ObjectiveTo evaluate the clinical efficacy of balloon bronchoplasty and metallic stents in lung transplant-related central airway stenosis.MethodsData of lung transplant recipients with central airway stenosis who underwent therapeutic bronchoscopic interventions between January 2011 and June 2019 at our institution were reviewed. The clinical follow-up included dyspnea index, forced expiratory Forced expiratory volume in one second (FEV1), six-minute walk distance (6MWD), and the rate of bronchoscopic dilation.ResultsThirty-four lung transplant recipients with airway stenosis were included in our study. All these patients were treated by balloon bronchoplasty through flexural bronchoscopy, and 7 additionally needed temporary metal stent implantation for 28 to 67 days in order to palliate recurrent central airway stenosis. The percentages of immediate efficacy were 86% (180/209) and 100% (7/7), respectively. After serial balloon dilatation, the recipients with central airway stenosis had significantly lower dyspnea index (3.24±0.55 vs. 1.91±0.62, P<0.01), higher FEV1 ［(1.43±0.21)L vs. (1.72±0.27)L, P<0.01］ and longer 6MWD ［(317.3±61.7)m vs. (372.9±52.6)m, P<0.01］. Six recipients with central airway stenosis received 33 interventions in 6 months before stent implantation and 10 interventions in 6 months after stent extraction.ConclusionsLung transplant recipients with central airway stenosis have a good respond to balloon bronchoplasty and stent placement. Airway stenosis after lung transplantation can be successfully managed with bronchoscopic dilatation and temporary stent placement.
Abstract： Objective To analyze clinical outcomes of interventional therapy for common congenital heart diseases （CHD）. Methods We retrospectively analyzed the clinical records of 57 patients with CHD who underwent catheter interventional therapy in People’s Hospital of Deyang City between March 2009 and January 2012. There were 31 male patients and 26 female patients with their mean age of 29.4±3.5 years（ranging from 1.5 to 75.0 years）. There were 21 patients with patent ductus arteriosus （PDA）, 12 patients with ventricular septal defect （VSD）, and 20 patients with atrial septal defect（ASD）；and 2 patients with VSD plus ASD, 1 patient with VSD plus PDA, and 1 patient with ASD plus PDA. Occluder and supplying system made in China were used in the interventional therapy. For the patients with ASD plus PDA, PDA was blocked before ASD；for the patients with VSD plus PDA, PDA was blocked before VSD；and for the patients with VSD plus ASD, VSD was blocked before ASD. Results The duration of interventional therapy ranged from 30 to 90 minutes. The success rate of operation was 98.3%（56/57）. Operation was given up in an old female patient with ASD and chronic obstructive pulmonary disease because of pulmonary hypertension. The hospital stay was 3 -7 days. All the patients were followed up at the outpatient department for 1 month to 2 years by color Doppler echocardiogram, chest X-ray and electrocardiograph, and no complication occurred during follow-up. Conclusion With complete understanding of surgical indications and strict compliance with procedures, catheter interventional therapy is safe, minimal invasive, and effective in CHD treatment.
