[Show abstract][Hide abstract] ABSTRACT: Atualização em Hemorragia Digestiva - Novos Conceitos na sua Fisiopatologia Diagnóstico e Tratamento é livro que reúne a experiência multidisciplinar dos professores da Faculdade de Medicina da Universidade de São Paulo e do Hospital das Clinicas com o tema. De forma prática, didática e atualizada, são analisados os aspectos fisiopatológicos, diagnósticos e terapêuticos dessa afecção, cuja abordagem envolve todos os profissionais de saúde, tornando o livro de grande utilidade para médicos de uma maneira geral, estudantes da área da saúde, residentes, enfermeiros, fisioterapeutas, gastroenterologistas, cirurgiões-gerais e do aparelho digestivo, e endoscopistas.
Em 48 capítulos didaticamente distribuídos, com o objetivo de permitir uma leitura de fácil assimilação, os autores descrevem de modo direto e prático os diferentes aspectos relacionados com a hemorragia digestiva. Discute-se a sua origem correlacionar exatamente a origem da hemorragia com as questões diagnóstica e terapêutica, e também os ordenaram para que se possa percorrer todo o aparelho digestivo de maneira prática e didática. Aliado aos problemas clínicos, os editores buscaram oferecer também subsídios para discussão das situações ético-profissionais que envolvem o tema. Esse delicado assunto é abordado de modo autêntico e atualizado pelos seus autores.
Deve-se fazer neste momento um agradecimento a todos os autores que, apesar de sua atribulada vida profissional, atenderam ao chamado para a composição desta obra, formulando seus capítulos com o maior rigor científico, de maneira ordenada e extremamente didática, contribuindo para que uma vez mais a Faculdade de Medicina da Universidade de São Paulo pudesse desempenhar seu papel na constante divulgação e atualização de conhecimentos. Por fim, queremos agradecer aos nossos coeditores, incansáveis no seu papel quer como autores quer como editores, para que este livro pudesse ser adequada e uniformemente equacionado.
Estamos certos que esta contribuição ao estudo da hemorragia digestiva como um todo irá trazer grandes benefícios não somente aos profissionais de saúde que poderão atualizar seus conhecimentos, como também aos nossos pacientes, objeto maior de toda nossa dedicação profissional.
Atualização em Hemorragia Digestiva - Novos Conceitos na sua Fisiopatologia, Diagnóstico e Tratamento, first edited by Bruno Zilberstein, Flair José Carrilho, Ivan Cecconello, Luiz Augusto Carneiro D'Albuquerque, 08/2014: chapter 38: pages 291-300; Atheneu., ISBN: 9788538805373
[Show abstract][Hide abstract] ABSTRACT: Prostatic artery embolization requires a refined technique to achieve good imaging and clinical success. The PErFecTED (Proximal Embolization First, Then Embolize Distal) technique has produced greater prostate ischemia and infarction than previously described methods with clinical improvement of lower urinary symptoms and lower recurrence rates. The microcatheter should cross any collateral branch to the bladder, rectum, corpus cavernosum, gonad, or penis and be placed distally into the prostatic artery before its branching to the central gland and peripheral zone. This technique allows better distribution of embolic material in the intraprostatic arteries and reduces risk of spasm or thrombus. Because benign prostatic hyperplasia develops primarily in the periurethral region of the prostate, the urethral group of arteries should be embolized first. Subsequent distal investigation and embolization completes occlusion and stasis of blood flow to the prostatic parenchyma. Since we added the second step to the PErFecTED technique, we have observed infarcts in all patients submitted to prostatic artery embolization.
