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Anthony Watkinson

Publications and source records attributed to Anthony Watkinson.

4 recordsLinked to original sources
PubMed2004

Bleeding ectopic varices--treatment with transjugular intrahepatic porto-systemic shunt (TIPS) and embolisation.

BACKGROUND/AIMS: Bleeding ectopic varices due to cirrhosis can be difficult to manage. We report our experience of uncontrolled bleeding from ectopic varices treated with transjugular intrahepatic porto-systemic shunt (TIPS). METHODS: We selected the 21 cirrhotics who underwent TIPS for bleeding ectopic varices from our database: Child-Pugh grade A (2), B (11) and C (8). Site of bleeding was rectal (11), colonic (2), ileal 1, jejunal 1, duodenal 1, and stomal (5). RESULTS: TIPS was performed successfully in 19/21 (90%) patients. All except 1 had either a reduction in portosystemic pressure gradient < or = 12 mmHg (n=12) or reduction by 25-50% of baseline (n=6). TIPS alone was used in 12/19: 7 of these 12 had no further bleeding; 5 (42%) rebled within 48 h, and had embolisation, 4 without further bleeding. In 7 of 19, TIPS and embolisation were performed together: 2 patients (28%) rebled; further embolisation stopped the bleeding. CONCLUSIONS: Ectopic varices do rebleed despite a reduction of porto-systemic pressure gradient < or = 12 mmHg or by 25-50% of baseline, following TIPS. Embolisation stopped bleeding in all but 1 patient. We recommend performing embolisation at the time of the initial TIPS to control bleeding from ectopic varices.

Adult↗
PubMed2004

Transjugular kidney biopsy.

BACKGROUND: Most previous studies demonstrating the feasibility of transjugular kidney biopsy have used a modified Colapinto aspiration biopsy needle. We present 25 high-risk patients, with contraindications to percutaneous renal biopsy, who underwent transjugular kidney biopsy using a transvenous side-cut needle. This technique is easier to learn and can be performed by an interventional radiologist with transjugular liver biopsy experience and equipment. The needle is designed for optimal cortical sampling but has a high incidence of capsular perforation. Elective coil embolization was used in selected patients to reduce the risk of bleeding. METHODS: We retrospectively reviewed the indications for obtaining renal histology, based on clinical presentation, and the specific indications for transjugular biopsy. Transjugular kidney biopsy was assessed for sampling effectiveness and adequacy, the impact of histology on patient management, and technique complication rates. RESULTS: Renal tissue was obtained in 23 cases, with diagnostic biopsies in 21 of 23 (91.3%). A mean of 3.5 cores were obtained with 9.9 glomeruli per procedure for light microscopy (range, 0 to 32), 2.2 (range, 1 to 7) for electron microscopy, and adequate tissue for immunoflorescence available in 11 of 23 biopsies. Histology influenced patient management in all 23 cases. Capsular perforation was recorded in 73.9% (17 of 23) of cases with 6 undergoing elective coil embolization. Two major complications occurred, both in patients with multiple risk factors for bleeding. One required coil embolization of an arterio-calyseal system fistula. A further patient developed renal vein thrombosis 6 days after a failed transjugular kidney biopsy. CONCLUSION: Transjugular kidney biopsy provides a histological diagnosis in high-risk patients, making an important contribution to patient management.

Adult↗
PubMed2003

TIPS for acute and chronic Budd-Chiari syndrome: a single-centre experience.

BACKGROUND/AIMS: Transjugular intrahepatic portosystemic shunt (TIPS) is a technically challenging but feasible treatment for Budd-Chiari syndrome (BCS). However, information about the outcome, particularly in patients with liver failure, is scarce. We report our experience of TIPS for BCS. METHODS: Fifteen patients with BCS underwent TIPS. Eight had hepatic failure and seven underwent TIPS for BCS uncontrolled by medical treatment. RESULTS: Fourteen out of 15 had successful TIPS placement. Out of the eight hepatic failure patients, four died soon after TIPS: one liver rupture, one portal vein rupture, one liver failure and one pulmonary oedema. Another patient had a significant intrahepatic haematoma, which resolved with conservative management. TIPS was successfully placed in all of the seven patients with chronic BCS, in whom there was an average follow-up of 20 months. Ascites resolved and liver function improved in all. One patient died after 18 months from the original hepatic metastatic disease. Four patients have had evidence of TIPS dysfunction requiring three balloon dilatations and one restenting. No patient has required liver transplantation. CONCLUSIONS: TIPS should be the first line treatment for BCS uncontrolled by medical therapy. However, mortality in BCS with hepatic failure is high and liver transplantation could be a better option.

Adult↗