Ultrasound-guided percutaneous transhepatic thrombolysis for treatment of portal vein thrombosis after liver transplantation
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Abstract:
Objective
To evaluate the effective and safety of ultrasound-guided percutaneous portal vein guide wire placement adjunct to thrombolytic catheter, which treating portal vein thrombosis after liver transplantation.
Methods
From Jan 2012 to Dec 2015, a total of 6 patients (5 male, 1 female, average age 50.6 years old, age range 41-65 years old ) with portal vein thrombosis after liver transplantation were retrospectively studied. The diagnosis was confirmed by contrast enhanced ultrasound (CEUS) with hypoechonic and no enhancement in portal vein. With ultrasound-guided a 18-guage guide wire was placed in right branch of portal vein, and a guidewire was placement. After exchanging the catheter, the thrombosis was confirmed again by venography. A thrombolytic catheter was placed and local thrombolysis therapy was performed.
Results
The guidewires were successfully placed in 6 patients. The thrombolytic catheters were successfully placed in 5 patients (day 2-60 after operation), and failed in 1 patient (9 years after operation). With 5-11 days urokinase injection, the patency of portal vein was found in 5 patients, of which 4 patients was treated by angioplasty and stent placement. With 16-31 months follow-up, the patency of portal vein was maintained. Neither server complication nor related-death was occurred.
Conclusions
Ultrasound-guided percutaneous portal vein guide wire placement adjuncts thrombolytic catheter is effective and safety for treating portal vein thrombosis after liver transplantation.
Key words:
Ultrasonography; Portal vein/SU; Hepatic veins/SU; Phlebotomy; Thrombolytic therapy; Venous thromboembolism/CO/SU; Liver transplantation/AEKeywords:
Portal vein thrombosis
Venography
Portography
Portal vein thrombosis
Paracentesis
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Objective:To assess the efficacy of percutaneous portal vein thrombolysis in the management of portal vein(PV) thrombosis.Methods: A total of 21 cases of thrombokinesis in portal vein system were treated with the method of percutaneous portal vein thrombolysis,20 men and 1 woman with the average 42.6-year-old(range,23-67 years) were involved in this group.The diagnosis of portal vein thrombosis were confirmed by enhancive CT scan and direct portal venography.They received percutaneous transhepatic thrombolysis during 12 to 36 hours after admission.Guided by ultrasound,we punctured the intrahepatic portal vein directly.Guide wire explored into the splenic vein and superior mesenteric vein,5F pig tail catheter which used as diagnostic angiography catheter was then placed into SMV and splenic vein.Rotated and push-pulled pig tail catheter repeatedly to make the large pieces thrombus broken into small fragments.Then we exchanged into infusion catheter,250 thousands of units urokinase was infused in 15 minutes,anchored catheter and returned to ward,from 30 to 50 thousands of unit urokinase per hour was continued infusing through the catheter.Interval 8 to 24 hours.Portography was carried out to monitor the statue of thrombus,and the position of catheter tip was adjusted properly.During the treatment period,we followed up the patient′s blood clotting function closely,and adjust the dose of urokinase at the right time.Results: Two cases were died.Portal vein blood flow was complete or partial recanalization,and the abdominal pain or distention was symptomatic relief in the rest 19 cases.Conclusions: It is a effective means to treat the portal vein thrombosis by the percutaneous transhepatic thrombolysis way,to choose thrombolytic path according to the specific circumstances of different cases can reduce the treatment risk and improve the therapeutic effect.
Venography
Portography
Portal vein thrombosis
Balloon catheter
Splenic vein
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Objective To investigate the technical outline and clinical value of percutaneons transhepatic portal vein port-catheter system implantation in preventing small hepatocellular carcinoma recurrence after curative treatments. Methods Fifteen patients with small hepatocellular carcinoma after curative treatment were included in this study. Guided by ultrasound and fluoroscopy, left branch of the portal vein were punctured and port-catheter system were implanted. Then drugs infusion into portal vein system was done for preventing recurrence of hepatic carcinoma. Results Interventional operations were succeed in all 15 cases. Drugs could drop into portal vein smoothly. No operating complications occurred. Conclusion Percutaneous transhepatic portal vein port-catheter system implantation was an easy operating and micro traumatic method. This technique could play an important role in preventing recurrence.
Key words:
Liver neoplasms; Chemotherapy, cancer, regional perfusion; Infusion pumps, implantable
Port (circuit theory)
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Objective
To compare the efficacy of transjugular intrahepatic portosystemic shunt(TIPS) and percutaneous transhepatic catheter directed thrombolysis(CDT) on acute portal vein thrombosis(PVT).
