Quiroga S, Sebastia MC, Margarit C, Castells L, Boye R, Alvarez-Castells A.

Department of Radiology and Institut de Diagnostic per la Imatge, Hospital General Universitari Vall d\'Hebron, Passeig Vall d\'Hebron 119-129, 08035 Barcelona, Spain. squiroga@hg.vhebron.es

Orthotopic liver transplantation has become the treatment of choice for patients with end-stage nonmalignant liver disease. The surgical techniques and immunosuppressive therapy for this procedure have improved considerably. Nevertheless, there are still significant complications, particularly those of vascular origin, which can lead to graft failure and require retransplantation unless prompt treatment is instituted. These complications include arterial and venous thrombosis and stenosis; arterial pseudoaneurysm; biliary leakage, stricture, and obstruction; liver ischemia, infarction, and abscess; fluid collections and hematomas; lymphoproliferative disorders; recurrent tumors; hepatitis C virus infection; and splenic infarction. Since the clinical presentation of posttransplantation complications is frequently nonspecific and varies widely, imaging studies are critical for early diagnosis. Helical computed tomography (CT) is a valuable complement to ultrasonography (US) in the postoperative period and is a safe, accurate, and noninvasive method of demonstrating hepatic vessels (hepatic artery, portal vein, hepatic veins, and inferior vena cava) and evaluating nonvascular complications (in the hepatic parenchyma and bile duct abnormalities) and extrahepatic tissues. Knowledge and early recognition of these complications is essential for graft salvage, and CT can provide valuable information, particularly for patients with indeterminate US results or in whom US examination is difficult.

PMID: 11553818 [PubMed - in process]

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2: Indian J Gastroenterol 2001 Jul-Aug;20(4):151-4 Related Articles, Books  

Management of the Budd-Chiari syndrome by balloon cavoplasty.

De BK, Biswas PK, Sen S, Das D, De KK, Das U, Mandal SK, Majumdar D.

Department of Medicine, Institute of Postgraduate Medical Education and Research, Kolkata. binaykde@apexmail.com

BACKGROUND: Obstruction of the suprahepatic inferior vena cava (IVC) by a membrane or stricture is the commonest cause of Budd-Chiari syndrome in the eastern hemisphere. We present our experience with the outcome of balloon cavoplasty in such cases. METHODS: We followed up 40 consecutive cases of Budd-Chiari syndrome over seven years. Doppler study of hepatic venous outflow tract (in all cases), liver biopsy (30 cases) and necropsy (two cases) were performed. Balloon cavoplasty was done in selected cases. RESULTS: Of 40 patients with BCS (mean age 35.2 [SD 8.7] years; 26 men) 5, 5 and 30 had fulminant, acute and chronic presentation, respectively. Inferior vena cavography was performed in 32 cases, and showed membranous obstruction of the IVC in 12, segmental occlusion of the IVC in 11 cases, and block in both the IVC and the main hepatic veins in the rest. Successful balloon cavoplasty was done in 18 cases with obstruction of the IVC (membrane or stricture); 15 of them are well over a mean follow up of 56 (14.6) months. Three patients developed restenosis; two of them, treated with redilatation, are doing well, and one died of septicemia and hepatic failure following a surgical bypass. Pressure gradient between the IVC and right atrium decreased significantly after cavoplasty (15.4 [2.8] vs 6.6 [2.0] mmHg; p< 0.001). CONCLUSION: Balloon cavoplasty gave encouraging results in the management of Budd-Chiari syndrome due to membranous obstruction or stricture of the IVC.

PMID: 11497174 [PubMed - indexed for MEDLINE]

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3: J Assoc Physicians India 2000 Aug;48(8):800-3 Related Articles, Books, LinkOut  

Etiology based prevalence of Budd-Chiari syndrome in eastern India.

De BK, De KK, Sen S, Biswas PK, Das TK, Das S, Hazra B.

Department of Medicine and Cardiology, Institute of Post Graduate Medical Education and Research, 244, Acharya JC Bose Road, Calcutta 700 020.