Cardiovascular and interventional radiology. 06/2014;
[Show abstract][Hide abstract] ABSTRACT: Prostatic artery embolization (PAE) is an alternative treatment for benign prostatic hyperplasia. Complications are primarily related to non-target embolization. We report a case of ischemic rectitis in a 76-year-old man with significant lower urinary tract symptoms due to benign prostatic hyperplasia, probably related to nontarget embolization. Magnetic resonance imaging revealed an 85.5-g prostate and urodynamic studies confirmed Inferior vesical obstruction. PAE was performed bilaterally. During the first 3 days of follow-up, a small amount of blood mixed in the stool was observed. Colonoscopy identified rectal ulcers at day 4, which had then disappeared by day 16 post PAE without treatment. PAE is a safe, effective procedure with a low complication rate, but interventionalists should be aware of the risk of rectal nontarget embolization.
CardioVascular and Interventional Radiology 10/2013; · 2.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: PURPOSE: Obstructive jaundice (OJ) is a cumbersome complication in late-stage malignancies, and percutaneous transhepatic biliary drainage (PTBD) is often used to relieve symptoms and allow chemotherapy (CT). METHODS: From July 2008 to August 2011, 71 patients (pts) with OJ due to solid malignancies underwent PTBD in our institution. Baseline characteristics, procedure complications, and outcomes were retrospectively collected. The primary objective was to estimate overall survival (OS) after PTBD. RESULTS: Median age was 60 years, 63 % had an ECOG performance status (PS) of 1-2, and 10 % were receiving supportive care (SC). Most had primary gastrointestinal tumors (89 %) and metastatic disease at diagnosis (59 %). Mean hospital stay was 16.6 days (2-90 days), with bilirubin value decreased (BVD) after 80 % of procedures. Cholangitis was observed in 66.2 % of pts and 60.6 % required readmissions. Only 51.6 % of pts not in SC were eligible for CT after PTBD. Median OS was 2.9 months (95 % CI 0.62-5.2). Prognostic factors on univariate analysis include ECOG ≤2 (6.8 versus 0.79 months, p < 0.0001), BVD (6.7 versus 0.33 months, p < 0.0001), and CT after PTBD (13.7 versus 1.2 months p < 0.0001). On multivariate analysis, CT after procedure was related to better OS (HR 0.15, CI 0.06-0.38, p < 0.001). CONCLUSIONS: Malignant OJ is a late event in cancer pts. Thorough evaluation is needed before determining eligibility to PTBD due to its high complication and hospitalization rates. In the current analysis, pts with PS >2 and who are not candidates for further CT had a dismal prognosis and should probably not be offered PTBD.
[Show abstract][Hide abstract] ABSTRACT: Como se sabe, os stents foram originalmente concebidos como condutos plásticos para obstrução maligna do trato biliar, evoluindo ao longo da prática para aplicações no ducto pancreático e muitas outras aplicações clínicas extrabiliares e pancreáticas: esôfago, estômago, duodeno, intestino delgado e cólon ...
Próteses Endoscópicas no Sistema Digestório, first edited by Everson Luiz de Almeida Artifon, Eduardo Guimarães Hourneaux de Moura, Paulo Sakai, 01/2012: chapter 14: pages 135-150; Atheneu., ISBN: 9788538802808
[Show abstract][Hide abstract] ABSTRACT: The introduction of the piggyback technique for reconstruction of the liver outflow in reduced-size liver transplants for pediatric patients has increased the incidence of hepatic venous outflow block (HVOB). Here, we proposed a new technique for hepatic venous reconstruction in pediatric living-donor liver transplantation.
Three techniques were used: direct anastomosis of the orifice of the donor hepatic veins and the orifice of the recipient hepatic veins (group 1); triangular anastomosis after creating a wide triangular orifice in the recipient inferior vena cava at the confluence of all the hepatic veins (group 2); and a new technique, which is a wide longitudinal anastomosis performed at the anterior wall of the inferior vena cava (group 3).
In groups 1 and 2, the incidences of HVOB were 27.7% and 5.7%, respectively. In group 3, no patient presented HVOB (P = .001). No difference was noted between groups 2 and 3.
Hepatic venous reconstruction in pediatric living-donor liver transplantation must be preferentially performed by using a wide longitudinal incision at the anterior wall of the recipient inferior vena cava. As an alternative technique, triangulation of the recipient inferior vena cava, including the orifices of the 3 hepatic veins, may be used.
