RESUMEN
OBJECTIVES: To analyze the safety and efficacy of percutaneous placement of coated self-expanding metallic stents (SEMS) in patients with biliary leaks. MATERIAL AND METHODS: This ethics committee at our center approved this study. We retrospectively reviewed all coated SEMS placed between October 2008 and September 2015. We analyzed patient-related factors such as the primary underlying disease, prior hepatic procedures, and clinical outcome. We evaluated the location, the number and type of leak (anastomotic or non-anastomotic), and the characteristics of the interventional procedure (number of stents deployed, location of the stents, technical success, and primary functionality). We recorded the complications registered. RESULTS: We studied 14 patients (11 men and 3 women). The mean follow-up period was 375.5 days (range 15-1920 days). Leaks were postsurgical in 12 patients. One patient developed an arteriobilioportal fistula. In another, the biliary leak occurred secondary to the rupture of the common bile duct after ERCP. A total of 23 coated SEMS were placed, including 21 Fluency® stents (Bard, Tempe, AZ, USA) and 2 Wallflex® stents (Boston Scientific, Galway, Republic of Ireland). The technical success of the procedure was considered total in 11 (78.6%) patients, partial in 2 (14.3%) patients, and null in 1 (7.2%) patient. The clinical outcome was good in 13 of the 14 patients. The mean period of primary functionality of the coated SEMS was 331 days (range 15-1920 days). No major complications were observed in 11 (78.6%) patients. CONCLUSIONS: Percutaneous placement of coated SEMS for the treatment of benign biliary leaks is safe and efficacious, with a high rate of technical and clinical success and a moderate rate of complications.
Asunto(s)
Bilis , Extravasación de Materiales Terapéuticos y Diagnósticos/cirugía , Stents Metálicos Autoexpandibles , Anciano , Anciano de 80 o más Años , Materiales Biocompatibles Revestidos , Femenino , Humanos , Hígado , Masculino , Persona de Mediana Edad , Implantación de Prótesis/métodos , Estudios RetrospectivosRESUMEN
OBJECTIVE: To review the principal findings on computed tomography angiography for segmental arterial mediolysis, and to emphasize the points that help to differentiate it from other vasculopathies such as vasculitis. We also review the protocols for follow-up and the various treatment options. CONCLUSION: Segmental arterial mediolysis is a rare disease that is defined as a non-atherosclerotic, non-hereditary, and non-inflammatory vasculopathy characterized by lysis of the medial layer of the arterial wall. It should be suspected in middle-aged patients with aneurysms, dissections, or spontaneous ruptures of visceral arteries of unknown etiology who do not fulfill the clinical and laboratory criteria for vasculitis. The arteries of the abdominal organs are the most commonly affected, including the arteries of the celiac trunk and the superior and inferior mesenteric arteries. Radiologically, segmental arterial mediolysis can present as arterial dilation; single or multiple, saccular or fusiform aneurysms; stenoses; or dissections.
Asunto(s)
Arterias , Angiografía por Tomografía Computarizada , Túnica Media/diagnóstico por imagen , Enfermedades Vasculares/diagnóstico por imagen , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Túnica Media/patología , Enfermedades Vasculares/patologíaRESUMEN
BACKGROUND AND AIMS: Magnetic resonance imaging (MRI) with gadoxetic acid is widely used in clinical practice in Spain for the diagnosis, treatment, and follow-up of patients with liver metastases, although its use varies. This paper aims to provide recommendations for the use of MRI with gadoxetic acid in the detection and diagnosis of liver metastases in clinical practice in Spain. MATERIAL AND METHODS: This project was undertaken by a group of nine experts who analyzed a series of recommendations about the use of gadoxetic acid extracted from international consensus documents. From this analysis, the experts decided to reject, adopt, contextualize, or adapt each of the recommendations. Once established, the final recommendations were voted on by the same group of experts. RESULTS: The experts reached a consensus about five recommendations related to the use of this imaging technique in the management of liver metastases in three clinical situations: (i) in the detection, (ii) in the diagnosis and preoperative characterization, and (iii) in the detection after a chemotherapy treatment. CONCLUSION: The results support a clinical benefit for MRI with gadoxetic acid in the detection of liver metastases, favoring preoperative planning, especially in metastases measuring less than 1â¯cm, thus facilitating early diagnosis of metastatic spread.