BACKGROUND: Diagnosis of Budd-Chiari syndrome (BCS) is often missed unless its possibility has been kept in mind. Obstruction of inferior vena cava (IVC) is reportedly the most frequent cause of BCS in Afro-Asian variety. AIM: An attempt was made to classify BCS (in an eastern Indian population) etiopathologically. PATIENTS AND METHODS: Thirty consecutive cases of BCS presenting over a period of five years were included. Following a thorough physical examination, necessary investigations (including coagulation profile, ultrasonography (with Doppler study) of hepatobiliary tract, hepatic vein and IVC angiography (n = 22) and liver biopsy (n = 26, including autopsy in two cases) were performed. RESULTS: Mean age at presentation was 32.7 +/- 10.36 years (range 12-60 years) with M:F = 21:9. Clinical presentations included, hepatomegaly in 28 (93.3%), ascites in 27 (90%), splenomegaly in 15 (50%), pain in abdomen in 26 (86.6%), jaundice in 10 (33.3%), back veins in 20 (66.6%) and gastrointestinal bleeding in three (10%) cases. Amongst the total of 30 patients, four, six and 20 cases presented as fulminant, acute and chronic BCS respectively. Twenty four cases of BCS could be diagnosed by ultrasonography alone, while the remainder required angiography for diagnosis. IVC and hepatic vein angiography revealed membranous obstruction in nine, partial stricture of IVC in six, and IVC and/or hepatic vein block in others. The etiopathological nature in 30 cases were as follows: idiopathic membranous obstruction in nine (30%), hepatocellular carcinoma in six (20%), idiopathic stricture in six (20%) cases and one case (3.3%) each of the following: cholangiocarcinoma, renal cell carcinoma, chronic pancreatitis, hydatid cyst in liver, protein S deficiency, oral contraceptive use, nephrotic syndrome (with antithrombin III deficiency), polycythemia rubra vera and chronic lymphatic leukemia. CONCLUSION: Idiopathic membranous obstruction and stricture of IVC are the commonest cause of BCS in the eastern part of India. Hepatocellular carcinoma is also a common cause, presenting in the fulminant form. Ultrasonography may be a helpful screening test for BCS, but IVC and hepatic vein catheterisation is essential for a complete work up of these patients.

PMID: 11273472 [PubMed - indexed for MEDLINE]

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4: J Am Coll Surg 2000 Aug;191(2):164-74 Related Articles, Books, LinkOut  

Focal hepatic ablation using interstitial photon radiation energy.

Koniaris LG, Chan DY, Magee C, Solomon SB, Anderson JH, Smith DO, De Weese T, Kavoussi LR, Choti MA.

Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

BACKGROUND: Intratumoral ablative therapy is being used increasingly for the treatment of primary and secondary hepatic malignancies. The interstitial point-source photon radiosurgery system (PRS) is a novel ablative technique that uses radiation therapy similar in dosimetry to interstitial brachytherapy. STUDY DESIGN: To determine the feasibility, toxicity, and local tissue destructive capabilities of the PRS in the liver, preliminary studies in a nontumor-bearing canine model were examined. A 6-month survival study was conducted. Each animal received three radiation treatments, in the right, central, and left hepatic regions. Three low-dose treatments were delivered to each of six animals (group A), generating a 2.0-cm-diameter radiated sphere with a dose of 20 Gy at the lesion edge. Three high-dose treatments were delivered to each of six animals (group B), generating a 3.0-cm-diameter radiated sphere with 20 Gy at the lesion edge. RESULTS: The treatment reproducibly generated sharply demarcated hepatic ablative lesions proportional to the administered dose. Mean lesion diameter at 1 month was 1.6+/-0.2 cm in group A and 3.4+/-1.0 cm in group B. Lesion size was independent of intrahepatic location, including near vascular structures. PRS therapy, when applied to portal structures, resulted in hilar damage. Hilar damage appeared to be associated with arteriolar thrombosis and bile duct injury. Treatment of regions adjacent to large hepatic veins and the IVC was not associated with vessel thrombosis or stricture. CONCLUSIONS: PRS ablation is a generally well-tolerated method that results in consistent, well-demarcated, symmetric lesions of complete necrosis with minimal adjacent parenchymal injury. Application of such an approach for the treatment of liver tumors is promising.

PMID: 10945360 [PubMed - indexed for MEDLINE]

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5: J Pediatr Surg 1999 Nov;34(11):1721-4 Related Articles, Books, LinkOut  

Liver transplantation in infants.