Objective To discuss the clinical effect and value of minimally invasive therapy on lower extremity deep venous thrombosis （DVT）. Methods The clinical data of 911 patients with acute lower extremity DVT from April 1998 to December 2011 were analyzed retrospectively. There were 489 males，422 females；the age ranged from 23-86 years old with （58.72±11.95） years old. Five hundred and sixty-eight patients occurred on the left leg，343 patients on the right leg. There were 487 cases of central type，166 cases of peripheral type，258 cases of mixed type. All the patients were implanted inferior vena cava filter under local anesthesia，then inserted an 8-14 F catheter via the femoral vein of the affected limbs to suck mechanically thrombus. Five hundred and twenty-seven cases of iliofemoral vein thrombus were inserted into sheathing canal with the help of technique of guide wire griped. The guide wire could be plugged into femoral vein，even more far，with the help of sheathing canal. Following the guide wire，a diameter-10 mm balloon catheter was used to pull the thrombus to iliac vein，with the watching of DSA，so it could be sucked from iliac vein. Before sucking thrombus，a diameter-12 mm balloon was put into the confluence of inferior vena cava and iliac vein，in case of thrombus fall off with blood flow to block inferior vena cava. Results Among 911 patients，423 cases were only treated by sucking thrombus，275 cases sucking thrombus plus endovascular thrombolysis，91 cases sucking thrombus plus endovascular thrombolysis plus percutaneous transluminal angioplasty （PTA），122 cases sucking thrombus plus endovascular thrombolysis plus PTA plus stenting，the average hospital stay was 7.5 d. ① Discharge success rate：907 （99.56%） cases were successful by interventional therapy，4 （0.44%） cases were failed. Nine hundred and eleven patients were performed mechanical thrombus suction，which was 556 cases of gradeⅢ，142 cases of gradeⅡ，213 cases of gradeⅠ. Among 213 cases of gradeⅠ，there were 91 cases only underwent PTA treatment for economic reasons or advanced stage malignant tumors，122 cases underwent PTA plus stenting. The circumferences of affected limb and the differences of circumference of healthy and affected limbs knees above and below 15 cm at discharge were significantly smaller than those at admission （P＜0.01）. Twenty-seven cases underwent anticoagulation and thrombolytic therapy after operation，which occurred mild subcutaneous bleeding，gum bleeding，epistaxis，hematuria，and the symptoms were disappearance after adjusting drugs. All the patients did not appear to complications such as bleeding，vessel dissection. ② Follow-up effective rate：After 6 to 12 months follow-up，there were 714 （78.38%） cases of excellent，136 （14.92%） cases of good，57 （6.26%） cases of middle，4 （0.44%） cases of poor. After 13 to 24 months follow-up，there were 691 （76.18%） cases of excellent，151 （16.65%） cases of good，65 （7.17%） cases of middle；65 cases occurred restenosis that the PTA and stent placement was underwent again， blood flow of 58 cases completely restored，blood flow of 7 cases partly recovered，and the contrast agent didn’t retent. After 25 to 36 months follow-up，there were 681 （75.08%） cases of excellent，128 （14.11%） cases of good，98 （10.81%） cases of middle；98 cases of limb swelling were not satisfied，and the patients still had a sense of pain after walking，but the symptoms obviously improved as compared with preoperative symptoms，the patients were advised to wear stretch socks with no further interventional therapy. Conclusions Minimally invasive therapy on lower extremity DVT can eliminate thrombus from venous cavity more early，restore the unobstructed flow instantly，preserve the function of venous valve in a greater degree. It has an advantage of minimally invasive，less complications，and notable clinic effect of short-term and medium-term follow-up.
Interventional embolization therapy is widely used for procedures such as targeted tumour therapy, anti-organ hyperactivity and haemostasis. During embolic agent injection, doctors need to work under X-ray irradiation environment. Moreover, embolic agent injection is largely dependent on doctors’ experience and feelings, and over-injection of embolic agent can lead to reflux, causing ectopic embolism and serious complications. As an effective way to reduce radiation exposure and improve the success rate of interventional embolization therapy, embolic agent injection robot is highly anticipated, but how to decide the injection flow velocity of embolic agent is a problem that remains to be solved. On the basis of fluid dynamics simulation and experiment, we established an arterial pressure-injection flow velocity boundary curve model that can avoid reflux, which provides a design basis for the control of embolic agent injection system. An in vitro experimental platform for injection system was built and validation experiments were conducted. The results showed that the embolic agent injection flow speed curve designed under the guidance of the critical flow speed curve model of reflux could effectively avoid the embolic agent reflux and shorten the embolic agent injection time. Exceeding the flow speed limit of the model would lead to the risk of embolization of normal blood vessels. This paper confirms the validity of designing the embolic agent injection flow speed based on the critical flow speed curve model of reflux, which can achieve rapid injection of embolic agent while avoiding reflux, and provide a basis for the design of the embolic agent injection robot.