Asunto(s)
Medios de Contraste , Neoplasias Hepáticas , Gadolinio DTPA , Humanos , EspañaRESUMEN
The celiac axis compression syndrome (CACS) due to median arcuate ligament (MAL) was first described by Harjola in 1963; originating postpandrial abdominal pain, weight loss, epigastric bruit and celiac axis stenosis > 75% in angiographic studies. This clinical condition has been the origin of controversies about its pathogenesis, diagnosis and its long term clinical results. Advances in diagnostic imaging as 64 multidetector-row CT (MDCT), 3-D reconstruction, magnetic resonance (MR) and color duplex ultrasonography, provide better understanding of the syndrome and allow to identify the best candidates for surgical division of MAL fibers. Since the introduction of laparoscopic approach, and also endovascular procedures, in 2000, a new perspective has established in this challenging syndrome. With the occasion of our own experience, a critical review of the syndrome is presented.
Asunto(s)
Plexo Celíaco , Síndromes de Compresión Nerviosa , Plexo Celíaco/diagnóstico por imagen , Plexo Celíaco/cirugía , Humanos , Laparoscopía , Ligamentos , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/fisiopatología , Síndromes de Compresión Nerviosa/cirugía , Radiografía , UltrasonografíaRESUMEN
PURPOSE: To assess the feasibility of performing same-day vascular flow redistribution and Yttrium-90 radioembolization (90Y-RE) for hepatic malignancies. MATERIALS AND METHODS: From November 2015 to February 2019, patients undergoing same-day hepatic flow redistribution during work-up angiography, 99mTechnetium-labeled macroaggregated albumin (99mTc-MAA) SPECT/CT and 90Y microsphere-RE, were recruited. Within 18 h following the delivery of 90Y resin microspheres, an 90Y-PET/CT study was performed. According to patients' vascular anatomy, flow redistribution was performed by microcoil embolization of extrahepatic branches (group A), intrahepatic non-tumoral vessels (group B) and intrahepatic tumoral arteries (group C). The accumulation of 99mTc-MAA particles and microspheres in the redistributed areas was qualitatively evaluated using a 5-point visual scale (grade 1 = < 25% accumulation; grade 5 = 100% accumulation). Differences in the distribution of microspheres among groups were assessed with Mann-Whitney U test. RESULTS: Twenty-two patients were treated for primary (n = 17) and secondary (n = 5) hepatic malignancies. The MAA-SPECT/CT showed uptake in all the redistributed areas. Regarding the accumulation of microspheres within the redistributed segments in all the groups, perfusion patterns were classified as 2 in 1 case, 4 in 6 cases and 5 in 15 cases. No statistically significant differences were observed between groups A and B-C (U value = 34, p = 0.32) and between groups B and C (U value = 26, p = 0.7). Mean predicted absorbed doses by the tumoral and normal hepatic tissues were 163.5 ± 131.2 Gy and 60.4 ± 69.3 Gy, respectively. Mean total procedure time (from work-up angiography to 90Y delivery) was 401 ± 0.055 min. CONCLUSION: Performing same-day redistribution of the arterial hepatic flow to the target and 90Y-microsphere delivery is feasible in the treatment of liver tumors. Clinical Trials Registry NCT03380130.
Asunto(s)
Angiografía , Embolización Terapéutica/métodos , Neoplasias Hepáticas/irrigación sanguínea , Neoplasias Hepáticas/radioterapia , Hígado/irrigación sanguínea , Agregado de Albúmina Marcado con Tecnecio Tc 99m/uso terapéutico , Radioisótopos de Itrio/uso terapéutico , Adulto , Anciano , Albúminas , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Tomografía de Emisión de Positrones , Flujo Sanguíneo Regional/fisiología , Tomografía Computarizada de Emisión de Fotón Único/métodosRESUMEN
We report a case of hormone-refractory prostate cancer (HRPC) treated with oxaliplatin plus gemcitabine in a third-line schedule after liver progression, with an excellent clinical, biochemical and radiological response and with an acceptable tolerance. Prior chemotherapy regimens included docetaxel plus estramustine and oral etoposide. To our knowledge, this is the first report that shows this approach in an HRPC patient.
