共查询到20条相似文献,搜索用时 0 毫秒
1.
Osamu Matsui M.D. Jun Yoshikawa Masumi Kadoya Tosifumi Gabata Tsutomu Takashima Takeshi Urabe Masasi Unoura Kenichi Kobayashi 《Cardiovascular and interventional radiology》1996,19(5):352-355
We report a cirrhotic patient with complete occlusion of the portal vein with marked cavernous transformation due to chronic
thrombosis in whom a transjugular intrahepatic portosystemic shunt (TIPS) was successfully created after direct minilaparotomy
mesenteric vein catheterization, lysis and aspiration of the thrombus, and stenting in the portal vein. The methods used,
we believe, provide a new technique for performing TIPS in chronically thrombosed portal veins in which previously no effective
surgical therapeutic options were available.
Received: 0/00/00/Accepted: 0/00/00 相似文献
2.
Noboru Terayama Osamu Matsui Masumi Kadoya Jun Yoshikawa Toshifumi Gabata Shiro Miyayama Tsutomu Takashima Kenichi Kobayashi Isao Nakanishi Yasuni Nakanuma 《Cardiovascular and interventional radiology》1997,20(6):457-461
Purpose: To assess the histologic findings associated with stenosed and occluded transjugular intrahepatic portosystemic shunt (TIPS)
tracts.
Methods: Four TIPS tracts within three autopsy livers were histologically studied for vascular components by routine staining and
immunohistochemical staining. TIPS had been performed for bleeding from esophageal varices in patients with cirrhosis of the
liver.
Results: Two TIPS, examined on days 4 and 53, showed occlusion by fibrin thrombus. In the former, no endothelial cells were detected,
but coagulative necrosis of hepatocytes was found in the surrounding liver. In the latter, bile pigments were seen on the
luminal surface. In the two other TIPS without tract occlusion, examined on days 49 and 293, a layer of endothelial cells,
proliferation of smooth muscle cells, and deposition of an extracellular matrix such as collagen were confirmed. In the tract
examined on day 293, there was protrusion of hepatocytes into the lumen through the stent wires.
Conclusion: Short- and midterm TIPS occlusions were caused by thrombus forming after necrosis of hepatocytes and bile leakage, respectively.
Long-term TIPS stenosis was associated with a combination of pseudointimal hyperplasia and ingrowth of hepatocytes.
Received: 0/00/00/Accepted: 0/00/00 相似文献
3.
本文采用经颈静脉肝内门腔静脉内支架分流术(TIPSS)治疗8例反复食管胃底静脉曲张出血的肝硬变门脉高压症(CPH),术中使用8~10mm金属内支架在门静脉和肝静脉之间形成人工通道,达到降低门脉压力、防止上消化道再出血、缩小脾脏、减少腹水的目的。TIPSS术后,症状均得到有效的控制或明显改善。笔者认为:TIPSS是一种有效而可靠的降低门脉压力的非手术疗法,具有疗效确切,创伤性小等优点,因此,应成为治疗CPH消化道大出血的首选方法、同时对Child分级较好的中早期CPH患者也可以起到预防出血的作用。 相似文献
4.
Bahramipour PF Festa S Biswal R Wachsberg RH 《Cardiovascular and interventional radiology》2000,23(3):232-234
Though polycystic liver disease (PCLD) has historically been considered a contraindication to TIPS, we present a case where
technically successful shunt creation was achieved without the need for modification of the standard TIPS procedure, as was
required in a previous report. 相似文献
5.
目的:回顾分析并探讨经颈静脉肝内门体分流术(TIPS)在原发性肝癌伴门静脉癌栓(PVTT)治疗中的应用价值.方法:回顾分析原发性肝癌伴门静脉癌栓,并接受TIPS手术治疗的患者的病例资料,了解术后主要症状改善情况,并发症及生存期等随访资料.结果:接受TIPS手术的肝癌伴PVTT患者共13例,其中成功进行手术患者10例.3例上消化道出血患者成功止血,7例腹水患者中的5例腹水减少,手术成功患者的平均生存期为(112.1±41.7)天,而未获成功的平均生存期仅(34.3±25.5)天,差异具有统计学意义(P<0.05).结论:TIPS应用于肝癌伴门脉癌栓的治疗可行,可改善生存质量、延长生存期,具有一定的临床应用价值. 相似文献
6.
7.
Endovascular treatment of a portal vein tear during TIPSS 总被引:1,自引:0,他引:1
During a transjugular portosystemic stent-shunt (TIPSS) procedure a portal vein laceration occurred with subsequent intraperitoneal
hemorrhage. A PTFE-covered nitinol stent was successfully placed eliminating the leak and creating a functioning portosystemic
shunt. This case demonstrates both the importance of portal vein puncture more than 1 cm from the bifurcation and the necessity
of maintaining a stock of available stent-grafts. 相似文献
8.