ObjectiveTo investigate therapeutic method, curative effect, and prognosis of inferior vena cava (IVC) blocking Budd-Chiari syndrome (BCS) with thrombosis. MethodsClinical data of 128 BCS patients with membranous or short-segment occlusion of IVC as well as IVC thrombosis, who accepted interventional treatment in The Affiliated Hospital of Zhengzhou University from Apr. 2004 to Jun. 2012, were retrospectively analyzed. Comparison of the difference on effect indicators between predilation group and stent filter group was performed. ResultsThereinto, 9 patients with fresh IVC thrombosis were treated with agitation thrombolysis (agitation thrombolysis group), 56 patients were predilated by small balloon (predilation group), for the rest 63 patients, a stent filter was deployed (stent filter group). Besides 1 stent filter fractured during the first removal attempt and had to be extracted surgically in the stent filter group (patients suffered with sent migration), in addition, the surgeries of other patients were technically successful without procedure-related complication. effect indicators were satisfactory in all patients, and there were no statistical differences between predilation group and stent filter group in dosage of urokinase, urokinase thrombolysis time, hospital stay, and incidence of complication (P > 0.05), but the cost of predilation group was lower than that of stent filter group (P < 0.01). All of the 128 patients were followed-up postoperation, and the duration range from 18 to 66 months with an average of 44.2 months. During the follow-up period, reobstruction of the IVC was observed in 13 patients without thrombosis, of which 1 patient in agitation thrombolysis group, 6 patients in predilation group, and 6 patients in stent filter group. There was no significant difference in recurrence rate between predilation group and stent filter group (P > 0.05). Patients with recurrence got re-expansion treatment, and no stenosis or thrombogenesis recurred. ConclusionsAgitation thrombolysis for fresh IVC trombosis in the patients with BCS is safe and effective. Predilation and stent filter techniques are all effective in the treatment of BCS with chronic IVC thrombosis, but the former technique seems to be more economic.
Objective To investigate the clinical effect and safety of balloon angioplasty (BAP) for patients with venous hypertension associated with autogenous arteriovenous fistula (AVF). Methods Thirty-three patients with venous hypertension associated with AVF were hospitalized between August 2012 and August 2014 in the Department of Nephrology, West China Hospital of Sichuan University. All of the patients received BAP therapy. The clinical characteristics and therapeutic effects were comparatively summarized before and after operation. Results Venous hypertension in all the 33 patients was caused by central venous stenosis or occlusion. Among them, there were 13 cases of stenosis on the site where the left innominate vein crossed the aorta, 10 cases of stenosis at the junction of the left innominate vein and superior vena cava, 4 cases of stenosis at the junction of the left subclavian vein and the innominate vein, 3 cases of right innominate vein stenosis, and 3 cases of innominate vein occlusion. The lesions were most common in the innominate vein. Innominate vein stenosis or occlusion occurred in 19 cases (57.6%), and stenosis at the junction of innominate vein and the superior vena cava or subclavian vein occurred in 14 cases (42.4%). Of the 33 patients, one patient with complete occlusion of the innominate vein did not receive BAP treatment because guide wire could not pass through the occlusion site. The other 32 patients underwent BAP treatment, among whom 30 (93.8%) were successful, and 2 (6.2%) failed. No obvious complications occurred. One day after BAP treatment, patients’ symptoms were significantly relieved. One to seven days later, swelling of the hands, pain, and other symptoms were relieved. In the 30 patients who underwent the treatment successfully, 29 were followed up for 3 to 24 months. Among them, 21 (72.4%) maintained clinical remission and the AVFs were functional, 6 patients (20.7%) got a restenosis later, and 2 patients died. Conclusions BAP is effective and safe for venous hypertension associated with AVF. However, the follow-up of patients has displayed the possible risk of restenosis in long-term outcomes.
Objective To evaluate the therapeutic efficacy of percutaneous transhepatic portal vein catheterization and thrombolysis on acute superior mesenteric vein thrombosis. Methods The treatment and therapeutic efficacy of 7 cases of acute superior mesenteric vein thrombosis underwent percutaneous transhepatic portal vein catheterization and thrombolysis under ultrasound guidance from August 2005 to April 2009 were analyzed. Results All the patients succeeded in portal vein catheterization and no bile leakage or abdominal bleeding occurred during the procedure. The clinical symptoms such as abdominal pain, abdominal distension， and passing bloody stool relieved were relieved and liquid diet began at postoperative of day 2-5. Emergency operation was done in one case and there was no intestinal fistula. The angiography after the operation showed that the majority of thrombosis were cleared and the blood of portal vein and superior mesenteric vein flowed smoothly. During the follow-up of 3 months to 3 years, all the patients’ status maintained well and no recurrence occurred. Conclusion Treatment of acute superior mesenteric vein thrombosis by percutaneous transhepatic portal vein thrombolysis is safe and effective.