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Adenocarcinoma/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Próstata/tratamiento farmacológico , Terapia Recuperativa/métodos , Adenocarcinoma/patología , Adenocarcinoma/fisiopatología , Desoxicitidina/administración & dosificación , Desoxicitidina/análogos & derivados , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/tratamiento farmacológico , Compuestos Organoplatinos/administración & dosificación , Oxaliplatino , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/fisiopatología , Tomografía Computarizada por Rayos X , GemcitabinaRESUMEN
Retroperitoneal fibrosis (RPF) is a well described clinical entity that is being diagnosed with increasing frequency. RPF is characterized by replacement of the normal tissue of the retroperitoneum with fibrosis and/or chronic inflammation. However, aetiology, clinical presentation and radiological appearance in many cases are protean. Up to 15% of patients have additional fibrotic processes outside the retroperitoneum. In the abdomen, RPF may spread contiguously to involve multiple structures in both the retroperitoneum and the peritoneal cavity or multiple non-contiguous sites may be involved. We retrospectively reviewed 30 patients (19 male, 11 female; age range 28-79 years) with biopsy proven RPF. Although we found RPF most commonly as an isolated fibrotic plaque in the lower lumbar region (18 patients), 12 patients (40%) presented with RPF in atypical locations (4 peripancreatic, 1 periduodenal, 7 pelvic). The RPF was non-malignant in 24 patients (21 idiopathic, 2 perianeurysmal, 1 ergot-derivative treatment) and malignant in six cases. We present a pictorial review of the varied appearances of RPF, concentrating on atypical sites. The radiological differential diagnosis and its appearance with various imaging modalities are discussed. Current concepts with respect to management, prognosis and treatment are summarized.
Asunto(s)
Fibrosis Retroperitoneal/diagnóstico , Neoplasias Retroperitoneales/diagnóstico , Adulto , Anciano , Medios de Contraste , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
No disponible
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Humanos , Medios de Contraste , Radiografía/tendencias , Insuficiencia Renal/complicaciones , Factores de RiesgoRESUMEN
Los errores en la interpretación radiológica son inevitables y generalmente multifactoriales. Pueden deberse a fallos de interpretación del radiólogo (incluyendo causas cognitivas, errores de percepción o ambigüedad en el informe) o a fallos relacionados con el sistema (problemas técnicos al adquirir la imagen, información clínica incorrecta, excesiva carga de trabajo o condiciones laborales inadecuadas). Es responsabilidad del radiólogo conocer por qué se producen los errores y cómo detectarlos para evitar su repetición. En este artículo nos vamos a centrar en el problema del error diagnóstico en el paciente oncológico, tanto en el momento del diagnóstico como en el seguimiento y en el estudio de la respuesta al tratamiento con las nuevas terapias moleculares. Una lectura sistemática y una valoración evolutiva de la respuesta oncológica en el contexto clínico del paciente son factores importantes que reducen los posibles errores cometidos por el radiólogo, así como el conocimiento y el manejo de los nuevos criterios específicos de respuesta de cada tipo tumoral
Errors in image interpretation are inevitable and generally multifactorial. They can be due to the radiologist's failure to interpret the findings correctly (including cognitive causes, perceptual errors, or ambiguity in reporting) or to problems related with the system (technical problems in image acquisition, incorrect clinical information, excessive workload, or inadequate working conditions). It is the radiologist's responsibility to know why errors occur and how to detect them to prevent them from occurring again. This article focuses on the problem of errors in diagnosing oncologic patients, both at the time of diagnosis and during follow-up as well as in the study of the response to treatment with new molecular therapies. To reduce possible errors, radiologists should ensure a systematic reading and an assessment of the oncologic response over time in the clinical context of the patient; they also need to have and apply knowledge of the new specific criteria for the response of each tumor type in the management of the patient
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Humanos , Registros Médicos/normas , Neoplasias/diagnóstico por imagen , Radiografía/normas , Errores Diagnósticos/prevención & control , Inmunoterapia/normas , Relación Dosis-Respuesta Inmunológica , Errores Diagnósticos/clasificaciónRESUMEN
Pulmonary nodules are a common finding in routine chest studies. Although there are no pathognomic clinical or radiological signs that enable the exact nature of a pulmonary nodule to be determined, the clinical context and the appropriate characterization of the pulmonary nodule make it possible to reach the correct diagnosis in most cases. This article discusses the most important aspects involved in the use of multislice computed tomography in the noninvasive detection and characterization of pulmonary nodules.
