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PubMed1980

Trauma to major visceral veins: an underemphasized cause of accident mortality.

In the period 1970-1978, a mortality rate of 44% resulted in 45 patients who suffered major intra-abdominal venous injuries. An especially grave prognosis accompanied wounds to the inferior vena cava and the hepatic and portal venous systems. Management of damage to major veins presents several difficulties. Exposure is poor; veins tear easily when clamped or sutured; exsanguination can occur as rapidly as with arterial trauma; because of low intraluminal pressure, postoperative chances of thrombosis and occlusion are high; veins (unlike arteries) have no intrinsic vasomotor capabilities to halt bleeding. Finally, the misconception persists that venous wounds are less serious than comparable arterial injuries. Simple pressure by packs or hand often controls bleeding: otherwise clamps, balloons, hemostats, or ligation can be selectively chosen. Our experience suggests that atrial-caval shunting without prior identification and control of the bleeding site is doomed to failure.

Abdomen↗
PubMed2002

Gastroduodenal artery stump haemorrhage following pylorus-sparing Whipple procedure: treatment with covered stents.

BACKGROUND/AIMS: To report a case of bleeding after pancreatoduodenectomy in a patient with pancreatic leak and portal thrombosis who was successfully treated with an endovascular approach. METHODS: A 58-year-old male, suffering from neoplasm of the distal bile duct, underwent a pylorus-preserving Whipple procedure. On the 18th day, following a sudden drop in pressure and low haematocrit values, the patient underwent surgery. The source of the bleeding was not found. Six days later, following the appearance of bleeding from the abdominal drainage and haematemesis with shock, the patient had an immediate angiography. Bleeding from the gastroduodenal artery stump was evident, the portography showed no portal flow. With respect to the shortness of the stump, safe embolisation with coils, while preserving the common hepatic artery patency, was difficult to obtain. RESULTS: By transcatheter placement of covered stents into the hepatic artery and thereby occluding the origin of the gastroduodenal artery, the bleeding was stopped. After 2 months, CT angiography showed patency of both the common and proper hepatic arteries. Nine months after the procedure the patient is in good health. CONCLUSIONS: Percutaneous placement of covered stents can be the solution in cases where transcatheter embolisation is not recommendable because of portal vein thrombosis.

Angiography↗
PubMedDate not supplied

Dynamic MR studies of hepatocellular carcinoma with portal vein tumor thrombosis.

Gd-DTPA enhanced dynamic MR studies were evaluated in six patients with hepatocellular carcinoma associated with portal vein tumor thrombus. The portal vein tumor thrombus was clearly visualized as a low intensity lesion. The hepatic segment supplied by the portal vein showed high intensity, probably due to decreased portal blood flow and compensatory arterial blood flow. Tumors located in this segment were shown as areas of relatively low intensity compared with segmental high intensity areas. Thus dynamic MR study was found to be a useful method for differentiating the tumor from the surrounding nontumorous tissue with decreased portal blood flow.

Adult↗
PubMed2004

Partial hepatic vein diversion in pulmonary arteriovenous malformations in congenital heart disease.

The late appearance of pulmonary arteriovenous malformations after operations for complex congenital cardiac conditions may be explained in many ways. The necessity of hepatic blood flow to the lungs is now generally accepted for carrying some labile substance that is secreted by the liver and that has not yet been identified. Rerouting of hepatic blood to the lungs in cardiac patients can be accomplished with different methods, most of which are predisposed to thrombosis because of the slow flow in the tunnel. My colleagues and I describe a case of partial diversion of hepatic blood into the pulmonary circulation and suggest a strategy to decrease the likelihood of conduit thrombosis and to treat pulmonary arteriovenous malformations.

Abnormalities, Multiple↗
PubMed2002

Predisposing factors of bile duct injury after transcatheter arterial chemoembolization (TACE) for hepatic malignancy.