Saing H, Fan ST, Chan KL, Lo CM, Wei WI, Tsoi NS, Yuen KY, Ng IL, Chau MT, Tso WK, Chan JK, Wong J.

Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong.

PURPOSE: In view of the earlier reports that children below 1 year of age constitute a high-risk group for liver transplantation, the authors reviewed their experience in performing orthotopic liver transplantation in this age group. METHODS: The records of 9 children aged less than 1 year who underwent 6 living-related liver transplants and 3 reduced-size liver transplants between December 1993 and June 1997 were reviewed. RESULTS: Five reexplorations were required for 3 children who had 1 or more of the following early complications: bleeding from hepatic vein to inferior vena cava anastomosis (n = 1), right hepatic vein stump bleeding (n = 1), intraabdominal hematoma (n = 2), jejuno-jejunostomy leakage (n = 1), and colonic perforation (n = 1). Late complications include stricture at the biliary-enteric anastomosis requiring percutaneous balloon dilatation (n = 3) and hepatitis of undetermined etiology requiring retransplantation (n = 1). There was no hepatic artery thrombosis despite the small arteries available for anastomosis. Follow-up ranged from 19 to 61 months (mean, 40 months). Patient survival rate was 100%, and graft survival with good liver function was 89%. All living donors, 2 fathers and 4 mothers, are well. CONCLUSIONS: Liver transplantation in infants less than 1 year of age is technically demanding but feasible and still can be performed with a good outcome. Age alone (under 1 year) should not be considered as a contraindication for liver transplantation.

PMID: 10591579 [PubMed - indexed for MEDLINE]

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6: Hepatogastroenterology 1999 Mar-Apr;46(26):855-8 Related Articles, Books, LinkOut  

Glutaraldehyde-fixed heterologous pericardium for vena cava grafting following hepatectomy.

Ohwada S, Watanuki F, Nakamura S, Kawashima Y, Nakagami K, Ogawa T, Ohya T, Kawashima K, Takeyoshi I, Yokoe T, Morishita Y.

Second Department of Surgery, Gunma University School of Medicine, Japan. sohwada@sb.gunma-u.ac.jp

BACKGROUND/AIMS: Glutaraldehyde-fixed heterologous pericardium has been widely used for grafts in cardiac surgery. We applied it for inferior vena cava (IVC) patch grafting following combined resection of the liver and the IVC. METHODOLOGY: IVC grafting using a glutaraldehyde-fixed horse pericardium following combined resection of the liver and the IVC was performed in 2 patients--one with hepatocellular carcinoma and the other with hepatic metastasis following rectal cancer. The retrohepatic vena cava defect was closed with a 10 x 5 cm patch in one patient and a 7 x 4 cm patch in the other. RESULTS: Hepatic vascular exclusion was avoided in both patients. The IVC exclusion period was 40 min for the first patient and 25 min for the second. One patient required a veno-venous bypass with an active centrifugal pump of 153 min. There was no complication and no graft infection. The microscopic extension to the IVC was evident in one patient, and fibrous adhesive was evident in the IVC wall of the other. One patient died of hepatic failure 3 years and 6 months after surgery, and the other died of hepatic recurrence 7 months after surgery. Both grafts were patent, without calcification and stricture, until the patients\' death. CONCLUSIONS: Glutaraldehyde-fixed heterologous pericardium is an option for IVC grafting.

PMID: 10370626 [PubMed - indexed for MEDLINE]

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7: Dig Dis Sci 1999 Mar;44(3):582-9 Related Articles, Books, LinkOut  

Surgical correction of patent ductus venosus in three brothers.

Ikeda S, Yamaguchi Y, Sera Y, Ohshiro H, Uchino S, Ogawa M.

Department of Pediatric Surgery, Kumamoto University Medical School, Japan.