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Nódulo Pulmonar Solitario/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Humanos , Nódulo Pulmonar Solitario/patologíaRESUMEN
Objetivo. Analizar la seguridad y eficacia en el uso percutáneo de endoprótesis metálicas autoexpandibles recubiertas (EMAR) en pacientes con fuga biliar. Material y métodos. Este estudio ha sido aprobado por el Comité de Ética de nuestro centro. Se realizó una revisión retrospectiva de las EMAR colocadas entre octubre de 2008 y septiembre de 2015. Se analizaron la enfermedad primaria subyacente, los procedimientos hepáticos previos y el éxito clínico. Se evaluó la localización, el número, el tipo de fuga y las características del procedimiento intervencionista (número de prótesis empleadas, localización, éxito técnico y funcionalidad primaria). Se recogieron las complicaciones registradas. Resultados. Se estudiaron 14 pacientes. El seguimiento medio fue de 375,5 días (rango de 15-1920 días). En 12 pacientes las fugas biliares fueron posquirúrgicas. Un paciente presentó una fístula arteriobilioportal. En otro paciente, la fuga biliar fue post-CPRE. Se colocaron un total de 23 EMAR: 21 prótesis tipo Fluency® (Bard, Tempe, Arizona, EE.UU.) y dos prótesis tipo Wallflex® (Boston Scientific, Galway, Irlanda). Se consiguió éxito técnico total en el 78,6% (n=11), parcial en el 14,3% (n=2) y no se obtuvo éxito en el 7,2% (n=1). Se consiguió éxito clínico en 13 de 14 pacientes. La media de funcionalidad primaria de las EMAR fue de 331 días (rango de 15-1920 días). Once pacientes no presentaron ninguna complicación mayor. Conclusiones. La colocación percutánea de EMAR es un método seguro y eficaz en el tratamiento de fugas biliares benignas, con una alta tasa de éxito técnico y clínico y un nivel moderado de complicaciones (AU)
Objectives. To analyze the safety and efficacy of percutaneous placement of coated self-expanding metallic stents (SEMS) in patients with biliary leaks. Material and methods. This ethics committee at our center approved this study. We retrospectively reviewed all coated SEMS placed between October 2008 and September 2015. We analyzed patient-related factors such as the primary underlying disease, prior hepatic procedures, and clinical outcome. We evaluated the location, the number and type of leak (anastomotic or non-anastomotic), and the characteristics of the interventional procedure (number of stents deployed, location of the stents, technical success, and primary functionality). We recorded the complications registered. Results. We studied 14 patients (11 men and 3 women). The mean follow-up period was 375.5 days (range 15-1920 days). Leaks were postsurgical in 12 patients. One patient developed an arteriobilioportal fistula. In another, the biliary leak occurred secondary to the rupture of the common bile duct after ERCP. A total of 23 coated SEMS were placed, including 21 Fluency® stents (Bard, Tempe, AZ, USA) and 2 Wallflex® stents (Boston Scientific, Galway, Republic of Ireland). The technical success of the procedure was considered total in 11 (78.6%) patients, partial in 2 (14.3%) patients, and null in 1 (7.2%) patient. The clinical outcome was good in 13 of the 14 patients. The mean period of primary functionality of the coated SEMS was 331 days (range 15-1920 days). No major complications were observed in 11 (78.6%) patients. Conclusions. Percutaneous placement of coated SEMS for the treatment of benign biliary leaks is safe and efficacious, with a high rate of technical and clinical success and a moderate rate of complications (AU)
Asunto(s)
Humanos , Masculino , Femenino , Stents Metálicos Autoexpandibles , Enfermedades de las Vías Biliares , Enfermedades de la Vesícula Biliar , Profilaxis Antibiótica , Colangiografía/métodos , Laparotomía/métodos , Embolización Terapéutica/instrumentación , Embolización Terapéutica/métodos , Conductos Biliares/patología , Conductos Biliares , Estudios Retrospectivos , Intubación Intratraqueal , Tomografía Computarizada de Emisión/métodosRESUMEN
Objetivo. Repasar los principales hallazgos de angiografía por tomografía computarizada de la mediólisis arterial segmentaria y enfatizar aquellos puntos que ayuden a diferenciarla de otras vasculopatías, como las vasculitis. Asimismo, se repasarán los protocolos de seguimiento y las diversas opciones terapéuticas. Conclusión. La mediólisis arterial segmentaria es una enfermedad rara que se define como una vasculopatía no ateroesclerótica, no hereditaria y no inflamatoria, caracterizada por la lisis de la capa media de la pared arterial. Debe sospecharse en pacientes de edad media con aneurismas, disecciones o roturas espontáneas de arterias viscerales de etiología desconocida, que no cumplen los criterios clínicos y analíticos de vasculitis. Las arterias viscerales abdominales son las más frecuentemente afectadas, entre ellas el tronco celíaco y las arterias mesentéricas superior e inferior. Sus formas de presentación radiológica incluyen la dilatación arterial, los aneurismas (saculares o fusiformes) únicos o múltiples, las estenosis y las disecciones (AU)
