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Passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts and assessment of clinical outcomes

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World Journal of Hepatology 2017年第12期9卷 603-612页

作者： Michael C Hsu Charles N Weber S William Stavropoulos Timothy W Clark Scott O Trerotola Richard D Shlansky Goldberg Michael C Soulen Gregory J Nadolski Department of radiology Division of Interventional RadiologyMount Sinai Hospital Department of radiology Division of Interventional RadiologyHospital of the University of Pennsylvania

AIM To assess for passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts(TIPS) and compare outcomes with maximally dilated *** Polytetrafluoroethylene covered TIPS(Viatorr) from July 2002 to December 2013 were retrospectively reviewed at two hospitals in a single institution. Two hundred and thirty patients had TIPS maximally dilated to 10 mm(m TIPS), while 43 patients who were at increased risk for hepatic encephalopathy(HE), based on clinical evaluation or low pre-TIPS portosystemic gradient(PSG), had 10 mm TIPS sub-maximally dilated to 8 mm(sm TIPS). Group characteristics(age, gender, Model for End-Stage Liver Disease score, post-TIPS PSG and clinical outcomes were compared between groups, including clinical success(ascites or varices), primary patency,primary assisted patency, and severe post-TIPS HE. A subset of fourteen patients with sm TIPS underwent follow-up computed tomography imaging after TIPS creation, and were grouped based on time of imaging( 6 mo). Change in diameter and crosssectional area were measured with 3D imaging software to evaluate for passive *** Patient characteristics were similar between the sm TIPS and m TIPS groups, except for pre-TIPS portosystemic gradient, which was lower in the sm TIPS group(19.4 mm Hg ± 6.8 vs 22.4 mm Hg ± 7.1, P = 0.01). Primary patency and primary assisted patency between sm TIPS and m TIPS was not significantly different(P = 0.64 and 0.55, respectively). Four of the 55 patients(7%) with sm TIPS required TIPS reduction for severe refractory HE, while this occurred in 6 of the 218 patients(3%) with m TIPS(P = 0.12). For the 14 patients with follow-up computed tomography(CT) imaging, the median imaging follow-up was 373 d. There was an increase in median TIPS diameter, median percent diameter change, median area, and median percent area change in patients with CT follow-up greater than 6 mo after TIPS placement compared to follow-up within 6 mo(

关键词： Variceal hemorrhage Portal hypertension Transjugular intrahepatic portosystemic shunts Ascites Sub-maximal dilation Underdilated Passive expansion Hepatic encephalopathy

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Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy

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World Journal of Gastroenterology 2017年第10期23卷 1735-1746页

作者： Murad Feroz Bandali Anirudh Mirakhur Edward Wolfgang Lee Mollie Clarke Ferris David James Sadler Robin Ritchie Gray Jason Kam Wong Department of radiology Foothills Medical Centre University of Calgary division of interventional radiology Department of Radiology UCLA Medical Center

Portal hypertension is a common clinical syndrome, defined by a pathologic increase in the portal venous pressure. Increased resistance to portal blood flow, the primary factor in the pathophysiology of portal hypertension, is in part due to morphological changes occurring in chronic liver diseases. This results in rerouting of blood flow away from the liver through collateral pathways to low-pressure systemic veins. Through a variety of computed tomographic, sonographic, magnetic resonance imaging and angiographic examples, this article discusses the appearances and prevalence of both common and less common portosystemic collateral channels in the thorax and abdomen. A brief overview of established interventional radiologic techniques for treatment of portal hypertension will also be provided. Awareness of the various imaging manifestations of portal hypertension can be helpful for assessing overall prognosis and planning proper management.

关键词： Portal hypertension Diagnostic imaging Portosystemic collaterals Image-guided therapy

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Evidence-based medical oncology and interventional radiology paradigms for liver-dominant colorectal cancer metastases

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World Journal of Gastroenterology 2016年第11期22卷 3127-3149页

作者： Alan Alper Sag Fatih Selcukbiricik Nil Molinas Mandel division of interventional radiology Department of RadiologyKoc University School of Medicine division of Medical Oncology Department of Internal MedicineKoc University School of Medicine

Colorectal cancer metastasizes predictably, with liver predominance in most cases. Because liver involvement has been shown to be a major determinant of survival in this population, liver-directed therapies are increasingly considered even in cases where there is(limited) extrahepatic disease. Unfortunately, these patients carry a known risk of recurrence in the liver regardless of initial therapy choice. Therefore, there is a demand for minimally invasive, non-surgical, personalized cancer treatments to preserve quality of life in the induction, consolidation, and maintenance phases of cancer therapy. This report aims to review evidence-based conceptual, pharmacological, and technological paradigm shifts in parenteral and percutaneous treatment strategies as well as forthcoming evidence regarding next-generation systemic, locoregional, and local treatment approaches for this patient population.