The purpose of this study was to investigate the predisposing factors of bile duct injury after transcatheter arterial chemoembolization (TACE) for treatment of hepatic malignancy. For patients (n = 31) with TACE-related bile duct injuries during a 36-month period, final diagnoses of the tumor, the liver profile, presence of portal vein thrombosis, total number and mode of the TACE just before the development of bile duct injury were compared, respectively with those of patients without bile duct injury n = 234) after TACE. The incidence of bile duct injury was higher in the patients with non-hepatocellular tumors than in patients with hepatocellular carcinoma (p <0.01), and higher in Child-Pugh class A patients than in B or C patients (p <0.01). Segmental or subsegmental TACE tended to induce bile duct injury more frequently than the proximal TACE (p = 0.01). Portal vein thrombosis, the total number of TACEs, total amount of iodized oil, and the usage of gelatin sponge were not closely related to bile duct injuries after TACE (p >0.05). It was concluded that the chance of bile duct injury after TACE is increased in non-cirrhotic livers with good liver profile and to the more selective embolization of distal arterial branches.

Adenocarcinoma↗
PubMedDate not supplied

Percutaneous trans-hepatic obliteration for bleeding esophagojejunal varices after total gastrectomy and esophagojejunostomy.

A 72-year-old man who had undergone a total gastrectomy with a Roux-en-Y esophagojejunostomy for gastric cancer 6 years earlier presented to our hospital with massive hematemesis and melena. Endoscopic examination indicated esophageal varices with cherry-red spots and hemorrhage arising from beyond the anastomosis. Abdominal contrast-enhanced computed tomography and angiography revealed a dilated vein in the elevated jejunal limb supplying the varices. Percutaneous trans-hepatic obliteration (PTO) of the varices through the jejunal vein was performed using microcoils, ethanolamine oleate, and gelatin sponge cubes. Ten days after the procedure, endoscopic examination revealed reduction and thrombosis of the varices. We consider PTO to be an effective alternative method for treating ruptured esophagojejunal varices after total gastrectomy.

Aged↗
PubMed2002

Arterial embolization of unresectable hepatocellular carcinoma with use of cyanoacrylate and lipiodol.

PURPOSE: To assess the potential of transarterial permanent embolization with use of a mixture of cyanoacrylate and lipiodol for treatment of unresectable primary hepatocellular carcinoma (HCC). MATERIALS AND METHODS: In a retrospective study, 36 patients with histologically proven HCC were treated with transarterial embolization (TAE) of the hepatic arteries. None of these patients were candidates for surgical resection and some had advanced disease with multinodular disease or bulky tumor, thrombosis of a segmental branch of the portal vein, and/or extrahepatic spread. To induce permanent and more peripheral embolization, cyanoacrylate, an adhesive polymerizing on contact with blood, was used in TAE. From 1990 to 1998, a total of 76 embolization procedures were performed. Cumulative survival rates were calculated. RESULTS: Most of the patients presented with a self-limited postembolization syndrome. Severe procedure-related complications were found after four treatment sessions (5.2%). The 30-day perioperative mortality rate was 2.7%. The mean follow-up period was 20.3 months (range, 1-68 mo), with a median survival of 26 months. The median survival was also estimated for different Okuda stages of disease: stage II (n = 26) versus stage III (n = 5) disease (32 vs 9 months; P <.05); patients with (n = 9) or without (n = 27) extrahepatic metastasis (10 vs 26 months; P <.05); and patients with (n = 10) or without (n = 26) thrombosis of a segmental branch of the portal vein (7 versus 34 months [P <.005]). CONCLUSION: TAE with use of cyanoacrylate and lipiodol for unresectable HCC is a feasible treatment modality. This retrospective report indicates beneficial effects on survival even in patients with advanced disease.

Adult↗
PubMedDate not supplied

[Comprehensive immunologic evaluation of patients with uveal and retinal pathology].

Clinical and immunologic examinations of 120 patients with central tapetoretinal abiotrophy, central serous choriopathy, central choroiditis, endogenic uveitis, thrombosis of the central retinal vein have revealed deviations in the T and B immunity systems and in autoimmune reactions to retinal S antigen, to uveopigmented antigens, and to human hepatic intracellular lipoprotein, as against the controls. The findings evidenced an imbalance of the T and B immunity parameters: reduced counts of T lymphocytes, theophylline-sensitive T suppressors, elevated immunoregulatory cell index, increased counts of B lymphocytes, circulating immune complexes, and blood serum immunoglobulins A and G. No essential shifts in leukocyte adhesion and antibody-dependent K cell cytotoxicity were found. The detected shifts are characteristic of the immune disorders common for various forms of uveoretinal abnormalities.

Adolescent↗
PubMed2003

Budd-Chiari syndrome: diagnosis with three-dimensional contrast-enhanced magnetic resonance angiography.