Methods
The clinical data of 34 patients with acute portal vein thrombosis were analyzed retrospectively. Among them, 14 cases were treated with TIPS and catheter contact thrombolysis, 17 cases received percutaneous transhepatic catheter thrombolysis, and 3 cases failed to be operated successfully. The thrombolytic therapeutic time, effect, complications and recurrence of PVT during the follow-up were compared.
Results
TIPS combined with CDT were successfully created in 14 patients. The mean thrombolytic therapeutic time was 7.2 days, and portal veins were recanalized more than 75.0% by imaging finding in 11 patients (78.6%). Four patients(28.6%) had complications. During follow-up, 1 patient (7.1%) had recurrence of thrombus. In the 17 cases treated by percu-taneous transhepatic catheter thrombolysis, the mean postoperative time of thrombolysis was 10.1 days, portal vein recanalization (>75.0%) examed by X-ray occurred in 6 cases(35.3%), 8 cases experienced complications (47.1%), during the follow-up 7 cases (41.2%) suffered recurrent thrombosis. After TIPS and catheter directed thrombolysis, the thrombolysis time was shortened (P=0.033), the recanalization rate of portal vein (>75%) was higher (P=0.029), and the recurrence rate of thrombus was low (P=0.045).
Conclusions
Both the two methods are effecive in the treatment of acute PVT, and TIPS combined with CDT may be better.
Key words:
Portosystemics hunt; Transjugular intrahepatic; Portal vein thrombosis; Catheter directed thrombolysis
Portal vein thrombosis
Portography
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Objective To study clinical efficacy of improved TIPS by percutaneous portal vein puncture for enhancing its accuracy and safety.Methods 23 cases of portal hypertension with acute upper gastrointestinal bleeding reformed percutaneous portal vein puncture improved TIPS from 2010 to 2011 at Air Force General Hospital of Chinese PLA were investigated retrospectively.The right portal branch was punctured under ultrasonic guidance.Then the Cobra catheter was put into the portal vein for portography,the gastric coronal vein was embolized and portal pressure was measured.The Cobra catheter was detained in the portal vein for portography of anterior and lateral position.The Rups-100 was guided under the Cobra catheter during the TIPS puncture procedure.The balloon was used to dilate the parenchyma channel and then the metal stent was released smoothly.To ensure the effectiveness,portography was made and portal pressure was measured again.Results All cases reformed portal vein puncture improved TIPS successfully,acute upper gastrointestinal bleedings were controlled immediately.Operative time was(140.32±43.56)min,time from the beginning of operation to gastric coronary vein occlusion was(12.53±13.18)min,the number of puncture was 4.16±2.73.TIPS can reduce portal pressure significantly.No significant difference was observed in blood ammonia before and after TIPS.Conclusions Ultrasound-guided percutaneous portal vein puncture angiography can guide TIPS operation,control gastric coronary vein bleeding at once,and improve the accuracy and safety of TIPS.
Portography
Coronary Vein
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Objective To assess the value of comprehensive interventional therapy in treating deep vein thrombosis(DVT) of lower extremities,and to retrospectively analyze the clinical data and related complications in patients with DVT of lower extremities.Methods A total of 196 patients with DVT,encountered in hospital during the period from Aug.2000 to Aug.2010,were enrolled in the study.Iliofemoral venography of the diseased side via the femoral vein on the healthy side was performed first to determine the location and extent of the DVT.In all of the 196 cases,a total of 185 filters were placed in inferior vena cava and 21 iliac vein stents were employed.The transcatheter thrombolysis,balloon dilatation technique and intravascular stent implantation were used to treat the DVT.The percutaneous puncture of popliteal vein was performed under ultrasonic guidance in patients with occlusion of the openings of iliac and femoral veins.The methods of drug administration for thrombolysis included catheter-directed thrombolytic infusion,thrombolytic instillation and infusion combined with instillation.Results A total of 185 patients received implantation of filter in inferior vena cava,and 21 patients underwent intravascular stent implantation in iliac veins.The mean retention time of indwelling catheters was 6.8 days(ranging from 3 to 11 days).The therapeutic outcome was completely curative in 136,obviously effective in 48,effective in 9 and inefficient in 3 patients,with a total effective rate of 98%.Conclusion The comprehensive interventional therapy is a safe and effective treatment for patients with DVT of lower extremities.