关键词： Colonic neoplasms Rectal neoplasms Neoplasm metastasis Antineoplastic agents FOLFOX protocol Irinotecan 5-flurouracil and leucovorin protocol Radiofrequency ablation Microwave ablation Chemoembolization Therapeutic Immunotherapy

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Editorial comment:a review on radiofrequency,microwave and high-intensity focused ultrasound ablations for hepatocellular carcinoma with cirrhosis

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Hepatobiliary Surgery and Nutrition 2022年第3期11卷 453-456页

作者： Merve Ozen Driss Raissi division of Vascular and interventional radiology Department of RadiologyUniversity of KentuckyLexingtonKYUSA

We read with great interest the article by Cheung et al.(1)recently published in Hepatobiliary Surgery and Nutrition,presenting a narrative review of various ablation systems for hepatocellular carcinoma(HCC)in cirrhotic *** would like to provide several *** would first like to offer our congratulations to the authors for their review,which extensively discusses radiofrequency(RFA),high-intensity focused ultrasound(HIFU),and microwave ablation(MWA)ablation *** review is a succinct summary to better understand the utility of various ablation techniques used in HCC treatment(1).

关键词： Surgery hepatocellular

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Preparing for Iiver surgery with "Alphabet Soup": PVE, ALPPS, TAE-PVE, LVD and RL

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Hepatobiliary Surgery and Nutrition 2020年第2期9卷 136-151页

作者： DaeHee Kim Joshua Cornman-Homonoff David C.Madoff Department of radiology Division of Interventional RadiologyMemorial Sloan Kettering Cancer CenterNew YorkNYUSA Department of radiology and Biomedical Imaging Section of Interventional RadiologyYale School of MedicineNew HavenCTUSA

Future liver remnant(FLR)is a critical limiting factor for treatment eligibility and postoperative prognosis when considering surgical ***-operative portal vein embolization(PVE)has been proven effective in modulating FLR and now widely accepted as a standard of ***,PVE is not always effective due to potentially inadequate augmentation of the FLR as well as tumor progression while awaiting liver *** concerns have prompted exploration of alternative techniques:associating liver partition and portal vein ligation for staged hepatectomy(ALPPS),transarterial embolization-portal vein embolization(TAE-PVE),liver venous deprivation(LVD),and radiation lobectomy(RL).The article aims to review the principles and applications of PVE and these newer hepatic regenerative techniques.

关键词： Hepatic regeneration future liver remnant embolization

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Doppler ultrasonography in living donor liver transplantation recipients: Intra- and post-operative vascular complications

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World Journal of Gastroenterology 2016年第27期22卷 6145-6172页

作者： Omar Abdelaziz Hussein Attia Department of Diagnostic and interventional radiology Cairo University Hospitals Department of Diagnostic and interventional radiology National Cancer Institute Cairo University

Living-donor liver transplantation has provided a solution to the severe lack of cadaver grafts for the replacement of liver afflicted with end-stage cirrhosis, fulminant disease, or inborn errors of metabolism. Vascular complications remain the most serious complications and a common cause for graft failure after hepatic transplantation. Doppler ultrasound remains the primary radiological imaging modality for the diagnosis of such complications. This article presents a brief review of intra- and post-operative living donor liver transplantation anatomy and a synopsis of the role of ultrasonography and color Doppler in evaluating the graft vascular haemodynamics both during surgery and post-operatively in accurately defining the early vascular complications. Intra-operative ultrasonography of the liver graft provides the surgeon with useful real-time diagnostic and staging information that may result in an alteration in the planned surgical approach and corrections of surgical complications during the procedure of vascular anastomoses. The relevant intraoperative anatomy and the spectrum of normal and abnormal findings are described. Ultrasonography and color Doppler also provides the clinicians and surgeons early post-operative potential developmental complications that may occur during hospital stay. Early detection and thus early problem solving can make the difference between graft survival and failure.

关键词： Doppler Ultrasound Living donor Liver transplantation Intraoperative Postoperative Vascular Complications

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Transcatheter arterial chemoembolization followed by immediate radiofrequency ablation for large solitary hepatocellular carcinomas

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World Journal of Gastroenterology 2013年第26期19卷 4192-4199页

作者： Zhi-Jun Wang Mao-Qiang Wang Feng Duan Peng Song Feng-Yong Liu Zhong-Fei Chang Yan Wang Jie-Yu Yan Kai Li Department of interventional radiology PLA General Hospital