José I. Bilbao Jesús M. Longo Hervé Rousseau Vanessa de Villa Francisco Mansilla Javier Alvarez-Cienfuegos Francis Joffre Jesús Prieto 《Cardiovascular and interventional radiology》1994,17(2):106-109
Portal vein (PV) thrombosis increases the risk of variceal bleeding in cirrhotic patients with portal hypertension. Its presence also complicates PV access during transjugular porto-caval shunt (TIPS) placement. We overcame this obstacle by using ultrasound (US) guidance for PV entry. Clot disruption by balloon catheters was then performed before placing the vascular endoprostheses for portal-venous shunting. We treated 3 cirrhotic patients in such fashion with good clinical results. Portal thrombi progressively disappeared after shunting due to both balloon disruption and the rise in portal blood flow velocity. 相似文献
9.
José I. Bilbao Isabel Vivas Beatriz Elduayen Carlos Alonso Iñaki González-Crespo Alberto Benito Antonio Martínez-Cuesta 《Cardiovascular and interventional radiology》1999,22(5):417-422
New therapeutic alternatives to portal vein thrombosis (PVT) include the percutaneous, transhepatic infusion of fibrinolytic
agents, balloon dilatation, and stenting. These maneuvers have proven to be effective in some cases with acute, recent PVT.
We have treated two patients with acute PVT via transhepatic or transjugular approaches and by using pharmacologic and mechanical
thrombolysis and thrombectomy. Although both patients clinically improved, morphologic results were only fair and partial
rethrombosis was observed. The limitations of percutaneous procedures in the recanalization of acute PVT in noncirrhotic patients
are discussed. 相似文献
10.
Mario Bezzi M.D. Laura Broglia Alessandro A Lemos Plinio Rossi 《Cardiovascular and interventional radiology》1995,18(2):102-105
Transjugular intrahepatic portosystemic shunt (TIPS) was performed in two patients with portal vein thrombosis. In both patients,
hepatopetal flow had been maintained by an anomalous insertion of the right gastric vein (RGV) into the portal vein bifurcation
and into the left portal branch respectively. In one patient, the main portal trunk could not be recanalized and the RGV was
used as an accessory portal vein to place one stent for TIPS. In the other case, access through the partial portal-vein occlusion
was gained and three stents were placed from the hepatic vein to the main portal vein distal to the thrombus. In portal vein
thrombosis, the aberrant insertion of the RGV into the left or right portal branches may maintain patency of the intrahepatic
portal system and, in case of unsuccessful recanalization of the porta, may represent the sole pathway for placing a TIPS 相似文献
11.
Peter M. T. Pattynama Bart van Hoek Leo J. Schultze Kool 《Cardiovascular and interventional radiology》1995,18(3):192-195
Penetrating the hepatic artery during transjugular intrahepatic portosystemic shunt (TIPS) is a relatively frequent but almost always benign complication. We report a patient in whom the right hepatic artery, originating from the superior mesenteric artery, was inadvertently catheterized and stented. The arteriovenous fistula was treated with a detachable balloon positioned within the hepatic artery. A second TIPS was attempted and successfully created during the same session. The patient died of cardiac failure, attributed to rapid resolution of massive ascites after TIPS with circulatory overload. At autopsy, the liver distal to the arterial occlusion balloon was infarcted, illustrating the importance of hepatic artery perfusion in liver cirrhosis. 相似文献
12.
We describe a simple technique for recatheterization of transjugular intrahepatic portosystemic shunts (TIPS) with severe hepatic vein ostial stenoses that are inaccessible to standard transvenous approaches. A small gauge needle is used to transhepatically introduce a guidewire into the shunt; the wire is passed through the hepatic vein stenosis, snared, and used to guide jugular or brachial catheters into the TIPS. 相似文献
13.
Francesco Florio Michele Nardella Silverio Balzano Antonio Giacobbe Francesco Perri 《Cardiovascular and interventional radiology》1998,21(5):421-424
The authors report a congenital intrahepatic portosystemic shunt detected by angiography in a young patient with acute onset
of hyperammoniemia and hepatic encephalopathy. 相似文献
14.
Jeffery Choh Bart Dolmatch Rami Safadi Phil Long Michael Geisinger Gary Lammert James Dempsey 《Cardiovascular and interventional radiology》1998,21(1):88-90
One hundred and five sequential transjugular core liver biopsies (TJLBx) were performed in 101 patients with coagulopathy
and/or ascites using the 19-gauge Quick-Core Biopsy (QCB) needle. Two-hundred and seventy-three cores were obtained in 295
passes (92.5%). One-hundred and two of the 105 procedures (97.1%) led to a histopathologic diagnosis. One of the three nondiagnostic
biopsies was done because of severe autolysis of the liver. There was one subcapsular hematoma, one hepatic arteriovenous
fistula, and one liver capsular puncture. Two minor neck hematomas occurred. One death was reported (unrelated to the procedure).