Journal of Pediatric Surgery 07/2011; 46(7):1379-84. · 1.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to describe the preliminary results of prophylactic temporary balloon occlusion of the internal iliac arteries for bleeding control in patients with placenta accreta during cesarean hysterectomy.
From May 2006 to March 2010, 21 patients diagnosed with placenta accreta using ultrasound and/or magnetic resonance imaging were submitted to prophylactic balloon occlusion before hysterectomy. Fluoroscopy, balloon occlusion time, surgical duration, intraoperative blood loss, transfusion volume, and procedure complications were analyzed.
The mean age was 30.5 years with a mean of 3.6 previous gestations. Imaging studies revealed that all patients had placenta accreta and all were submitted to cesarean hysterectomy. One hysterectomy was due to previous diagnosis of fetal death and another due to cesarean with uterine curettage. Mean fluoroscopy time was 7.5 min, balloon occlusion time was 164 min, and surgery duration was 260 min. Estimated blood loss was 1,671.5 ml with mean reposition fluids of 3,538 ml of crystalloids, 309.5 ml of colloids, and 1.24 ml of packed red blood cells. Two patients were submitted to thromboembolectomy due to prolonged surgical time. There was no maternal or fetal mortality related to the procedure.
The results demonstrated that prophylactic balloon occlusion of internal iliac artery is a safe method and appears to reduce blood loss and transfusion requirements in patients diagnosed with placenta accreta who undergo cesarean hysterectomy. Antenatal imaging diagnosis of placenta accreta enables preoperative planning.
CardioVascular and Interventional Radiology 05/2011; 34(4):758-64. · 2.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The patency of vascular reconstructions is an important factor for the success of LT (1–3). Disproportion in the diameters of the donor and recipient vessels, tension, and graft torsion increases the risk of PV obstruction (3–5). The paucity of suitable hepatic allografts in the pediatric population led to the development of reduced-size LT, such as living-donor, split liver and reductions, which markedly decreased wait-ing time for an organ and improved patient survival (6, 7). But despite the advances in surgical techniques, controlling immune and infectious problems, incidence of complications related to anastomosis between small structures, especially in children, remains high (4). As the PV segment of the donor is relatively short or thin, interposition of grafts is used occasionally to reduce tension on the anastomosis and the incidence of peroperative PV thrombosis. How-ever, patients are prone to delayed stenoses, which are difficult to manage surgically (3, 8). PV stenosis is clinically characterized by signs and symptoms of portal hypertension, such as splenomegaly, ascites, anemia, and digestive hemorrhage, caused by gastroesophageal varices (9–11). PTA, with or without stent, has become a safe and efficient therapeutic modality and, in many cases, the first treatment option for vascular complications after LT (12–18). Surgical revision including PV reanastomosis, meso-Rex shunt, and retransplantation are other options (3, 5, 7). The published pediatric studies on PV stenoses have limited follow-up and with small number of patients (6, 9, 11, 15, 19–25). This paper aims to Carnevale FC, de Tarso Machado A, Moreira AM, dos Santos ACB, da Motta-Leal-Filho JM, Suzuki L, Cerri GG, Tannuri U. Long-term results of the percutaneous transhepatic venoplasty of portal vein stenoses after pediatric liver transplantation. Pediatr Transplantation 2011. Ó 2011 John Wiley & Sons A/S.
