Objective To evaluate the clinical effects of bronchial artery embolization ( BAE) for massive hemoptysis due to bronchiectasis.Methods 205 patients with massive hemoptysis were treated with bronchial artery embolization using coils, polyvinyl alcohol ( PVA) microspheres, line segmen, and gelatin sponge after the site of bleeding or the abnormal arteries were identified by arteriography. Super selective bronchial artery embolization was performed with a coaxial microcatheter inserted into the bronchial artery. Results BAE was successfully performed in 205 cases with massive hemoptysis ( left and right bronchial artery embolization in 35 cases, left bronchial artery embolization in 20 cases, right bronchial artery embolization in 126 cases, common bronchial artery embolization in 22 cases, right inferior phrenic artery embolization in 2 cases) . Of 205 patients, 169 were cured, 24 were relieved with a success rate of 94.1% . Long termcumulative hemoptysis nonrecurrence rates was 82.4% . 23 patients developed post embolization syndrome characterized by mild fever and chest pain and ended with spontaneous recovery without special management. No severe complications including spinal cord injury or dystopia embolization were observed. Conclusions Bronchial arterial embolization interventional therapy is a rapid, safe and effective method in the treatment of massive hemoptysis due to bronchiectasis.
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.
Objective To compare the therapeutic effect of percutaneous transhepatic cholangial drainage (PTCD) and operation drainage for the patients with inoperable malignant obstructive jaundice. Methods A total of 131 patients with inoperable malignant obstructive jaundice were treated in this hospital, in which 102 patients had PTCD by placement of metallic stent and (or) plastic tubes to remove obstruction of bile duct (interventional treatment group). Simultaneously 29 patients were selected for operation by intraexternal drainage (operation drainage group). The patients were followed up for comparison of the serum level of total bilirubin, postoperative complications, average length of hospitalization and average cost between the two groups. Results PTCD was successfully performed in all the patients of the interventional treatment group. There were no significant differences of 50% decrease period of average total bilirubin level or postoperative complications between the two groups (Pgt;0.05). The average length of hospitalization and average cost of interventional treatment group were less than those of operation drainage group (Plt;0.05). Conclusions Compare with operation drainage, interventional treatment can reduce average length of hospitalization and average cost, without increase of postoperative complications, which is a main chance of treatment for malignant obstructive jaundice.
ObjectiveTo investigate therapeutic strategy of acute pulmonary embolism. MethodsClinical data of 48 patients with acute pulmonary embolism who were treated in Affiliated Hospital of North Sichuan Medical College form January 2009 to May 2014 were analyzed retrospectively. ResultsOf the 48 cases, 14 cases of low risk (low risk group) were treated with anticoagulation, 24 cases of middle risk (middle risk group) were treated with anticoagulation and systematic thrombolysis or interventional therapy (local thrombolysis after thrombus fragmentation or thrombolytic catheter placement in pulmonary artery), 10 cases of high risk (high risk group) were treated with anticoagulation and interventional therapy. In low risk group, 12 cases (85.7%) were cured and 2 cases (14.3%) were markedly effective, and total effective rate was 100%. In middle risk group, 16 cases (66.7%) were cured and 8 cases (33.3%) were markedly effective, and total effective rate was 100%. In high risk group, 1 case died, 3 cases were cured, 2 cases were markedly effective, and 4 cases were better, and the total effective ratio was 9/10. All cases suffered from no complication such as hemorrhage of cerebral and digestive system. Forty-eight cases were followed up for 3-12 months, with a median time of 8 months. During the follow-up period, there was no complication occurred such as dyspnea, pulmonary embolism, placement change of filter net, and thrombosis. ConclusionsCorresponding therapeutic strategy would be taken according to risk stratification of the acute pulmonary embolism.
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.
In recent years, the transcatheter interventional therapy of valvular disease has been developed rapidly, and new therapeutic devices are emerging, which has become the first-line treatment in parallel with surgery. Although the interventional therapy of valve disease in China started relatively late, the development speed is relatively fast, and many remarkable achievements has been accomplished. This article will introduce the application of transcatheter intervention in valvular diseases in China, including aortic valve disease, mitral valve disease, pulmonary valve disease and tricuspid valve disease.
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.
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.
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.
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.