Yu-Fei Fu

Accessory hepatic vein recanalization for treatment of Budd-Chiari syndrome due to long-segment obstruction of the hepatic vein: initial clinical experience

PURPOSE We aimed to investigate the feasibility and effectiveness of accessory hepatic vein recanalization (balloon dilatation/stent insertion) for patients with Budd-Chiari syndrome (BCS) due to long-segment obstruction of the hepatic vein. METHODS From March 2010 to December 2013, 20 consecutive patients with BCS, due to long-segment obstruction of three hepatic veins, treated with accessory hepatic vein recanalization (11 males, 9 females; mean age, 33.4±10.9 years; range, 22-56 years) were included in this retrospective study. Data on technical success, clinical success, and follow-up were collected and analyzed. RESULTS Technical and clinical success was achieved in all patients. Each patient was managed with a single accessory hepatic vein recanalization procedure. No procedure-related complications occurred. The diameter of the accessory hepatic vein was 8.45±1.47 mm (6-11 mm) at the stem, and there were many collateral circulations between the hepatic vein and the accessory hepatic vein. The mean pressure of accessory hepatic vein decreased from 47.50±5.59 cm H2O before treatment to 28.80±3.47 cm H2O after treatment (P < 0.001). Abnormal levels of total bilirubin, albumin, aspartate aminotransferase, and alanine transaminase improved after the treatment. During the follow-up, three patients experienced restenosis or stenting of the accessory hepatic vein. CONCLUSIONS In BCS due to long-segment obstruction of the hepatic veins, it is important to confirm whether there is a compensatory accessory hepatic vein. For patients with a compensatory but obstructed accessory hepatic vein, recanalization is a simple, safe, and effective treatment option.

Double Stent Insertion for Combined Malignant Airway and Esophageal Stenoses: Feasibility, Safety, and Long-Term Outcome.

PURPOSE We determined the feasibility, safety, and long-term outcome of double stent insertion in management of combined malignant airway and esophageal stenoses (CAES). PATIENTS AND METHODS Between March 2005 and May 2014, 11 consecutive patients (9 males and 2 females), 56-78 years of age (mean, 63.4 ± 6.1 years), with CAES who underwent double stent insertion (airway and esophageal stents) were enrolled in this retrospective study. Data regarding the technical success, clinical success, and long-term outcome were collected and analyzed. RESULTS Airway and esophageal stents were successfully inserted in all patients. The interval between insertion of the two stents was 0-42 days (mean, 13.2 ± 14.2 days). No procedure-related complication occurred. Relief of dyspnea and dysphagia was achieved in all patients. The mean Hugh-Jones grade improved from 4.5 ± 0.7 before airway stent insertion to 1.5 ± 0.5 after airway stent insertion (P < .001). The mean dysphagia grade improved from 3.5 ± 0.5 before esophageal stent insertion to 1.3 ± 0.5 after esophageal stent insertion (P < .001). Stent-related complications included restenosis of the airway stent (n = 2) and mild migration of the esophageal stent (n = 2). There was no occurrence of airway-esophageal fistula after treatment. The mean survival of the 11 patients after double stent insertion was 105.5 ± 18.5 days. The cumulative 3- and 6-month survival rates after double stent insertion were 54.5% and 9.1%, respectively. CONCLUSIONS Double stent insertion is an easy, safe, and effective method in palliative treatment for patients with CAES.