Objective. To review the principal findings on computed tomography angiography for segmental arterial mediolysis, and to emphasize the points that help to differentiate it from other vasculopathies such as vasculitis. We also review the protocols for follow-up and the various treatment options. Conclusion. Segmental arterial mediolysis is a rare disease that is defined as a non-atherosclerotic, non-hereditary, and non-inflammatory vasculopathy characterized by lysis of the medial layer of the arterial wall. It should be suspected in middle-aged patients with aneurysms, dissections, or spontaneous ruptures of visceral arteries of unknown etiology who do not fulfill the clinical and laboratory criteria for vasculitis. The arteries of the abdominal organs are the most commonly affected, including the arteries of the celiac trunk and the superior and inferior mesenteric arteries. Radiologically, segmental arterial mediolysis can present as arterial dilation; single or multiple, saccular or fusiform aneurysms; stenoses; or dissections (AU)
Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Enfermedades Vasculares , Aneurisma , Vasculitis , Angiografía/instrumentación , Angiografía/métodos , Angiografía , Enfermedades de las Arterias Carótidas , Aterosclerosis , Arterias/patología , Arterias , Diagnóstico DiferencialRESUMEN
El síndrome de compresión del tronco celiaco fue descrito porHarjola en 1963 como la compresión extrínseca del tronco celiacopor las fibras tendinosas del ligamento arcuato; causando uncuadro de dolor intenso post-pandrial en epigastrio, pérdida depeso, soplo epigástrico y estenosis mayor del 75% en la angiografíaselectiva. Desde entonces, dicho síndrome ha sido motivo demúltiples controversias relacionadas con su patogenia y la variabilidadde los resultados obtenidos con la cirugía.Debido a la proliferación y accesibilidad de técnicas de imagenmás precisas y menos invasivas (angio-TAC multicorte, angio-RMN, eco-doppler), el diagnóstico de dicho síndrome puede realizarsecon mayor precisión y sentar las bases de la indicación quirúrgicacon mayor seguridad y eficacia.La introducción, en el año 2000, de técnicas laparoscópicasen la liberación del tronco celiaco, junto con procedimientos endovascularescomplementarios, ha representado un notable avanceen el tratamiento del síndrome.Basados en nuestra experiencia personal, presentamos una revisióncrítica y propuesta terapéutica del síndrome(AU)
The celiac axis compression syndrome (CACS) due to medianarcuate ligament (MAL) was first described by Harjola in 1963;originating postpandrial abdominal pain, weight loss, epigastricbruit and celiac axis stenosis > 75% in angiographic studies. Thisclinical condition has been the origin of controversies about itspathogenesis, diagnosis and its long term clinical results.Advances in diagnostic imaging as 64 multidetectorrow CT(MDCT), 3-D reconstruction, magnetic resonance (MR) and colorduplex ultrasonography, provide better understanding of the syndromeand allow to identify the best candidates for surgical divisionof MAL fibers.Since the introduction of laparoscopic approach, and also endovascularprocedures, in 2000, a new perspective has establishedin this challenging syndrome. With the occasion of our ownexperience, a critical review of the syndrome is presented(AU)
Asunto(s)
Humanos , Arteria Celíaca/fisiopatología , Laparoscopía/métodos , Enfermedades Vasculares Periféricas/cirugía , Diafragma/fisiopatología , Diagnóstico Diferencial , Dolor Abdominal/etiologíaRESUMEN
Concentrations of total sialic acid (TSA) and lipid-bound sialic acid (LSA) were determined in serum samples from 88 patients with squamous cell carcinoma of the cervix, 26 normal subjects, and 44 patients with benign uterine or ovarian disease. TSA concentrations in patients with cervical cancer were found to correlate with advanced-stage disease. LSA concentrations were only increased in stage IV of the disease. Sensitivity of the test for stage IB was zero for TSA and 27% for LSA. The specificity of both markers was about 80% due to a low incidence of false-positive values in the pathologic control group. Measurements of TSA or LSA appear to be of no value for the early detection of cervical cancer or to complement the clinical staging of this tumor.
