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Transjugular intrahepatic portosystemic shunt for the management of acute variceal hemorrhage

World Journal of Gastroenterology 2013年第37期19卷 6131-6143页

作者： Romaric Loffroy Louis Estivalet Violaine Cherblanc Sylvain Favelier Pierre Pottecher Samia Hamza Anne Minello Patrick Hillon Pierre Thouant Pierre-Henri Lefevre denis krausé Jean-Pierre Cercueil Department of Vascular Oncologic and Interventional RadiologyUniversity of Dijon School of MedicineBocage Teaching Hospital Department of Intensive Care Medicine Gastroenterology and HepatologyUniversity of Dijon School of MedicineBocage Teaching Hospital

Acute variceal hemorrhage,a life-threatening condition that requires a multidisciplinary approach for effective therapy,is defined as visible bleeding from an esophageal or gastric varix at the time of endoscopy,the presence of large esophageal varices with recent stigmata of bleeding,or fresh blood visible in the stomach with no other source of bleeding *** of blood products,pharmacological treatments and early endoscopic therapy are often effective;however,if primary hemostasis cannot be obtained or if uncontrollable early rebleeding occurs,transjugular intrahepatic portosystemic shunt(TIPS)is recommended as rescue *** TIPS represents a major advance in the treatment of complications of portal *** variceal hemorrhage that is poorly controlled with endoscopic therapy is generally well controlled with TIPS,which has a 90%to 100%success ***,TIPS is associated with a mortality of 30%to 50%in such a *** TIPS should be considered early in patients with refractory variceal bleeding once medical treatment and endoscopic sclerotherapy failure,before the clinical condition ***,admission to specialized centers is mandatory in such a setting and regional protocols are essential to be organized *** review article discusses initial management and then focuses on the specific role of TIPS as a primary therapy to control acute variceal hemorrhage,particularly as a rescue therapy following failure of endoscopic approaches.

关键词： Cirrhosis Portal hypertension Transjugular intrahepatic portosystemic shunt Variceal hemorrhage

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Transcatheter embolization as the new reference standard for endoscopically unmanageable upper gastrointestinal bleeding

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World Journal of Gastrointestinal Surgery 2012年第10期4卷 223-227页

作者： Romaric Loffroy Louis Estivalet Violaine Cherblanc Damien Sottier Boris Guiu Jean-Pierre Cercueil denis krausé Department of Vascular and Interventional Radiology University of Dijon School of MedicineBocage Teaching Hospital21079 Dijon CedexFrance

Acute nonvariceal upper gastrointestinal bleeding(UGIB) is a major medical emergency problem associated with significant morbidity and *** is considered the first method of choice to detect and treat *** therapy usually achieves primary hemostasis,but 10%-30% of these patients have repeat *** patients in whom hemostasis is not achieved with endoscopic techniques,treatment with transcatheter angiographic embolization(TAE) or surgery is *** intervention is usually an expeditious and gratifying endeavor,but it can be associated with high operative mortality rates.A large number of studies support the use of TAE as salvage therapy as an alternative to ***,few studies have compared the results of TAE with that of emergency surgery in terms of efficiency,the frequency of repeat bleeding,and ***,Ang et al retrospectively compared the outcome of TAE and surgery as salvage therapy of UGIB after failed endoscopic *** were no significant differences in 30 d mortality,complication rates and length of stay although higher rebleeding rates were observed after TAE compared with *** this commentary,we discuss the advantages and drawbacks of these two therapeutic strategies for *** also attempt to define the exact role of TAE for acute nonvariceal UGIB.

关键词： Upper gastrointestinal bleeding Endoscopic hemostasis Transcatheter embolization Surgery

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Endovascular management of visceral artery aneurysms: When to watch, when to intervene?

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World Journal of Radiology 2015年第7期7卷 143-148页

作者： Romaric Loffroy Sylvain Favelier Pierre Pottecher Pierre-Yves Genson Louis Estivalet Sophie Gehin Jean-Pierre Cercueil denis krausé Department of Vascular Oncologic and Interventional Radiology University of Dijon School of Medicine Bocage Teaching Hospital

Visceral artery aneurysms(VAA) include splanchnic and renal artery aneurysms. They represent a rare clinical entity, although their detection is rising due to an increased use of cross-sectional imaging. Rupture is the most devastating complication, and is associated with a high morbidity and mortality. In addition, increased percutaneous endovascular interventions have raised the incidence of iatrogenic visceral artery pseudoaneurysms(VAPAs). For this reason, elective repair is preferable in the appropriately chosen patient. Controversy still exists regarding their treatment. Over the past decade, there has been steady increase in the utilization of minimally invasive, non-operative interventions, for vascular aneurysmal disease. All VAAs and VAPAs can technically be fixed by endovascular techniques but that does not mean they should. These catheter-based techniques constitute an excellent approach in the elective setting. However, in the emergent setting it may carry a higher morbidity and mortality. The decision for intervention has to take into account the size and the natural history of the lesion, the risk of rupture, which is high during pregnancy, and the relative risk of surgical or radiological intervention. For splanchnic artery aneurysms, we should recognize that we are not, in reality, well informed about their natural history. For most asymptomatic aneurysms, expectant treatment is acceptable. For large, symptomatic or aneurysms with a high risk of rupture, endovascular treatment has become the firstline therapy. Treatment of VAPAs is always mandatory because of the high risk of rupture. We present our point of view on interventional radiology in the splanchnic arteries, focusing on what has been achieved and the remaining challenges.

关键词： Visceral artery Aneurysm False aneurysm Angiography Embolization Stent-graft

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