[Show abstract][Hide abstract] ABSTRACT: This paper has the objective to evaluate retrospectively the long-term results of transhepatic treatment of PV stenoses after pediatric LT. During an eight-yr period, 15 children with PV stenoses underwent PTA with balloon dilation or stent placement in case of PTA failure after LT. Patients' body weights ranged from 9.3 to 46kg (mean, 15.5kg). PV patency was evaluated in the balloon dilation and in the stent placement groups. Technical and clinical successes were achieved in all cases with no complication. Eleven patients (11/15; 73.3%) were successfully treated by single balloon dilation. Four patients (4/15; 26.7%) needed stent placement. One patient was submitted to stent placement during the same procedure because of PTA failure. The other three developed clinical signs of portal hypertension because of PV restenoses two, eight, and twenty-eight months after the first PTA. They had to be submitted to a new procedure with stent placement. The follow-up time ranged from 3 to 8.1 yr (mean, 6.3 yr). In conclusion, transhepatic treatment of PV stenoses after pediatric LT with balloon dilation or stent placement demonstrated to be a safe and effective treatment that results in long-term patency.
[Show abstract][Hide abstract] ABSTRACT: Portal vein thrombosis is a complication that occurs anytime after liver transplantation and can compromise the patient and graft survival. We describe a combined technique for PV recanalization in cases of PV obstruction after liver transplantation. Four children (1%), of 367 subjected to liver transplantation from June 1991 to December 2008, underwent PV recanalization through a combined approach (transhepatic and minilaparotomy). All children received left lateral hepatic segments, developed Portal vein thrombosis (n=3) and stenosis (n=1), and presented with symptoms of portal hypertension after transplantation. PV recanalization was tried by transhepatic retrograde access, and a minilaparotomy was performed when percutaneous recanalization was unsuccessful. Three patients underwent a successful portal recanalization and stent placement with the combined technique. In one patient, the recanalization was unsuccessful because of an extensive portomesenteric thrombosis. The other three children had the portal flow reestablished and followed with Doppler US studies. They received oral anticoagulation for three consecutive months after the procedure and the clinical symptoms subsided. In case of PV obstruction, the combined approach is technically feasible with good clinical and hemodynamic results. It' is a minimally invasive procedure and can be tried to avoid or delay surgical treatment or retransplantation.
[Show abstract][Hide abstract] ABSTRACT: Background: Percutaneous transhepatic venous access is an option for hemodialysis patients who have exhausted all traditional sites of venous access. Objectives: To present a small sample regarding the possibility and the functionality of transhepatic implantation of long-term catheters for hemodialysis in patients with no other possible access routes. Methods: Retrospective observational analysis was made of the charts of six patients in which nine tunneled dialysis catheters were implanted by the percutaneous transhepatic route. Transhepatic catheters were placed in the absence of an available peripheral venous site. Patients were monitored to evaluate technical success, the complication rate, the infection rate and the duration of catheter patency. Results: Four men and two women aged 31 to 85 years (mean age: 55 years). Technical success was 100%. The mean duration of catheter function was 300.5 days (range: 2 to 814 days). Means of primary and secondary patency were 179.60 and 328.33 days, respectively. The catheter thrombosis rate was 0.05 per 100 catheter-days as the infection rate. There were three early complications (within the first 30 days of catheter implantation): two catheter displacement and one infection. Two late complications were observed: one thrombosis and one migration. Three patients (50%) needed to have their catheters changed. The 30-day mortality rate was 33% but with no relation to the procedure. Conclusion: It may be suggested that this technique is safe, however transhepatic hemodialysis catheters may be used in patients with no other options for deep venous access for hemodialysis, albeit as a last resort access route. Resumo Contexto: Acesso venoso trans-hepático percutâneo para hemodiálise é uma opção para pacientes que já exauriram acessos venosos tradicionais. Objetivo: Apresentar uma série de casos que demonstram a factibilidade e a funcionalidade da implantação dos cateteres semi-implantáveis por meio de acesso venoso trans-hepático percutâneo em pacientes sem possibilidades de outros acessos. Métodos: Análise observacional retrospectiva dos prontuários de seis pacientes que foram submetidos à implantação de nove cateteres trans-hepáticos percutâneos para hemodiálise. Os cateteres foram implantados na ausência de acessos venosos periféricos disponíveis. No seguimento dos pacientes, procurou-se avaliar: sucesso técnico do procedimento, taxa de complicação, taxa de infecção e patência do acesso. Resultados: Quatro homens e duas mulheres com idades entre 31 e 85 anos (média: 55 anos). Sucesso técnico obtido em 100%. A média de duração dos cateteres foi de 300,5 dias (2 a 814 dias). Médias de patência primária e secundária foram de 179,60 e 328,33 dias, respectivamente. Taxa de trombose dos cateteres foi de 0,05 por 100 cateteres-dias, assim como a taxa de infecção. Houve três complicações precoces (30 primeiros dias de implantação dos cateteres): dois deslocamentos dos cateteres e uma infecção. Duas complicações tardias foram observadas: uma trombose e uma migração. Três pacientes (50%) tiveram que trocar seus cateteres. Taxa de mortalidade em 30 dias foi de 33%, porém não relacionada ao procedimento. Conclusão: Implantação do cateter para hemodiálise por meio do acesso venoso trans-hepático percutâneo parece ser uma técnica segura, porém a utilização desse acesso deve ser aplicada somente em casos de esgotamento de outros acessos vasculares profundos. Palavras-chave: Cateteres de demora; Cateterismo venoso central; Diálise; Radiologia intervencionista; Circulação hepática.
