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transhepatic venous approach to permanent pacemaker placement in a patient with limited central venous access

World Journal of Clinical Cases 2015年第9期3卷 835-837页

作者： Adeel M Siddiqui Gregory S Harris Assad Movahed Karl S Chiang Mihail G Chelu Rajasekhar Nekkanti Department of Internal Medicine East Carolina School of Medicine Department of Cardiovascular Sciences East Carolina Brody School of Medicine Vascular Interventional Radiology Vidant Medical Center

The end-stage renal disease population poses a challenge for obtaining venous access required for life-saving invasive cardiac procedures. In this case report, we describe an adult patient with end-stage renal disease in whom the hepatic vein was the only available access to implant a single-lead permanent cardiac pacemaker. A 63-year-old male with endstage renal disease on maintenance hemodialysis and permanent atrial fibrillation/atrial flutter presented with symptomatic bradycardia. Imaging studies revealed all traditional central venous access sites to be occluded/non-accessible. With the assistance of vascular interventional radiology, a trans-hepatic venous catheter was placed. This was then used to place a right ventricular pacing lead with close attention to numerous technical aspects. The procedure was completed successfully with placement of a single-lead permanent cardiac pacemaker.

关键词： trans-hepatic venous access Permanent cardiac pacemaker End-stage renal disease

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Role of endoscopy in the conservative management of biliary complications after deceased donor liver transplantation

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World Journal of Hepatology 2015年第30期7卷 2927-2932页

作者： Andrea Lisotti Pietro Fusaroli Giancarlo Caletti Unità Operativa di Gastroenterologia Ospedale Nuovo di Imola Department of Medical and Surgical Sciences University of Bologna Gastroen- terology Unit Hospital of Imola

The clinical outcome of patients receiving liver trans-plantation could be significantly affected by biliary complications, including strictures, leaks, stones and bilomas; early diagnosis and treatment of these con-ditions lead to markedly reduction in morbidity and mortality. Therapeutic gold standard is represented by conservative approaches, both endoscopic and percutaneous, based on the type of biliary reconstruction, the local availability of the procedures and specific expertise. In patients with previous transplantation, the difficult biliary access and the possible presence of concomitant complications(mainly strictures) further restrict the efficacy of the endoscopic and percutaneous treatments; on the other hand, surgery should generally be avoided because of the even increased morbidity and mortality due to technical and clinical issues. Here we review the most common biliary complications occurring after liver transplantation and discuss available treatment options including future perspectives such as endoscopic ultrasound-guided biliary access in patients with Roux-en-Y choledocho-jejunostomy or extracorporeal shock wave lithotripsy for difficult stones.

关键词： Endoscopic ultrasonography Endoscopicultrasound Percutaneous trans-hepatic drainage Endoscopicretrograde cholangiopancreatography Biliarydrainage

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