AIM: To evaluate the role of three-dimensional contrast-enhanced magnetic resonance angiography (3D CE MRA) in the diagnosis of Budd-Chiari syndrome (BCS). METHODS: Twenty-three patients with BCS underwent 3D CE MRA examination, in which 13 cases were secondary to either hepatocellular carcinoma (11 cases), right adrenal carcinoma (1 case) or thrombophlebitis (1 case) and 10 suffered from primary BCS. The patency of the inferior vena cava (IVC), hepatic and portal veins as well as the presence of intra- and extrahepatic collaterals, liver parenchymal abnormalities and porto-systemic varices were evaluated. Inferior vena cavography was performed in 10 cases. The diagnosis of IVC obstruction by 3D CE MRA was compared with that demonstrated by inferior vena cavography. RESULTS: The major features of BCS could be clearly displayed on 3D CE MRA. Positive hepatic venous signs included tumor thrombosis (9 cases), tumor compression (2 cases), nonvisualization (4 cases) and focal stenosis (2 cases). Positive IVC findings were noted as severe stenosis or occlusion (10 cases), tumor invasion (2 cases), thrombosis (3 cases), thrombophlebitis (1 case) and septum formation (3 cases). Intrahepatic collaterals were shown in 9 patients, 2 of them with "spider web" sign. The displayed extrahepatic collaterals included dilated azygos and hemi-azygos veins (13 cases) and left renal-inferior phrenic-pericardiophrenic veins (2 cases). The occlusion of the left intrahepatic portal veins was found in 2 cases. Porto-systemic varices were detected in 10 patients. Liver parenchymal abnormalities displayed by 3D CE MRA were enlargement of the caudate lobe (7 cases), heterogenous enhancement (18 cases) and complicated tumors (13 cases). Compared with the inferior vena cavography performed in 10 cases, the accuracy of 3D CE MRA was 100 % in the diagnosis of IVC obstruction. CONCLUSION: 3D CE MRA can display the major features of BCS and provide an accurate diagnosis.

Adult↗
PubMed2000

Combined therapy consisting of intraarterial cisplatin infusion and systemic interferon-alpha for hepatocellular carcinoma patients with major portal vein thrombosis or distant metastasis.

BACKGROUND: Hepatocellular carcinoma (HCC) patients with major vascular involvement or extrahepatic metastasis are not good candidates for surgery or transarterial chemoembolization (TACE). In this study, the authors evaluated the efficacy of combined therapy with intraarterial cisplatin infusion and systemic administration of interferon-alpha (IFN-alpha) as a palliative treatment for these patients. METHODS: Sixty-eight HCC patients with major portal vein thrombosis (n = 47) or distant metastasis (n = 27) were randomly allocated to 1 of 3 groups. Group I (n = 19) received combined therapy consisting of intraarterial cisplatin infusion and systemic IFN-alpha, Group II (n = 23) received intraarterial cisplatin infusion, and Group III (n = 26) was managed with only supportive care. Cisplatin 2 mg/kg was infused through the proper hepatic artery every 8 weeks, and IFN-alpha 3 million IU/m2 was administered subcutaneously 3 times a week. RESULTS: The partial response (defined as a 50% or greater reduction in the product of the 2 longest perpendicular tumor measurements) rate of Group I was significantly higher than that of Group II (33% vs. 14%; P < 0.05). Also, the 1-year survival rate of Group I (27%) was higher than that of Group II (9%) or Group III (0%) (P < 0.05 and P < 0.01, respectively). The median survival period of Group I was 19 weeks, which was significantly longer than that of Group II (11 weeks) or Group III (5 weeks) (P < 0.05 and P < 0.01, respectively). CONCLUSIONS: These results suggest that combined therapy consisting of intraarterial cisplatin infusion and systemic IFN-alpha may be useful as a palliative treatment for HCC patients with major vascular involvement or extrahepatic metastasis.

Antineoplastic Agents↗
PubMed2001

[Spontaneous portal vein thrombosis associated with acute cytomegalovirus infection in an immunocompetent patient].