We report the presence of a patent ductus venosus in three brothers who underwent surgical correction. Patent ductus venosus was demonstrated by ultrasonography. Portosystemic venous shunt ratios as evaluated by [123I]iodoamphetamine per rectal portal scintigraphy were 67%, 50%, and 77%, respectively. Histologic examination of liver biopsy specimens revealed fatty degeneration in all cases. Portal vein pressure before and after temporarily occluding the patent ductus venosus was estimated by an Anthron P-U catheter introduced into the portal vein via the ligament teres hepatis. Portal venous pressure increased from 10 to 17 cm H2O, 16 to 23 cm H2O, and 14 to 27 cm H2O, respectively. Therefore, banding of the ductus venosus with Teflon tape was attempted to prevent portal hypertension following complete ligation. As a result, portal venous pressures after stricture of the ductus venosus were 12, 21, and 20 cm H2), respectively. Bile acid and liver enzymes decreased and returned to normal within 14 days after surgery. Interestingly, serum concentrations of hepatocyte growth factor (HGF) increased significantly after restoration of the portal blood flow and then gradually decreased, but remained persistently elevated for at least two weeks in two cases measured after surgical correction. One month after correction, liver function returned to normal as assessed by serological and histological parameters in all cases. These results suggest that it is important to determine whether stricture or complete ligation is indicated for a patent ductus venosus during surgical correction, based on the portal venous pressure after temporal test occlusion of the duct. In addition, HGF may be a useful marker for normalization of hepatic microcirculation after surgery.

PMID: 10080154 [PubMed - indexed for MEDLINE]

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8: Eur J Surg Oncol 1998 Aug;24(4):292-7 Related Articles, Books, LinkOut  

Vascular interventions during post-chemotherapy retroperitoneal lymph-node dissection for metastatic testis cancer.

Christmas TJ, Smith GL, Kooner R.

Department of Urology, Charing Cross Hospital, London. UK.

AIMS: Complete excision of nodal masses during post-chemotherapy retroperitoneal lymph-node dissection (RPLND) for metastatic non-seminomatous germ-cell tumours (NSGCT) of the testis often requires vascular surgical intervention. We report our experience of vascular interventions and complications in a large series of men undergoing postchemotherapy RPLND. METHODS: A retrospective review of vascular interventions during post-chemotherapy RPLND in 98 patients was undertaken (103 procedures). RESULTS: Macroscopic tumour clearance was complete in 95/98 men (97%). Vascular intervention was required in all cases. Major complications included acute tubular necrosis in one patient who had undergone left nephrectomy and extensive dissection around the right renal artery, progressive atrophy of the ipsilateral kidney in three men and a colonic stricture and associated colocutaneous fistula in one patient after division of the inferior mesenteric artery. Iliac and femoral venous thrombosis developed in both patients in whom the inferior vena cava (IVC) was excised and in one patient after partial IVC excision. Eight of the 98 patients have died. No late vascular complications have occurred to date. CONCLUSION: Complete tumour clearance can be achieved in most post-chemotherapy RPLNDs but invariably involves vascular intervention. Metastatic NSGCT should be treated by surgeons with the ability to undertake the vascular procedures required.

PMID: 9724996 [PubMed - indexed for MEDLINE]

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9: J Urol 1998 Sep;160(3 Pt 2):1212-5 Related Articles, Books, LinkOut  

Surgical complications of pediatric kidney transplantation: a single center experience with the extraperitoneal technique.

Tanabe K, Takahashi K, Kawaguchi H, Ito K, Yamazaki Y, Toma H.

Department of Urology and Pediatric Nephrology, Kidney Center, Tokyo Women\'s Medical College, Japan.

PURPOSE: The complex nature of pediatric renal transplantation and the often fragile condition of children with end stage renal disease create the potential for a number of complications. To decrease surgical complications we have performed renal transplantation via the extraperitoneal approach at our institution even in children who weigh less than 20 kg. We retrospectively evaluated whether renal transplantation via the extraperitoneal approach decreases surgical complications in pediatric kidney transplant recipients. MATERIALS AND METHODS: From February 1983 to December 1996, 1,115 patients underwent renal transplantation at our institution, including 60 boys and 47 girls with a mean age of 11.9 years who comprise the study group. Mean weight was 30 kg. at transplantation, and 32 and 75 patients weighed less than 20 and 20 or more kg., respectively. All 107 patients were treated with cyclosporine or tacrolimus based immunosuppression, including methylprednisolone and azathioprine or mizoribine. Living related and cadaveric renal transplantation was performed in 92 and 15 cases, respectively. The extraperitoneal technique was performed in all recipients, even in low weight children. The aorta and inferior vena cava, common iliac artery and vein or hypogastric artery and external vein were used for vascular anastomosis depending on recipient size. The ureter was anastomosed to the bladder via a modification of Paquin\'s method or an extravesical technique. RESULTS: During observation 7 surgical complications (6.5%) developed, including ureteral stricture, ureteral necrosis, renal artery stenosis, lymphocele, subcapsular hematoma, bladder leakage and significant vesicoureteral reflux to the graft in 1 patient each. There were no gastrointestinal complications. One patient with ureteral necrosis and 1 with subcapsular hematoma required surgical repair, and 1 underwent laparoscopic fenestration of a lymphocele. One patient with ureteral stricture and 1 with bladder leakage were treated conservatively, while another underwent ureteroneocystostomy. Overall only 1 graft (1%) was lost to a surgical complication (renal artery stenosis). CONCLUSIONS: The incidence of surgical complications of the extraperitoneal technique in pediatric renal transplant patients was low (6.5%) and seems to be acceptable. The extraperitoneal technique did not cause any gastrointestinal complications, which seems to be its greatest advantage. The extraperitoneal technique may be used safely even in low weight children.

