Hepatic artery pseudoaneurysm is a rare complication of liver directed procedures. Several strategies for treatment of pseudoaneurysms have been described. We describe a challenging case in which a small bleeding hepa...Hepatic artery pseudoaneurysm is a rare complication of liver directed procedures. Several strategies for treatment of pseudoaneurysms have been described. We describe a challenging case in which a small bleeding hepatic artery pseudoaneurysm is complicated by a proximal hepatic arterial occlusion, preventing transcatheter access. The aneurysm was too small to be seen on ultrasound. Using combined angiographic and fluoroscopic guidance, however, the aneurysm was triangulated and successfully treated with percutaneous direct thrombin injection. Combined angiography and fluoroscopy guided percutaneous thrombin injection of intrahepatic pseudoaneurysms can be a valuable treatment approach, particularly when other methods are not feasible or have failed.展开更多
Objective To evaluate the toxic response to intrahepatic arterial admin istration of radioactive phosphorus32 glass microspheres (32 P GMS) in domestic pigs Methods Through selective catheterization of hepatic artery...Objective To evaluate the toxic response to intrahepatic arterial admin istration of radioactive phosphorus32 glass microspheres (32 P GMS) in domestic pigs Methods Through selective catheterization of hepatic artery,32P GMS was infused to 5 healthy domestic pigs in a dosage equivalent to the thera peutic dose for human being, and31PGMS was infused to other 5 healthy domestic pigs Two pigs se rved as the whole course blank controls One pig from each group was surrendere d to euthanasia at week 1, 2, 4, 8 and 16, respectively, and liver biopsies were performed on the rest of pigs at the corresponding time points Liver tissues f r om different sites were taken for light and electron microscopy The ultrastruc t ural histopathological changes were evaluated semiquantitatively Results The accumulative amount of32PGMS in the target tissue attained more th an 90% of the total dose administrated Histologically, abnormal hepatocytes we re easily found at week 1 or 2 At week 4 they were less than at week 1 or 2, a n d endothelium of the sinuses were damaged prominently At week 8 they were scar cely seen, and liver tissue recovered gradually The histological features of l i ver tissue restored to normal at week 16 Semiquantitative analysis of ultrastr u ctural morphology in the experimental group showed no statistical difference ( P >050) between the nuclear abnormality (Nabn) and mitochrondri a l variability (Mvar) at week 1 or 2, but revealed prominent difference ( P <001, P <0001) as compared with those in other groups I n the experimental group the Nabn in tissues showed no significant differe nce ( P >020) between week 8 and week 16 Conclusion 32 PGMS internal irradiation at the dosag e equiva lent to human therapeutic dosage exerts reversible injury to domestic pig liver tissue, and it takes more than 8 weeks for the injured liver tissue to recover展开更多
Background The main therapeutic treatments for hepatic artery complications after orthotopic liver transplantation （OLT） include thrombolysis, percutaneous transluminal angioplasty, stent placement, and liver retran...Background The main therapeutic treatments for hepatic artery complications after orthotopic liver transplantation （OLT） include thrombolysis, percutaneous transluminal angioplasty, stent placement, and liver retransplantation. The prognosis of hepatic artery complications after OLT is not only related to the type, extent, and timing but also closely associated with the selection and timing of the therapeutic methods. However, there is no consensus of opinion regarding the treatment of these complications. The aim of this study was to determine optimal treatment for hepatic artery complications after OLT. Methods The clinical data of 25 patients diagnosed with hepatic artery thrombosis （HAT） and hepatic artery stenosis （HAS） between October 2003 and March 2007 were retrospectively reviewed. Treatments included liver retransplantation and interventions which contain thrombolysis, percutaneous transluminal angioplasty and stent placement. Results Among five patients with HAT, 3 were treated with thrombolysis. One recovered, one died after thrombolysis and another one died of multi-organ failure after retransplantation because of recurrent HAT. The remaining 2 patients underwent successful retransplantation and have survived after that. Among 12 patients presented with HAS within 1 month postoperatively, 2 patients underwent retransplantation due to irreversible liver failure and another 10 patients were treated with interventions. The liver function failed to improve in 3 patients and retransplantations were performed in 4 patients after stent placement because of ischemic cholangitis. Among 6 patients undergoing liver retransplantations, two died of intracranial hemorrhage and infection respectively. Eight patients presented with HAS after 1 month postoperatively, 5 patients were treated with interventional management and recovered after stent placement. Among another 3 patients presented with HAS, 2 patients’ liver function was stable and one patient received late liver retransplantation due to ischemic bile duct lesion. Conclusions Individualized therapeutic regimens should be adopted in treating hepatic artery complications after OLT, according to postoperative periods, types and whether ischemic bile duct lesion exists or not. Liver retransplantation is the best treatment for patients with hepatic artery thrombosis. Interventional treatments of late HAS without irreversible liver failure or bile duct ischemia are appropriate, whereas retransplantation is recommended for early HAS.展开更多
文摘Hepatic artery pseudoaneurysm is a rare complication of liver directed procedures. Several strategies for treatment of pseudoaneurysms have been described. We describe a challenging case in which a small bleeding hepatic artery pseudoaneurysm is complicated by a proximal hepatic arterial occlusion, preventing transcatheter access. The aneurysm was too small to be seen on ultrasound. Using combined angiographic and fluoroscopic guidance, however, the aneurysm was triangulated and successfully treated with percutaneous direct thrombin injection. Combined angiography and fluoroscopy guided percutaneous thrombin injection of intrahepatic pseudoaneurysms can be a valuable treatment approach, particularly when other methods are not feasible or have failed.
