosis (n = 19), pain and orbital swelling (n = 11), reduction in visual acuity (n = 4), diplopia (n = 2), disk swelling (n = 5), and motility disturbance (n = 3). RESULTS All 19 patients underwent technically successful percutaneous intralesional PLE injection under fluoroscopy. Complete resolution of proptosis, swelling, and pain was achieved in 17 patients 3-9 months after the procedure. In the other two patients with diffuse lesions, light proptosis was still present after the first procedure. A second procedure was performed in these two patients, and the symptom disappeared 3 months later. All four patients with reduced visual acuity recovered their vision, and diplopia in two patients disappeared. Examinations of the fundus revealed normal findings in the five patients with preprocedural disk swelling. None of the patients presented with a motility disturbance after the procedure. Local swelling in the eyelid and epiphora were present for 1 month in one patient and disappeared after treatment. No other complications, including acute orbital compartment syndrome, were observed during follow-up periods. The mean follow-up was 23 months. CONCLUSION PLE sclerotherapy under fluoroscopic guidance is safe and effective for the treatment of orbital venous malformations and can be used as one of the treatment alternatives.

Digital Subtraction Angiography–Guided Foam Sclerotherapy of Peripheral Venous Malformations

OBJECTIVE The purpose of this article is to describe a modified technique of using digital subtraction angiography guidance combined with the double-needle technique and the filling-defects technique for foam sclerotherapy of peripheral venous malformations. The short-term efficacy and safety of the technique were evaluated. MATERIALS AND METHODS Fourteen patients with peripheral venous malformations were treated with foam sclerotherapy. Sclerosing foam was prepared using the Tessari method to mix room air with 5% sodium morrhuate in a 4:1 ratio. Percutaneous foam sclerotherapy of venous malformations under digital subtraction angiography guidance was performed using a combined technique modified with the double-needle technique and the filling-defects technique. Follow-up clinical and radiologic assessment and evaluation of patient satisfaction were performed to evaluate the end result. RESULTS At a mean of 9.3 months (range, 6-12 months) after the last session, the overall outcome was rated as excellent improvement (i.e., clinical obliteration and asymptomatic) in four (28.6%) of 14 patients, good improvement (i.e., substantial improvement in size and symptoms of > 50%) in nine patients (64.3%), or moderate improvement (i.e., significant decrease in size and symptoms of </= 50%) in one patient (7.1%). No major complications occurred. CONCLUSION Digital subtraction angiography-guided percutaneous foam sclerotherapy modified with the double-needle technique and the filling-defects technique is an alternative method with favorable short-term results for treating peripheral venous malformations.

Percutaneous implantation of a Port-Catheter System using the left subclavian artery

AbstractPurpose: To evaluate the safety and feasibility of a percutaneous Port-Catheter System (PCS) implanted via the subclavian artery (SCA) for regional chemotherapy or chemoembolization of thoracic, abdominal, and pelvic malignant tumors. Methods: Percutaneous puncture of the SCA was performed in 256 patients with thoracic, abdominal, or pelvic malignant tumors; then a catheter was inserted into the target artery. After the first transcatheter chemotherapy or chemoembolization with an emulsion of lipiodol and anticancer agents, an indwelling catheter was introduced with its tip placed in the target artery and its end subcutaneously connected to a port. Results: The procedure was successfully completed in all 256 cases (100%). The indwelling catheter tip was satisfactorily placed in the target arteries in 242 cases (98%). Complications attributable to the procedure occurred in 20 (7.8%) cases, including pneumothorax (n=10, 4%), hemothorax (n=1, 0.4%), infections in the pocket (n=4, 1.6%), and hematoma at the puncture site (n=5, 2%). There were no severe sequelae or deaths. The duration of PCS usage was 1–36 months (median 9.5 months), During the course of treatment, occlusion of the target artery occurred in 20 cases (7.8%). Dislocation of the tip of the indwelling catheter occurred in 12 cases (4.7%); in 10 of the 12, the tip of the indwelling catheter was repositioned into the target artery. In all 10 cases no large symptomatic hematomas developed after the PCS was removed. Conclusion: Percutaneous PCS implantation via the left SCA, a relatively new procedure, is a safe and less invasive treatment approach than surgical placement for malignancies.

