ABSTRACT
Objective To assess the diagnostic value of DSA for nontumorous arterioportal shunt in cirrhosis.Methods One hundred seventy cirrhotic patients without HCC under going transhepatic artery self bone marrow stem cell transplantation were taken liver arterial DSA together with 165 CT data.Arterioportal shunt(APS)appearance phase,persisting time and characteristics of liver parenchyma staining caused by APS were analyzed dynamically.Small HCC was differentiated from nontumorous APS.TACE procedure was done when HCC lesion was confirmed by DSA findings.Results 31.7%(54/170)DSA presented the sign of APS. Among the 142 cases with no evidence of APS on CT examinations,but APS was seen in DSA of 31 cases (21.8%).All patients with CT findings of liver abnormal enhancement of APS,23 cases including 16 cases as nontermorous and 7 cases whose CT arterial phase showing local persistant enhancement without declination in portal venous phase which were recognized to be HCC later by DSA characteristics with only one having tumorous APS.Conclusions DSA has a comparative high visualization rate of nontumorous APS in liver cirrhosis and benefits the differentiation with malignant lesions guiding the interventional procedure.
ABSTRACT
Objective To assess the technique and clinical outcome of subintimal recanolization (SIR)for peripheral artery total occlusion.Methods Eighteen patients with 20 arterial occlusions underwent SIR.The occlusive lesions were located in the lilac-femoral artery(14 lesions),the infrapopliteal arteries(4 lesions)and the left subclavian artery(2 lesions),respectively.Basic procedure of SIR was to create a subintimal path in the wall of the occluded artery and reentry the true lumen by using 0.035 inch diameter TERUMO guidwire and angiographic catheter.Subsequently,balloon angioplasty was performed in all recanalized lesions,and stent was placed in initial parts or whole recanalized path except one lesion in the lilac-femoral artery,and the lesions in the infrapopliteal arteries.Results Seventeen occlusive lesions in 15 patients were successfully recanalized by means of SIR,and the corresponding symptoms were disappeared or improved obviously.Technical failure occurred in 3 patients due to inability to reenter the distal true lumen or balloon angioplasty was not satisfactory.No complications of artery rupture,thrombosis or embolization were found.Conclusion SIR is an effective and safe therapy for peripheral artery total occlusion.This technique provides a feasible alternative to conventional percutaneous transluminal angioplasty especially in the complicated cases.