[Show abstract][Hide abstract] ABSTRACT: The incidence of intravascular embolization of venous catheters reported in the world medical literature corresponds to 1% of all the described complications. However, its mortality rate may vary between 24 to 60%. Catheter malfunction is the most likely signal of embolization, since patients are usually asymptomatic.
To report the method of removing intravascular foreign bodies, catheters with the use of various endovascular techniques and procedures.
This is a two-year retrospective study of 12 patients: seven women and five men. The average age was 29 years (ranging from two months to 65 years).
Technical performance was 100% successful. Ten port-a-caths, one intra-cath and one PICC were extracted. The most common sites for the lodging of one of the ends of the intravascular foreign bodies were the right atrium (41.6%) and the right ventricle (33.3%). In 100% of the cases, only one venous access was used for extraction of foreign bodies, and in 91.6% of the cases (11 catheters) the femoral access was used. The loop-snare was used in 10 cases (83.3%). The most common cause of intravascular foreign body insertion was a catheter fracture, which occurred in 66.6% of the cases (eight cases). One major complication, the atrial fibrillation, occurred (8.3%), which was related to the intravascular foreign body extraction. The mortality rate in 30 days was zero.
Percutaneous retrieval of intravascular foreign bodies is considered gold standard treatment because it is a minimally invasive, relatively simple, safe procedure, with low complication rates compared to conventional surgical treatment.
Brazilian Journal of Cardiovascular Surgery 06/2010; 25(2):202-8.
[Show abstract][Hide abstract] ABSTRACT: Attending physician, Vascular Interventional Radiology Service -InRad -ICHC-FMUSP/ InCor/ICESP. 2. Doctorage degree in Radiology by InRad -HC-FMUSP / Full Member, Brazilian Society of Interventional Radiology & Endovascular Surgery (SoBrice); Head, Vascular Interventional Radiology Service -InRad -ICHC-FMUSP/InCor/ICESP. 3. Doctorage degree in Radiology by InRad -HC-FMUSP / Full Member, Brazilian Society of Interventional Radiology & Endovascular Surgery (SoBrice); Attending Physician, Vascular Interventional Radiology Service -InRad -ICHC-FMUSP/InCor. 4. Vascular surgeon; Resident Physician, Vascular Interventional Radiology Service -InRad -ICHC-FMUSP/InCor/ICESP. 5. Vascular surgeon; Resident Physician, Vascular Interventional Radiology Service -InRad -ICHC-FMUSP/InCor/ICESP. 6. Full member, Brazilian Society of Interventional Radiology & Endovascular Surgery (SoBrice); Attending Physician, Vascular Interventional Radiology Service -InRad -ICHC-FMUSP/InCor. Táticas e técnicas endovasculares para retirada de corpos estranhos intravenosos Endovascular techniques and procedures, methods for removal of intravascular foreign bodies 7. Full member, Brazilian Society of Interventional Radiology & Endovascular Surgery (SoBrice); Attending Physician, Vascular Interventional Radiology Service -InRad -ICHC-FMUSP/InCor. 8. Doctorage degree in Radiology by InRad -HC-FMUSP / Full Member, Brazilian Society of Interventional Radiology & Endovascular Surgery (SoBrice); Attending Physician, Vascular Interventional Radiology Service -InRad -ICHC-FMUSP/InCor.