PMID: 9719313 [PubMed - indexed for MEDLINE]

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10: J Thorac Cardiovasc Surg 1997 Dec;114(6):1020-30; discussion 1030-1 Related Articles, Books, LinkOut  

Extracardiac Fontan operation for complex cardiac anomalies: seven years\' experience.

Amodeo A, Galletti L, Marianeschi S, Picardo S, Giannico S, Di Renzi P, Marcelletti C.

Dipartimento Medico-Chirurgico di Cardiologia Pediatrica, Ospedale Bambino Gesu, Rome, Italy.

METHODS: Between 1988 and 1995, 60 patients with complex cardiac anomalies underwent a total extracardiac cavopulmonary connection, a combination of a bidirectional cavopulmonary anastomosis with an extracardiac conduit interposition between the inferior vena cava and pulmonary arteries, except in one patient in whom direct anastomosis was possible. In 40 patients the total extracardiac cavopulmonary connection followed preliminary bidirectional cavopulmonary anastomosis, associated with a modified Damus-Kaye-Stansel anastomosis in 16. The conduits were constructed of Dacron fabric (n = 34), homografts (n = 3), and polytetrafluoroethylene (n = 22). RESULTS: Total early failure rate was 15% (n = 9). Six patients died, and three more had conduit takedown owing to pulmonary artery stenosis and hypoplasia (n = 2) and severe atrioventricular valve regurgitation (n = 1). Two other patients required anastomosis revision owing to stricture. In a mean follow-up of 48 months (6 to 86 months) there were no late deaths (actuarial 5-year survival 88% +/- 4%); 52 of 54 patients are in New York Heart Association class I or II. Two patients required pulmonary artery balloon dilation or stent implantation, or both, after total extracardiac cavopulmonary connection. Late tachyarrhythmias were detected in four of 54 patients: two had sick sinus syndrome with flutter necessitating a pacemaker implantation and two had recurrent flutter (actuarial 5-year arrhythmia-free rate 92% +/- 4%). Conduit patency was evaluated by serial magnetic resonance imaging studies. Preliminary data showed a 17.8% +/- 7.6% mean reduction in conduit internal diameter during the first 6 months after total extracardiac cavopulmonary connection, with no progression over the next 5 years. CONCLUSION: These results demonstrate that the total extracardiac cavopulmonary connection provides good early and midterm results and may reduce the prevalence of late arrhythmias in patients undergoing the Fontan operation.

PMID: 9434697 [PubMed - indexed for MEDLINE]

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11: Radiographics 1996 Jul;16(4):825-40 Related Articles, Books, LinkOut  

Imaging of complications in liver transplantation.

Nghiem HV, Tran K, Winter TC 3rd, Schmiedl UP, Althaus SJ, Patel NH, Freeny PC.

University of Washington, Department of Radiology, Seattle 98195, USA.