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Biomarcadores de Tumor/sangre , Carcinoma de Células Escamosas/diagnóstico , Glucolípidos/sangre , Ácidos Siálicos/sangre , Sialoglicoproteínas/sangre , Neoplasias Uterinas/diagnóstico , Adulto , Carcinoma de Células Escamosas/sangre , Femenino , Humanos , Persona de Mediana Edad , Ácido N-Acetilneuramínico , Estadificación de Neoplasias , Sensibilidad y Especificidad , Neoplasias Uterinas/sangreRESUMEN
Acetylcholine (ACh) synthesis and release from isolated superfused retina of the teleost Eugerres plumieri has been studied under different physiological conditions. The retinas were superfused with Krebs-Ringer solutions containing [14C]choline and the extracellular space of 32% was determined by [3H]inulin. The retina accumulates choline (Ch) from the superfusion medium and this process is mediated by a high affinity transport system with a Km of 1.82 microM. The incorporated Ch is mainly utilized for the synthesis of ACh. The ACh content of the light-adapted retina is not significantly different from that of a dark-adapted one. However, the release of [14C]ACh from the light-adapted retina was 52% higher as compared to the release from the dark-adapted retina. Flicker stimulation induced a larger increase in ACh release, than from either light or dark adapted retina, proportional to flicker frequency. The results suggest that changes in ACh utilization were related to the function of cellular units responsible for light changes transduction rather than light detection.
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Acetilcolina/metabolismo , Retina/metabolismo , Animales , Transporte Biológico , Colina/metabolismo , Oscuridad , Peces , Inulina , Cinética , PerfusiónRESUMEN
Circumscribed to endemic areas throughout tropical countries, filariasis is a rare and unknown disease in Europe. We report four cases of calcified filariasis involving the breast, supporting the diagnosis on the typical mammographic appearance of the calcified worms and the past history of filarial infection. Few reports have been published in the radiology literature about this infrequent manifestation of the parasitation. The purpose of this article is to show the mammographic characteristics of this disease that soon will be seen frequently in developed countries due to the increasing population from the endemic areas.
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Enfermedades de la Mama/diagnóstico por imagen , Calcinosis/diagnóstico por imagen , Filariasis/diagnóstico por imagen , Enfermedades de la Mama/patología , Femenino , Filariasis/patología , Humanos , Mamografía , Persona de Mediana EdadRESUMEN
The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of complications of portal hypertension such as variceal hemorrhage and ascites is well established. However, TIPS has a limited patency due to dysfunction consisting in occlusion or stenosis of the intrahepatic tract or stenosis of the outflow hepatic vein. Timing of dysfunction cannot be predicted, so routine surveillance and percutaneous intervention are continuously required to maintain TIPS patency. Trans-shunt venography is the gold standard technique in TIPS evaluation, but it is expensive and invasive. Doppler ultrasound (DU) has been the most commonly used noninvasive tool in TIPS patency. Despite many reported series, its role remains controversial. After more than 10 years of experience with TIPS, we followed our patients with DU and trans-shunt venography to establish Doppler criteria of dysfunction and its accuracy in assessing shunt dysfunction.
Asunto(s)
Derivación Portosistémica Intrahepática Transyugular , Complicaciones Posoperatorias/diagnóstico por imagen , Ultrasonografía Doppler , Velocidad del Flujo Sanguíneo , Estudios de Seguimiento , Venas Hepáticas/diagnóstico por imagen , Humanos , Sistema Porta/fisiopatología , PortografíaRESUMEN
BACKGROUND: We evaluated the efficacy and safety of CO(2) wedged hepatic venography (CO(2) WHV) by comparing it with direct transjugular (DP) and indirect arterial portography (IP). METHODS: Twenty-one CO(2) WHV and IP examinations were performed in 20 patients; 13 of them also underwent DP within 48 h of CO(2) WHV and IP. IP involved the injection of iodinated contrast into the superior mesenteric and splenic arteries. DP was performed from a transjugular approach, during transjugular intrahepatic portosystem shunt placement, with the injection of iodinated contrast into the superior mesenteric or splenic vein. The parameters evaluated were visualization of vessels and varices, portal vein thrombosis detection, and complications. RESULTS: CO(2) WHV depicted the splenic vein in 57%, the superior mesenteric vein in 62%, the main portal vein in 90%, the right portal vein in 95%, and the left portal vein in 90% of patients. It also demonstrated gastroesophageal varices in seven cases, a splenorenal shunt in one case, mesenteric varices in one case, and a recanalized umbilical vein in one case; other varices were also seen. CONCLUSION: CO(2) WHV is a good and safe technique for demonstrating the portal circulation. It may provide information not obtainable by IP and DP. However, IP provides better demonstration of the variceal network.