Objective To investigate the efficacy and influential factors of interventional therapy for post-intubation tracheal stenosis. Methods The clinical data of 69 patients with tracheal stenosis after tracheal intubation in the First Affiliated Hospital of Guangzhou Medical University from February 2010 to March 2015 were retrospectively analyzed. The effects of interventional treatment for tracheal stenosis after intubation were evaluated by reviewing the medical records and telephone follow-up for more than 1 year. Multivariate logistic regression model was used to analyze the influential factors. Results The study recruited 69 patients with the median age of 44 years. After the interventional treatment, ATS dyspnea score decreased from (2.41±0.76) points to (0.65±0.62) points ( P<0.01), the diameter of airway lumen increased from (4.24±2.05)mm to (10.57±3.14)mm ( P<0.01). The short-term effective rate of interventional therapy was 92.8% (64/69) but the restenosis rate in 1 month, 3 months and 1 year after interventional treatment were 56.5%, 26.1% and 36.2%, respectively. Multivariate logistic regression analysis showed that diabetes (OR=2.819, 95%CI 1.973-4.062）, shortness of breath score >3 points (OR=13.816, 95%CI 5.848-32.641）, trachea stenosis diameter <4.5 mm (OR=7.482, 95%CI 4.015-13.943), tracheal stenosis grade ≥4 (OR=3.815, 95%CI 2.258-6.447), stenosis in the upper trachea (OR=5.173, 95%CI 3.218-8.316) were risk factors of interventional therapy for post-intubation tracheal stenosis. Conclusions The general efficacy of interventional treatment for tracheal stenosis after tracheal intubation is poor, and the recurrence rate is still high. The high degree of tracheal stenosis, diabetes mellitus and upper tracheal stenosis are important factors that affect the efficacy of respiratory interventional therapy.
ObjectiveTo summarize the types of difficult cases and complications during interventional therapy for Budd-Chiari syndrome, and to propose solutions to these problems and complications. MethodsClinical data of 1 859 cases of Budd-Chiari syndrome (2 214 times) who underwent interventional diagnosis and therapy from Jan. 1990 to Sep. 2014 in our hospital were retrospectively analyzed. ResultsOf the 2 214 times, complications happened in 31 times, which were related to the interventional therapy, and the incidence of complication was 1.40% (31/2 214). Of the 31 times who suffered from complications, 25 times were successfully treated, and the successful rate was 80.65%. Three hundreds and seventy two times had been successful treated in 396 times with difficult situation (there were 9 times without treatment), and the successful rate was 96.12% (372/387). Seven patients abandoned inteventional therapy. Six cases died during the operation and hospital stay period, and the mortality was 0.32% (6/1 852). There were 1 553 cases were followed-up for 10-284 months (average of 100.9 months). During the follow-up period, 209 cases suffered from restenosis, and the restenosis rate was 13.46% (209/1 553). ConclusionInterventional therapy for Budd-Chiari syndrome has entered a mature stage, discover timely and correct handling of intraoperative complications are important to improve the successful rate and curative effect.
Hemoptysis is a common respiratory emergency, and severe cases can lead to death. Patients with massive hemoptysis need emergency management at the bedside, and fully evaluation for indications and timing of tracheal intubation and transtracheal intervention. When a relatively stable state is achieved, emergency vascular intervention is performed to stop bleeding. CT plays an important role in the risk assessment and interventional treatment of hemoptysis, and it is worthy of clinical promotion and more exploratory research. This article introduces the emergency treatment for massive hemoptysis, the vascular interventional procedure, the exploration of clinical application of preoperative CT, and the clinical application value of CT for hemoptysis risk assessment. It aims to provide a better way to deal with massive hemoptysis and to apply CT to the interventional treatment of hemoptysis more reasonably for clinicians.