AIM: To assess the technical safety and efficacy of transcatheter arterial chemoembolization (TACE) combined with immediate radiofrequency ablation (RFA) for large hepatocellular carcinomas (HCC) (maximum diameter ≥ 5 cm). METHODS: Individual lesions in 18 patients with HCCs (mean maximum diameter: 7.5 cm; range: 5.1-15.5 cm) were treated by TACE combined with percutaneous RFA between January 2010 and June 2012. All of the patients had previously undergone one to four cycles of TACE treatment. Regular imaging and laboratory tests were performed to evaluate the rate of technical success, technique-related complications, local-regional tumor responses, recurrence-free survival time and survival rate after ***: Technical success was achieved for all 18 visible HCCs. Complete response (CR) was observed in 17 cases, and partial response was observed in 1 case 1 mo after intervention. The CR rate was 94.4%. Local tumors were mainly characterized by coagulative necrosis. During follow-up (2-29 mo), the mean recurrencefree survival time was 16.8 ± 4.0 mo in 17 cases of CR. The estimated overall survival rate at 6, 12, and 18 mo was 100%. No major complications were observed. Levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the blood of 17 patients transiently increased on the third day after treatment (ALT 200.4 ± 63.4 U/L vs 24.7 ± 9.3 U/L, P < 0.05; AST 228.1 ± 25.4 U/L vs 32.7 ± 6.8 U/L, P < 0.05). Severe pain occurred in three patients, which was controlled with morphine and fentanyl. CONCLUSION: TACE combined with immediate RFA is a safe and effective treatment for large solitary HCCs. Severe pain is a major side effect, but can be controlled by morphine.

关键词： Large hepatocellular carcinoma Transcatheter arterial chemoembolisation Radiofrequency ablation Combination therapy Synchronism

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

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World Journal of Gastroenterology 2014年第6期20卷 1602-1607页

作者： Jian-Bo Zhao Chao Feng Qiao-Hua Zhu Xiao-Feng He Yan-Hao Li Yong Chen Department of interventional radiology Nanfang Hospital Southern Medical University Department of interventional radiology People’s Hospital Southern Medical University

AIM: To evaluate transjugular intrahepatic portosystemic shunt (TIPS) with covered stents for hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (PVTT).

关键词： Transjugular intrahepatic portosystemic shunt Covered stent Portal hypertension Main portal vein tumor thrombus Hepatocellular carcinoma

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interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis

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World Journal of Gastroenterology 2009年第40期15卷 5028-5034页

作者： Feng-Yong Liu Mao-Qiang Wang Qing-Sheng Fan Feng Duan Zhi-Jun Wang Peng Song Department of interventional radiology Clinical Division of Internal Medicine Chinese People's Liberation Army General Hospital Beijing 100853 China

AIM: To summarize our methods and experience with interventional treatment for symptomatic acute-sub-acute portal vein and superior mesenteric vein throm-bosis (PV-SMV) thrombosis. METHODS: Forty-six patients (30 males, 16 females, aged 17-68 years) with symptomatic acute-subacute portal and superior mesenteric vein thrombosis were ac-curately diagnosed with Doppler ultrasound scans, com-puted tomography and magnetic resonance imaging. They were treated with interventional therapy, including direct thrombolysis (26 cases through a transjugular intrahepatic portosystemic shunt; 6 through percutane-ous transhepatic portal vein cannulation) and indirect thrombolysis (10 through the femoral artery to superior mesenteric artery catheterization; 4 through the radial artery to superior mesenteric artery catheterization). RESULTS: The blood reperfusion of PV-SMV was achieved completely or partially in 34 patients 3-13 d after thrombolysis. In 11 patients there was no PV-SMV blood reperfusion but the number of collateral vessels increased signif icantly. Symptoms in these 45 patients were improved dramatically without severe operationalcomplications. In 1 patient, the thrombi did not respond to the interventional treatment and resulted in intestinal necrosis, which required surgical treatment. In 3 patients with interventional treatment, thrombi reformed 1, 3 and 4 mo after treatment. In these 3 patients, indirect PV-SMV thrombolysis was performed again and was successful. CONCLUSION: interventional treatment, including direct or indirect PV-SMV thrombolysis, is a safe and effective method for patients with symptomatic acutesubacute PV-SMV thrombosis.

关键词： Portal thrombosis Superior mesenteric vein thrombosis Thrombolysis interventional treatment

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Bugbee flexible electrocautery facilitates choledochoscopic biopsy,fulguration,and debulking of a high grade intraductal papillary neoplasm of the bile duct

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Hepatobiliary & Pancreatic Diseases International 2018年第2期17卷 176-179页

作者： Ravi N Srinivasa Rajiv N Srinivasa Joseph J Gemmete Jeffrey Forris Beecham Chick Department of radiology Division of Vascular and Interventional radiology University of Michigan Health System 1500 East Medical Center Drive Ann Arbor MI 48109 USA

To the Editor:Intraductal papillary neoplasm of the bile duct(IPNB)may occur in the setting of primary sclerosing cholangitis,choledochal cysts or hepatolithiasis[1].The entity may be a precursor of cancer or intrahepatic *** carcinoma,tubular or mucinous adenocarcinoma is present in approximately 40%-80%of IPNBs[1–3].IPNB is frequently found in the resection margins of patients undergoing hepatectomy for cholangiocarcinoma[4].

关键词： fulguration and debulking of a high grade intraductal papillary neoplasm of the bile duct Bugbee flexible electrocautery facilitates choledochoscopic biopsy flexible

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