Percutaneous Intratumoral Injection With Pingyangmycin Lipiodol Emulsion for the Treatment of Recurrent Sacrococcygeal Chordomas

This study describes fluoroscopy-guided percutaneous intratumoral injection therapy (PIIT) with a pingyangmycin lipiodol emulsion in the management of recurrent sacrococcygeal chordomas after surgical excision. Seven patients underwent a total of 22 treatment sessions (3-4 sessions per patient); treatment responses were evaluated clinically, and lesion size was determined using computed tomography (CT). Over 10-26 months of follow-up, tumor sizes and visual analogue scale (VAS) scores of all patients were decreased. No patients had complications during the follow-up period. Preliminary results showed that PIIT with pingyangmycin lipiodol emulsion under fluoroscopic guidance is effective and safe and may be considered as a treatment option.

Transarterial embolization using pingyangmycin lipiodol emulsion and polyvinyl alcohol for the treatment of focal nodular hyperplasia of the liver.

BACKGROUND/AIMS Surgical resection is the current treatment for focal nodular hyperplasia of the liver (FNH) when indicated. However, tumor location and size, patient comorbidities, and risk of complications may limit surgical options in some cases. Our goal was to evaluate the therapeutic effect of transarterial embolization (TAE) using pingyangmycin lipiodol emulsion (PLE) and polyvinyl alcohol particles to treat FNH. METHODOLOGY Four patients with FNH, who experienced dull pain in the upper abdomen or liver area and confirmed by biopsy, were treated by TAE with PLE and polyvinyl alcohol (diameter: 500µm-700µm). Therapeutic effects including changes in lesion diameter and symptomatic improvement, and occurrence of complications, were evaluated for a follow-up period ranging from 12 to 42 months after the procedure. RESULTS All of four patients were successfully treated with PLE and polyvinyl alcohol embolization. One month after the procedure, dull pain in the upper abdomen or liver area vanished completely. Follow-up examination by CT or MRI revealed complete resolution in two cases and an obvious decrease in the other two cases. No immediate or delayed postembolization complications were encountered. CONCLUSION Transarterial embolization using PLE and polyvinyl alcohol should be considered as a safe and effective method for the treatment of FNH.

Treatment of large lumbar disc herniation with percutaneous ozone injection via the posterior-lateral route and inner margin of the facet joint

AIM To evaluate the effects of percutaneous ozone injection via the posterior-lateral route and inner margin of the facet joint in the treatment of large lumbar disc herniation. METHODS Fifty-eight patients with large lumbar disc herniation were treated with percutaneous injection of ozone via the posterior-lateral route and inner margin of the facet joint under digital subtraction angiography. Second injections were performed 5 d after the initial injection. All patients were followed up for 6-18 mo. A modified Macnab method was used for assessing clinical outcomes after oxygen-ozone therapy. RESULTS Successful puncture was obtained in all patients. The overall efficacy was 91.4%; the outcome was the excellent in 37 cases (63.8%), good in 16 cases (27.6%) and fair/poor in 5 cases (8.6%) according to the Macnab criteria. No severe complications were found throughout this study. CONCLUSION Percutaneous intradiscal ozone injection via the posterior-lateral route and inner margin of the facet joint is effective and safe for treatment of large lumbar disc herniation.

CT-guided percutaneous large-needle aspiration and bleomycin sclerotherapy for bronchogenic cyst: report of four cases.