QCB needle TJLBx is an effective and relatively safe way to obtain core liver samples.
Received: 0/00/00/Accepted: 0/00/00 相似文献
15.
Manfred Cejna Siegfried Thurnher Johann Pidlich Klaus Kaserer Maria Schoder Johannes Lammer 《Cardiovascular and interventional radiology》1999,22(4):305-310
Purpose: To investigate whether placement of a polyester-covered stent-graft increases the primary patency of transjugular intrahepatic
portosystemic stent shunts (TIPSS).
Methods: Between 1995 and 1997 Cragg Endopro or Passager MIBS stent-grafts were used for the creation of TIPSS in eight male patients,
35–59 years of age (mean 48 years). All patients suffered from recurrent variceal bleeding and/or refractory ascites due to
liver cirrhosis. Seven stent-grafts were dilated to a diameter of 10 mm, one to 12 mm. Follow-up was performed with duplex
ultrasound, clinical assessment, and angiography.
Results: The technical success rate for creation of a TIPSS was 100%. The mean portosystemic pressure gradient decreased from 25 mmHg
to 12 mmHg. In seven of eight patients TIPSS dysfunction occurred between 2 days and 3 years after stent-graft placement.
In one patient the TIPSS is still primarily patent (224 days after creation). The secondary patency rates are 31 days to 3
years.
Conclusion: The primary use of polyester-covered stent-grafts for TIPSS did not increase primary patency rates in our small series. 相似文献
16.
常规的经颈静脉肝内门腔支架分流术均经右颈内静脉入路。这种入路操作容易,已成为经典途径。本文报告了114例肝硬化门脉高压患者中12例经左颈静脉入路完成Tipss操作。12例患者在造影时发现右颈静脉血栓形成、狭窄甚至闭塞。在右颈内静脉闭塞的情况下,经左侧入路是可行的。 相似文献
17.
经颈内静脉肝内门腔静脉分流术治疗BuddChiari综合征 总被引:1,自引:0,他引:1
目的探讨经颈静脉肝内门腔静脉分流术(TIPS)治疗Budd-Chiari综合征(BCS)的疗效。方法本组14例患者经影像学检查确诊为BCS,因进行性肝功能损害,或严重门脉高压并发症(顽固性腹水,食管胃底静脉曲张上消化道出血),或广泛肝静脉闭塞而行TIPS术治疗。其中混合型8例,肝静脉型5例,肝静脉广泛闭塞型1例。TIPS术中对于下腔静脉、肝静脉的不同情况,灵活选择肝静脉或下腔静脉穿刺点进行穿刺,7例从肝静脉开口处行门静脉穿刺,建立门-腔静脉分流道,4例从下腔静脉直接穿刺门静脉分支,3例经皮穿刺开通肝右静脉后再经肝右静脉穿刺门静脉。术后对分流道支架开通情况进行长期随访。结果14例手术均获成功,门静脉压力由术前平均(4.9±1.4)kPa,降至术后(3.2±1.5)kPa,术后随访5~64个月,2例因支架狭窄分别于术后13、24个月再发上消化道出血,行分流道球囊扩张治疗,术后恢复良好。结论TIPS适用BCS合并有进行性肝功能损害或门静脉高压引起的上消化道出血、顽固性腹水的治疗。对于已行下腔静脉或肝静脉成形术后再发或加重的门静脉高压患者亦为适应证,但手术难度增加。 相似文献
18.
19.
Holger M. Strunk Jochen Textor Karl-August Brensing Hans H. Schild 《Cardiovascular and interventional radiology》1997,20(4):311-313
The case of a 28-year-old man with acute Budd-Chiari syndrome due to veno-occlusive disease is reported. Transjugular intrahepatic
portosystemic shunt (TIPS) was performed after upper gastrointestinal endoscopy, duplex sonographic and abdominal computed
tomographic examination, inferior cavogram with hepatic venous catheterization, and transvenous biopsy. A 10-mm parenchymal
tract was created. The patient did well after the procedure; ascites resolved and liver function improved markedly. The shunt
has remained patent up to now for 6 months. 相似文献
20.
This study was designed to retrospectively evaluate transjugular intrahepatic portosystemic shunt (TIPS) performed on an emergency basis in patients with hemorrhagic shock from recurrent uncontrolled variceal bleeding. Over a 3.5-year period we reviewed the medical records as well as the imaging studies of 16 patients who had uncontrolled variceal bleeding and presented to our department for an emergent placement of TIPS. In our study the technical success was 88% (14/16 patients), the overall mortality was 36% (5/14 patients), and the shunt immediately reduced the portal venous pressure gradient by a mean of 64%. Given the poor outcome of other alternatives, aggressive treatment and placement of TIPS is justified regardless of the severity of the bleeding episode. 相似文献