BACKGROUND: Portal vein thrombosis (PVT) generally results from a local cause (hepatocellular and pancreatic carcinoma). Spontaneous PVT related to a general cause is less common. We report here a case of spontaneous PVT associated with acute cytomegalovirus (CMV) infection in an immunocompetent patient. CASE REPORT: A 31-year-old white female was admitted with fever and lymph node enlargement. The patient was a heavy smoker and was taking oral contraception. Blood tests revealed an inflammatory syndrome. Liver enzymes were elevated (2N) and platelet count was 118 G/l. Abdominal ultrasonography disclosed partial portal thrombosis. Computed tomography did not show any evidence of a hepatic or pancreatic mass. Protein S, protein C, and anti-thrombin III levels were normal. No antiphospholipid antibodies, no mutation for factors II and V and no abnormality suggestive of paroxysmal nocturnal hemoglobinuria at flow cytometry could be demonstrated. Acute CMV infection was diagnosis with positive viremia (PCR). The patient was given anticoagulation treatment and has done well with no relapse. CONCLUSION: Cytomegalovirus, by damaging endothelial cells, is thought to trigger a cascade of events leading to deep vein thrombosis. CMV infection does not appear to act alone on endothelial cells but rather behaves as an associated factor.

Acute Disease↗
PubMed1999

Duplex Doppler sonography in patients with Budd-Chiari syndrome.

BACKGROUND: Angiography has been the mainstay for diagnosis of Budd-Chiari syndrome even though other modalities are increasingly being used. We have evaluated our findings of duplex Doppler sonography (DDS) in patients with Budd-Chiari syndrome. METHODS: Duplex Doppler sonography was performed in 37 consecutive angiographically proven patients with Budd-Chiari syndrome. RESULTS: Real time ultrasonography showed abnormalities of right, middle and left hepatic veins (HV) in 21, 15 and 18 patients, respectively. Duplex Doppler sonography showed abnormal flow patterns in 37, 22 and 31 patients in the right, middle and left HV, respectively, thereby increasing the diagnostic yield by 40%. An abnormal waveform in one or more HV was present in all 37 patients. Uniphasic flow was the commonest abnormality and was seen in 22, nine and 14 patients, respectively, in the right, middle and left HV, while there was no flow in five, four and seven patients in the right, middle and left HV, respectively. Intrahepatic collaterals were seen in 35 of 37 patients (94.6%). Hepatopetal flow was found in the portal vein of 21 of 23 patients (91.3%), while flow was hepatofugal in one and portal vein thrombosis was found in another. CONCLUSION: Duplex Doppler sonography is a useful procedure which helps in the diagnosis of patients with Budd-Chiari syndrome.

Adolescent↗
PubMedDate not supplied

Early experience of Budd-Chiari syndrome treatment with transjugular intrahepatic portosystemic shunt.

The Budd-Chiari syndrome is a heterogeneous group of disorders characterized by obstruction of hepatic venous outflow at any level from the small hepatic veins to the junction of the inferior vena cava with the right atrium. We present two cases of Budd- Chiari syndrome with severe ascites associated with polycythemia vera in first case and protein C deficiency in the second, in both cases transjugular intrahepatic portosystemic shunt were placed, with excellent control of symptoms, no mortality were observed, and just one episode of pulmonary venous thrombosis was observed. To our knowledge this is the first time that transjugular intrahepatic portosystemic shunt are used and reported in Budd-Chiari syndrome in Mexico.

Adolescent↗
PubMed2006

[Prophylaxis and treatment of operation-correlated complications in orthotopic liver transplantation].

OBJECTIVE: To investigate the common reasons, prophylaxis and treatment of operation-correlated complications in orthotopic liver transplantation (OLT). METHODS: Six hundred and forty-seven patients who underwent OLT from Apr 1993 to Dec 2004 were enrolled and analyzed retrospectively. RESULTS: There were totally 39 cases (6.0%, 39/647) of vascular complications including 23 cases (3.6%) of hepatic artery complications, 6 cases (0.9%) of portal vein complications and 10 cases (1.5%) of vena cava complications. All vena cava complications were occurred in the patients of non-cavaplasty. The success rate of stent placement in treatment of hepatic artery stenosis was 2/2; for patients with hepatic artery thrombosis, the success rate of retransplantation was 4/6, that of revasculation and balloon dilation were 3/7 and 2/7 respectively. Stent placement can treat both anastomotic strictures and venae cavae stricture with the cure rate of 3/3 and 10/10 respectively. There were 34 cases of biliary complications, in which 27 cases were in patients with T tube, and 7 cases in without T tube. The incidence of biliary leak and biliary infection was significantly different between these two groups. CONCLUSIONS: The modified piggyback (cavaplasty) technique could prevent the incidence of venae cavae complications effectively. Stent placement is an effective way to treat vascular stenosis. And retransplantation should be performed in early hepatic artery thrombosis. It is important to protect the blood supply of biliary system, and choledochostomy without T tube is the first choice for biliary reconstruction.