PURPOSE Fine needle aspiration alone has been used as a treatment for bronchogenic cysts, but is subject to a high rate of recurrence. The purpose of this study was to review our experience with computed tomography (CT)-guided percutaneous large-needle aspiration and bleomycin sclerotherapy of bronchogenic cysts in four patients. MATERIALS AND METHODS Four patients with bronchogenic cysts at subcarinal (n = 1), paraspinal (n = 1), or intrapulmonary (n = 2) sites were treated at two medical centers with percutaneous transthoracic aspiration with a 17.5-gauge needle and sclerotherapy with use of bleomycin as the sclerosant agent. Clinical symptoms were seen in three of the four patients: recurrent cough in two and recurrent chest discomfort and palpitation in one. CT was used to guide the procedures. After sclerotherapy, the sizes of ablated cysts were followed by CT. RESULTS At a median follow-up of 10 months (range, 6-14 months), all three patients with symptoms had symptomatic relief and all four patients showed a nearly complete regression of bronchogenic cyst on follow-up CT. No recurrence was encountered. Minor complications included a small asymptomatic pneumothorax at the end of the procedure in one patient and a mild fever (38.0 degrees C-38.5 degrees C) on the first day after sclerotherapy in one patient, which resolved spontaneously without treatment. No major complications occurred. CONCLUSIONS CT-guided percutaneous treatment of bronchogenic cysts with large-needle aspiration and bleomycin sclerotherapy was safe and effective in this limited series. Further investigation of this technique is warranted.

Percutaneous extraction of deeply-embedded radiopaque foreign bodies using a less-invasive technique under image guidance.

Background: Radiopaque foreign bodies (RFBs) retained in soft tissue are a common clinical problem. Image-guided extraction plays a great role in this realm. We describe our experience in the management of RFBs imbedded deeply in soft tissue using a percutaneous less-invasive technique under fluoroscopic guidance. Methods: In all, 76 patients with 251 RFBs including gun pellets (n = 223), needle fragments (n = 4), and irregular metallic splinters (n = 24) underwent percutaneous extraction of RFBs with the modified technique, which consists of: (1) percutaneously gaining access to the RFB using an 18-gauge needle, several tapered dilators, and an outer cannula and (2) grasping and withdrawal of RFB using a forceps through the cannula. The following periods were 6 months to 6 years. Results: The direct distance between RFB and skin was from 2.5 cm to 8.5 cm (average 4.8 cm). Every RFB was successfully removed with technique success rate of 100%. The RFBs measured 0.2 cm to 3.0 cm in length and 0.1 cm to 0.5 cm in width. The procedural time and exposure time of X-ray for each RFB extraction were 8 minutes to 15 minutes and 1 minute to 4 minutes (mean, 10 minutes and 2 minutes, respectively). The radiation doses for each RFB and patient were 15.64 mGy to 62.56 mGy and 15.64 mGy to 500.48 mGy (mean, 30.26 mGy and 72.47 mGy, respectively). Blood lead concentration decreased to normal one month after the procedures in four patients with preprocedural high level. No complications were observed during the procedures and the following periods. Conclusion: Percutaneous extraction of RFBs from deep soft tissue with the present technique is safe, effective, and minimally invasive.

Transjugular intrahepatic portosystemic shunt with covered stents for hepatocellular carcinoma with portal vein tumor thrombosis

AIM To evaluate transjugular intrahepatic portosystemic shunt (TIPS) with covered stents for hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (PVTT). METHODS Eleven advanced HCC patients (all male, aged 37-78 years, mean: 54.3 ± 12.7 years) presented with acute massive upper gastrointestinal bleeding (n = 9) or refractory ascites (n = 2) due to tumor thrombus in the main portal vein. The diagnosis of PVTT was based on contrast-enhanced computed tomography and color Doppler sonography. The patients underwent TIPS with covered stents. Clinical characteristics and average survival time of 11 patients were analyzed. Portal vein pressure was assessed before and after TIPS. The follow-up period was 2-18 mo. RESULTS TIPS with covered stents was successfully completed in all 11 patients. The mean portal vein pressure was reduced from 32.0 to 11.8 mmHg (t = 10.756, P = 0.000). Gastrointestinal bleeding was stopped in nine patients. Refractory ascites completely disappeared in one patient and was alleviated in another. Hepatic encephalopathy was observed in six patients and was resolved with drug therapy. During the follow-up, ultrasound indicated the patency of the shunt and there was no recurrence of symptoms. Death occurred 2-14 mo (mean: 5.67 mo) after TIPS in nine cases, which were all due to multiple organ failure. In the remaining two cases, the patients were still alive at the 16- and 18-mo follow-up, respectively. CONCLUSION TIPS with covered stents for HCC patients with tumor thrombus in the main portal vein is technically feasible, and short-term efficacy is favorable.