Venography
Femoral vein
Popliteal vein
External iliac vein
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Objective To assess the clinical value of ultrasound-guided percutaneous catheter-directed thrombolysis in treating lower extremity deep venous thrombosis(DVT).Methods A total of 34 patients with DVT,admitted to our department during the period from September 2009 to September 2010,were enrolled in this study.After the inferior vena cave filter was implanted,ultrasound-guided percutaneous catheter-directed thrombolysis was carried out in all patients.Urokinase 500 000 U/d and heparin 5 000 U/d were administered continuously by using a micro-pump.Transjugular inferior vena cava filter placement was employed in 2 patients because of inferior vena cava thrombosis.Other 2 patients were treated with catheterdirected thrombolysis via the great saphenous vein.In the remaining patients ultrasound-guided insertion of thrombolysis catheter into popliteal vein was performed.The clinical results were analyzed.Results The thrombolysis catheter was successfully inserted in all patients,and the indwelling catheter remained in the vein for 5 to 7 days.After the treatment,the swelling basically disappeared and the daily activity was significantly improved in 27 patients.However,5 patients still felt lacking in strength and leg heaviness after activity.One patient who relapsed 3 months after the surgery was treated by catheter-directed thrombolysis once more and got better.Another patient who relapsed 6 months after the surgery had deep venous thrombosis,which occurred in the contralateral lower extremity.Then the anticoagulation and thrombolysis through peripheral vein was applied.Angiography of the diseased lower extremity was performed in all the patients.Iliofemoral veins were unobstructed in 26 patients after the treatment,while in the other 8 patients the iliofemoral veins were unobstructed in segment.Conclusion Ultrasound-guided percutaneous catheterdirected thrombolysis has many advantages,such as minimal invasion,accurately positioning, individualization of drug dosage,high success rate of thrombolysis,etc.Therefore,this technique is an effective treatment for lower extremity DVT.
Popliteal vein
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Objective To study the clinical application of transhepatic portal vein catheterization under ultrasonic guidance in the treatment of patients with primary and metastatic liver carcinoma.Methods 100 patients with primary and metastatic liver carcinoma underwent transhepatic portal vein catheterization under ultrasonic guidance.Results Of the 100 cases,the success rate of puncture was 96.9%.The catheter in portal vein at the early stage was 7 to 14 days(9.2±2.7days on average),while 23 to 60days(44.7±13.5 on average) when the technique improved.The efficacy of chemotherapy via transhepatic portal vein catheterization for patients with hepatoma was superior to conventional peripheral vein administration.Conclusions The method could be repeatedly used for intraportal administration of drugs and enhance the effects.It is safe,reliable with no serious complications and worth being applied.
Metastatic carcinoma
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Objective:To evaluate the therapeutic value of direct portal vein thrombolysis.Methods:12 cases of thrombokinesis in portal vein system was treated with the method of direct portal vein thrombolysis.11 men and 1 women with a median age of 45.9 years(range.34-65 years)were involved in this group.All cases started with persistent middle to serious upper abdomi- nal pain or distention.But in physical examination,abdominal tenderness,rebound tenderness is not obvious.All cases were confirmed by enhancive CT scan and direct portal venography.We took the TIPS(transjugular intra-hepatic,portal-systemic shunt)route in 2 cases,and the direct transhepatic route in other 10 cases.The side-holes segment of the side-holes catheter was inserted into thrombus,250 thousand unit urokinase wsa infused in 15 minutes,anchored catheter and returned to ward, 30-50 thousand unit urokinase was continued infusing through the catheter.Interval 6 to 12 hours.DSA was carried out to mo- nitor the statue of thrombus,and the position of catheter tip was adjusted properly.During the treatment period,we,followed up the patient's blood clotting function closely,and adjust the dose of urokinase at the right time.Results:Two cases was died. Portal vein blood flow was complete or partial recanalization,and the abdominal pain or distention was symptomatic relief after 24-120 hours in the rest 10 cases.Conclusion:The interventional radiology method of direct portal vein thrombolysis is safety and efficient.Choosing suitable eases,full-scale imageology evaluation and closely follow-up during thrombolysis can ensure the success of operation.
Venography
Popliteal vein
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Objective To assess the clinical value of ultrasound-guided popliteal venous cath- eter-directed thrombolysis for lower extremity deep venous thrombosis （ DVT ）. Methods The data on 79 patients with iliofemoral venous thrombosis who had been hospitalized from April 2007 to October 2009 were retrospectively analyzed. Ultrasound-guided insertion of thrombolysis catheter into popliteal vein was performed. Tthrombolytic drugs were administered continuously by a micro-pump and anticoagulant therapy was conducted simultaneously. Results Thrombolysis catheter was successfully inserted in all the patients. Of all the patients, 33 were cured, 38 had obvious effect, and 8 had postive effect, with a total effectiveness rate of 100%. Conclusions Ultrasound-guided popliteal venous catheter-directed thrombolysis has a high curative rate and effectiveness rate. It shortens the course of therapy, reduces urokinase use, has fewer complications, and is worth popularizing.
Key words:
Ultrasound guided; Catheter-directed thrombolysis; Popliteal vein; Deep vein thrombosis
Popliteal vein
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