Adolescent↗
PubMed1990

Hepatic resection for advanced hepatocellular carcinoma with removal of portal vein tumor thrombi.

In 13 of 398 patients who underwent hepatectomy, tumor thrombi of the remnant portal vein was concomitantly removed by the balloon catheter method in 8, an open method under hepatic vascular exclusion in 1, and resection of the occlusive portal segment followed by portal reconstruction in 4. In 8 of these patients the liver was cirrhotic. The mode of hepatectomy consisted of bisegmetectomy or trisegmentectomy in 11, segmentectomy in one, and partial resection in one patient. Two patients died of portal thrombosis or hepatic failure in the hospital. The mean survival in four patients was 12 months. Seven are still alive (mean, 16 months). In the corresponding period, nine patients with occlusive tumor thrombi of the portal confluence were hospitalized without operation and survived up to 4 months (mean, 64 days) after detection of the tumoral occlusion. The causes of death of the nine patients were bleeding esophageal varices, rupture of the tumor, or hepatic failure. It was revealed that removal of tumor thrombi in the remnant portal vein contributes to (1) portal decompression, (2) feasibility of arterial embolization, and (3) increase in resectability of the main tumor. At present, this procedure might be regarded as an emergency procedure for the avoidance of the above lethal impendence, but it may open the door to an adjuvant therapy.

Aged↗
PubMedDate not supplied

[Thrombosis of the superior vena cava and lateral-cervical lymphadenopathy (probably of metastatic origin). Report of a case].

The authors describe a case of superior vena cava thrombosis with laterocervical lymphoadenopathy (probably of metastatic origin). Vascular tumors are a large neoplasm family with a wide clinical and histological spectrum. They may localize on the skin, soft tissues, liver, spleen and parotid gland. The case describes a 65 year-old male, affected by COLD and chronic hepatitis. He came to the hospital for strong gastric pain, which did not vary with meal assumption and objectivity of inflated superficial veins of arms, jugular veins, chest superficial veins and venous capillars and of the epigastric zone, accompanied with right laterocervical lymphoadenomegaly. Endoscopic ultrasonic and X-ray examinations showed a superior vena cava thrombosis determining superficial collateral, azygos and emiazygos vein inflation. The histologic examination of pathologic lymph nodes resulted as hemangioendotelioma/angiosarcoma, a rare case of lymphonodal vascular tumor with a very poor prognosis.

Aged↗
PubMed2001

[Relation between transcatheter arterial chemoembolization and time of death in patients with hepatic carcinoma].

OBJECTIVE: To evaluate the relationship between transcatheter arterial chemoembolization (TACE) and time of death in hepatic carcinoma patients. METHODS: One hundred and ninety-five patients (male 188, female 7) with liver cancer underwent TACE with patients dying at different intervals after treatment. Dose of antitumor drugs, amount of iodized oil, liver function, size, recurrence of surgical resection, pattern of tumor, metastasis, presence of portal vein thrombosis, post TACE relapse, post TACE liver function and AFP, etc, altogether 15 variables were subjected to statistical analysis with the Cox's hazard proportional model. RESULTS: According to univariate and forward stepwise regression analysis, factors associated with significantly worse survival were diffused type, multi-nodular growth of tumor, and tumor embolus in the portal vein (P < 0.0001). Before death, most patients had symptoms of chest oppression, shortness of breath, ascites, abdominal distension, jaundice, hepatic failure and hematemesis. Causes of death were hepatic coma (27.2%, n = 53), hepatic failure (23.1%, n = 45), hemorrhage from the digestive tract (36.9%, n = 72), multiple organ failure (5.1%, n = 10) and others (7.2%, n = 14). CONCLUSION: Several factors of TACE may lead to failure in liver function and death. TACE may hasten death in patients with severe liver functional embarrassment. Before instituting TACE, careful weighing the pros and cons of the general condition and liver function is important for patients with portal vein embolism, multiple tumors or diffused lesions. Tolerance of liver to the drug, time, dose and method of treatment should be meticulously and carefully planned. Post TACE protection of liver is also very important.

Adolescent↗