Brazilian Journal of Cardiovascular Surgery 01/2010; 25(2):202-208.
[Show abstract][Hide abstract] ABSTRACT: Symptomatic benign prostatic hyperplasia (BPH) typically occurs in the sixth and seventh decades, and the most frequent obstructive urinary symptoms are hesitancy, decreased urinary stream, sensation of incomplete emptying, nocturia, frequency, and urgency. Various medications, specifically 5-alpha-reductase inhibitors and selective alpha-blockers, can decrease the severity of the symptoms secondary to BPH, but prostatectomy is still considered to be the traditional method of management. We report the preliminary results for two patients with acute urinary retention due to BPH, successfully treated by prostate artery embolization (PAE). The patients were investigated using the International Prostate Symptom Score, by digital rectal examination, urodynamic testing, prostate biopsy, transrectal ultrasound (US), and magnetic resonance imaging (MRI). Uroflowmetry and postvoid residual urine volume complemented the investigation at 30, 90, and 180 days after PAE. The procedure was performed under local anesthesia; embolization of the prostate arteries was performed with a microcatheter and 300- to 500-microm microspheres using complete stasis as the end point. One patient was subjected to bilateral PAE and the other to unilateral PAE; they urinated spontaneously after removal of the urethral catheter, 15 and 10 days after the procedure, respectively. At 6-month follow-up, US and MRI revealed a prostate reduction of 39.7% and 47.8%, respectively, for the bilateral PAE and 25.5 and 27.8%, respectively, for the patient submitted to unilateral PAE. The early results, at 6-month follow-up, for the two patients with BPH show a promising potential alternative for treatment with PAE.
CardioVascular and Interventional Radiology 11/2009; 33(2):355-61. · 2.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to evaluate the mid- and long-term results of percutaneous transhepatic cholangiography (PTC) and biliary drainage in children with isolated bilioenteric anastomotic stenosis (BAS) after pediatric liver transplantation. Sixty-four children underwent PTC from March 1993 to May 2008. Nineteen cholangiograms were normal; 10 showed intrahepatic biliary stenosis and BAS, and 35 showed isolated BAS. Cadaveric grafts were used in 19 and living donor grafts in 16 patients. Four patients received a whole liver, and 31 patients received a left lobe or left lateral segment. Roux-en-Y hepaticojejunostomy was performed in all patients. Indication for PTC was based on clinical, laboratory, and histopathologic findings. In patients with isolated BAS, dilation and biliary catheter placement, with changes every 2 months, were performed. Patients were separated into 4 groups according to number of treatment sessions required. The drainage catheter was removed if cholangiogram showed no significant residual stenosis and normal biliary emptying time after a minimum of 6 months. The relationship between risk factors (recipient's weight <10 kg, previous exposure to Cytomegalovirus, donor-recipient sex and weight relations, autoimmune disease as indication for transplantion, previous Kasai's surgery, use of reduced liver grafts, chronic or acute rejection occurrence) and treatment was evaluated. Before PTC, fever was observed in 46%, biliary dilation in 23%, increased bilirubin in 57%, and increased gamma-glutamyltransferase (GGT) in 100% of patients. In the group with BAS, 24 of 35 (69%) patients had histopathologic findings of cholestasis as did 9 of 19 (47%) patients in the group with normal PTC. Of the 35 patients, 23 (65.7%) needed 1 (group I), 7 needed 2 (group II), 4 needed 3 (group III), and 1 needed 4 treatment sessions (group IV). The best results were observed after 1 treatment session, and the mean duration of catheter placement and replacement was 10 months. The primary patency rate was 61.2%, and the recurrence rate was 34.3% (group I). Seven patients (7 of 35; 20%) had their stricture treated with a second treatment session (group II). The average drainage time in group II was 24 months. During a period >20 months, 4 patients (4 of 35; 11.4%) required 1 