文摘Objective To evaluate the toxic response to intrahepatic arterial admin istration of radioactive phosphorus32 glass microspheres (32 P GMS) in domestic pigs Methods Through selective catheterization of hepatic artery,32P GMS was infused to 5 healthy domestic pigs in a dosage equivalent to the thera peutic dose for human being, and31PGMS was infused to other 5 healthy domestic pigs Two pigs se rved as the whole course blank controls One pig from each group was surrendere d to euthanasia at week 1, 2, 4, 8 and 16, respectively, and liver biopsies were performed on the rest of pigs at the corresponding time points Liver tissues f r om different sites were taken for light and electron microscopy The ultrastruc t ural histopathological changes were evaluated semiquantitatively Results The accumulative amount of32PGMS in the target tissue attained more th an 90% of the total dose administrated Histologically, abnormal hepatocytes we re easily found at week 1 or 2 At week 4 they were less than at week 1 or 2, a n d endothelium of the sinuses were damaged prominently At week 8 they were scar cely seen, and liver tissue recovered gradually The histological features of l i ver tissue restored to normal at week 16 Semiquantitative analysis of ultrastr u ctural morphology in the experimental group showed no statistical difference ( P >050) between the nuclear abnormality (Nabn) and mitochrondri a l variability (Mvar) at week 1 or 2, but revealed prominent difference ( P <001, P <0001) as compared with those in other groups I n the experimental group the Nabn in tissues showed no significant differe nce ( P >020) between week 8 and week 16 Conclusion 32 PGMS internal irradiation at the dosag e equiva lent to human therapeutic dosage exerts reversible injury to domestic pig liver tissue, and it takes more than 8 weeks for the injured liver tissue to recover
基金This study was supported by grants from the Major State Basic Research Development Program （973 Program） of China （No. 2003CB515500）, the National Natural Science Foundation of China （No. 30571769 and No. 30772044）, Sci-tech Research Development Program of Guangdong Province （No. 2007A032000001 and No. 2007B060401033）, and the Teamwork Projects Funded by Guangdong Natural Science Foundation （No. 05200177）.
文摘Background The main therapeutic treatments for hepatic artery complications after orthotopic liver transplantation （OLT） include thrombolysis, percutaneous transluminal angioplasty, stent placement, and liver retransplantation. The prognosis of hepatic artery complications after OLT is not only related to the type, extent, and timing but also closely associated with the selection and timing of the therapeutic methods. However, there is no consensus of opinion regarding the treatment of these complications. The aim of this study was to determine optimal treatment for hepatic artery complications after OLT. Methods The clinical data of 25 patients diagnosed with hepatic artery thrombosis （HAT） and hepatic artery stenosis （HAS） between October 2003 and March 2007 were retrospectively reviewed. Treatments included liver retransplantation and interventions which contain thrombolysis, percutaneous transluminal angioplasty and stent placement. Results Among five patients with HAT, 3 were treated with thrombolysis. One recovered, one died after thrombolysis and another one died of multi-organ failure after retransplantation because of recurrent HAT. The remaining 2 patients underwent successful retransplantation and have survived after that. Among 12 patients presented with HAS within 1 month postoperatively, 2 patients underwent retransplantation due to irreversible liver failure and another 10 patients were treated with interventions. The liver function failed to improve in 3 patients and retransplantations were performed in 4 patients after stent placement because of ischemic cholangitis. Among 6 patients undergoing liver retransplantations, two died of intracranial hemorrhage and infection respectively. Eight patients presented with HAS after 1 month postoperatively, 5 patients were treated with interventional management and recovered after stent placement. Among another 3 patients presented with HAS, 2 patients’ liver function was stable and one patient received late liver retransplantation due to ischemic bile duct lesion. Conclusions Individualized therapeutic regimens should be adopted in treating hepatic artery complications after OLT, according to postoperative periods, types and whether ischemic bile duct lesion exists or not. Liver retransplantation is the best treatment for patients with hepatic artery thrombosis. Interventional treatments of late HAS without irreversible liver failure or bile duct ischemia are appropriate, whereas retransplantation is recommended for early HAS.
