Mesojugular shunt for Budd-Chiari syndrome: a case report with long-term follow-up.

BACKGROUND: We report a case of a mesojugular shunt for Budd-Chiari syndrome (BCS) with long-term follow-up. METHODS: A 32-year-old woman presented with late stage BCS. She was treated with a mesojugular shunt to relieve her portal hypertension. In a 17-year follow-up, she had a pregnancy, a postpartum period, and was diagnosed with systemic lupus eythematosus. She has resumed work as an operating room nurse and is having a normal life. Her graft remains patent. CONCLUSION: A mesojugular shunt has less surgical trauma and satisfactory long-term patency than other shunts. It can be used to treat severe patients with BCS who are not candidates for intervention.

Cognitive improvement after carotid artery stenting in patients with symptomatic internal carotid artery near-occlusion.

BACKGROUND AND PURPOSE: To investigate the influence of carotid artery stenting (CAS) with embolic protection device (EPD) on the cognitive function of patients with near-occlusion of the cervical internal carotid artery (ICA). METHODS: From February 2014 to December 2017, a total of 79 symptomatic patients were recruited in this study. Of these patients, 31 patients refused to receive CAS therapy. They were divided into the CAS group (48 patients) and the medical treatment group (31 patients). Montreal cognitive assessment (MoCA) instrument was used for the evaluation of cognitive function. The analyzed endpoints included cumulative 12 month incidence of ipsilateral ischemic cerebrovascular events and MoCA scores at 1 month and 12 months after treatment. RESULTS: Cumulative 12 months incidence of ipsilateral ischemic cerebrovascular events was lower in patients who underwent CAS than in patients on medical treatment (P < 0.05). In CAS group, the total MoCA score, scores of attention and delayed recall at months 1 and 12 increased when compared with those at baseline (P < 0.05). In medical treatment group, the total MoCA score and attention score at month 12 decreased when compared with those at baseline (P < 0.05). In CAS group, the total MoCA score, scores of line connection test, drawing clock, attention and delayed recall were improved at 1 and 12 months when compared with medical treatment at the same time points (P < 0.05). CONCLUSIONS: CAS with EPD not only decreases the risk of ipsilateral TIA and stroke but also may improve the cognitive function of symptomatic patients with ICA near-occlusion.

Surgical treatment of brachiocephalic vessel involvement in Takayasu's arteritis.

BACKGROUND: Takayasu's arteritis (TA) is a chronic idiopathic inflammatory disease that affects large and medium size arteries. The brachiocephalic trunk is the most frequently involved site in TA, and multi-vessel lesions are common. Surgical treatment includes vessel reconstruction surgery and percutaneous transluminal angioplasty (PTA). Herein, we report our preliminary experience with surgical treatment of cerebral ischemia caused by cervical arterial lesions due to TA. METHODS: From January 2000 to December 2007, 38 patients with cerebral ischemia caused by cervical arterial occlusive lesions due to TA were treated surgically. There were three males and 35 females, with an age range of 15 - 42 years (mean 26.5 years). All patients had operative repairs undertaken. Twenty eight patients received bypass operation and 10 patients received percutaneous transluminal angioplasty. One case with coronary stenosis received coronary artery bypass simultaneously. Patients were followed up for 11 months to eight years. RESULTS: There were no peri-operative deaths in cerebrovascular reconstruction patients. Symptoms of cerebral ischemia were improved or cured in 25 of 38 patients. There was a low incidence of cerebral reperfusion syndrome. Two patients died at five and seven years after surgery due to heart failure. Another 8 patients (20%) required further surgery for stenosis (5 patients) or anastomotic aneurysms (3 patients). Percutaneous transluminal angioplasty was performed successfully for treatment of aortic and renal lesions. Repeated angioplasty for revascularization was performed in six PTA cases with restenosis after 5 - 24 months. CONCLUSIONS: When cerebral perfusion has potential to be affected by TA, a definitive corrective procedure is advised when the patient is relatively stable. Although the recurrence rate is very high, percutaneous transluminal angioplasty is the first choice procedure. Bypass operation is optimal for brachiocephalic-vessel involvement in TA. Cerebral reperfusion syndrome can be avoided by careful selection of the operation method and improved post-operative treatment.