additional treatment session (group III), and 1 patient (1 of 35; 2.9%) had a catheter placed at the end of the study period (group IV). Drainage time in group I was significantly shorter than those in groups II, III, and IV (p < 0.05). There was no statistically significant relation between therapeutic response and the selected risk factors (p > 0.05). The majority of complications, such as catheter displacement and leakage, were classified as minor; however, 2 patients (5.7%) with hemobilia were noted. Complications increased according to the need for reintervention. In conclusion, balloon dilation and percutaneous drainage placement is safe and effective, and it has long-term patency for children with BAS after liver transplantation. Because of prolonged treatment time, reintervention may be necessary, thereby increasing the complication rate. Balloon dilation and percutaneous drainage placement should be considered as the first treatment option because of its minimally invasive nature.
CardioVascular and Interventional Radiology 06/2009; 33(1):90-6. · 2.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Portal vein thrombosis (PVT) after orthotopic liver transplantation is an infrequent complication, and when it is present surgical treatment is considered for traditional management. Percutaneous transhepatic portal vein angioplasty has been described as an option to treat PVT with a lower morbidity than conventional surgical treatments. This article describes a case of chronic PVT in a child after a living donor liver transplantation managed by percutaneous transhepatic and surgical approaches.
CardioVascular and Interventional Radiology 05/2009; 32(5):1083-6. · 2.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate retrospectively the midterm and long-term results of percutaneous endovascular treatment of venous outflow obstruction after pediatric liver transplantation.
During a 9-year period, 18 children with obstruction of a hepatic vein (HV) or inferior vena cava (IVC) anastomosis underwent percutaneous transluminal angioplasty (PTA) with balloon dilation or stent placement in case of PTA failure after liver transplantation. Patients' body weights ranged from 7.7 kg to 42.6 kg (mean, 18.8 kg +/- 9). Potential predictors of patency were compared between balloon dilation and stent placement groups.
Forty-two procedures were performed (range, 1-11 per patient; mean, 2). Technical and initial clinical success were achieved in all cases. Major complications included one case of pulmonary artery stent embolization and one case of hemothorax. Three children (25%) with HV obstruction were treated with PTA and nine (75%) were treated with stent placement. Three children with IVC obstruction (75%) were treated with PTA and one (25%) was treated with a stent. There were two children with simultaneous obstruction at the HV and IVC; one was treated with PTA and the other with a stent. Cases of isolated HV stenosis have a higher probability of patency with balloon-expandable stent treatment compared with balloon dilation (P < .05). Follow-up time ranged from 7 days to 9 years (mean, 42 months +/- 31), and the primary assisted patency rate was 100% when stent placement was performed among the first three procedures.
In cases of venous outflow obstruction resulting from HV and/or IVC lesions after pediatric liver transplantation, percutaneous endovascular treatment with balloon dilation or stent placement is a safe and effective alternative treatment that results in long-term patency.
Journal of vascular and interventional radiology: JVIR 09/2008; 19(10):1439-48. · 1.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Orthotopic liver transplantation is the standard of care in patients with Budd-Chiari syndrome (BCS), and transjugular intrahepatic portosystemic shunt (TIPS) has become an important adjunct procedure while the patient is waiting for a liver. No long-term follow up of TIPS in BCS patients has been published in children. We report successful 10-year follow-up of a child with BCS and iatrogenic TIPS dysfunction caused by oral contraceptive use.
CardioVascular and Interventional Radiology 09/2008; 31(6):1244-8. · 2.09 Impact Factor