Hepatic transplantations are being performed with increasing frequency, leading to greater demand for accurate evaluation of related complications. Ultrasonography (US) is the primary screening technique for detection of vascular complications of hepatic transplantation: angiography is used to confirm the US findings or when the US study is suboptimal. Hepatic artery thrombosis, the most common (as high as 42% of pediatric cases; 4%-12% of adult cases) and important vascular complication, may be associated with bilomas, infarcts, or abscesses at gray-scale US and absence of proper hepatic and intrahepatic arterial flow at Doppler analysis. Hepatic artery stenosis (seen in 11% of cases) is suspected if a focal accelerated velocity of greater than 2-3 m/sec with turbulence is seen at or distal to the stenosis or if a tardus parvus pattern of intrahepatic arterial flow is seen. In cases of inferior vena cava thrombosis and stenosis, US may show echogenic thrombus or obvious narrowing, with a substantially increased flow velocity through the stenosis or reversal of flow in the hepatic veins. Biliary complications occur relatively often (13%-25% of cases) after liver transplantation; bile leakage and biliary stricture, the most common biliary complications, are seen as a fluid collection and a stricture, respectively. Although acute rejection is one of the most serious complications affecting graft survival, it cannot be reliably detected with available diagnostic tests or radiologic methods.

PMID: 8835974 [PubMed - indexed for MEDLINE]

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12: Cardiovasc Intervent Radiol 1994 Nov-Dec;17(6):336-8 Related Articles, Books  

Postlaminectomy arteriovenous fistula masked by stenosis of the inferior vena cava.

Johnsrude IS, Bogey WM Jr, Tripp MD.

Cardiovascular and Interventional Radiology, East Carolina University School of Medicine, Greenville, NC 27834.

Discovery of a postlumbosacral discectomy fistula between the right iliac artery and vein was obscured by an associated severe stricture of the infrarenal inferior vena cava in a 49-year-old man. During venous stenting for treatment of peripheral edema, the fistula was suspected because of faint pulsatile right iliac vein flow and increased O2 saturation of the venous blood. The suspicion was confirmed on subsequent iliac arteriography. Surgical closure of the fistula with arterial interposition grafting was then performed. The patient improved substantially.

PMID: 7882402 [PubMed - indexed for MEDLINE]

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13: Cardiovasc Intervent Radiol 1992 Sep-Oct;15(5):328-33 Related Articles, Books  

Gianturco self-expanding stents: clinical experience in the vena cava and large veins.

Irving JD, Dondelinger RF, Reidy JF, Schild H, Dick R, Adam A, Maynar M, Zollikofer CL.

Department of Radiology, Centre Hospitalier, Luxembourg, England.

Twenty-five patients with stenosis of the vena cava (21) and other large veins (4) have been treated with self-expanding Gianturco metallic stents. Eighteen patients had superior vena cava syndrome. In 17, the stricture was due to malignant superior vena cava compression recurrent after maximum tolerance radiotherapy and/or chemotherapy. In 16 of these patients there was early symptomatic relief. In 1 patient with a benign posttraumatic superior vena cava stricture, the stenosis was not relieved, and occlusion occurred after 1 month. Stenoses associated with dialysis shunts were relieved in 2 other patients. Two malignant and one benign inferior vena cava stenoses were relieved either until death, or in the benign case, for 30 months. One malignant subclavian vein obstruction occluded after 24 h due to stent misplacement and another with extrinsic mediastinal compression remained patent until death, extensive thrombus having been lysed prior to stent placement. The results of this short series suggest that the Gianturco self-expanding stent in the vena cava and large veins is easy and safe to place, and in most cases produces almost immediate palliation of the distressing effects of venous obstruction, often in a preterminal and inoperable patient.

Publication Types:

Multicenter study

PMID: 1423394 [PubMed - indexed for MEDLINE]

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14: Zhonghua Wai Ke Za Zhi 1990 Dec;28(12):760-3, 783-4 Related Articles, Books  

[Diagnosis and treatment of membraneous obstruction of the inferior vena cava].

[Article in Chinese]

Guan H.

Peking Union Medical College Hospital, Beijing.

From 1984 to 1989, 52 cases with Budd-Chiari syndrome were surgically treated at the PUMC Hospital. Among them there were 31 cases of membranous obstruction of the inferior vena cava (MOVC, 59.6%). There were 24 males and 7 females, ase ranging from 24 to 36 years. Diagnosis was confirmed by inferior venocavagraphy. According to Sugiura\'s Classification, there were type Ia and Ib in 26 cases, and type II in 5. Edema and varicosity on both legs, the chest, the abdomen, and the back were found in 93.5% (29/31), and hepatomegaly, splenomegaly, and large amount of ascites were found in 61.3% (19/31), 64.5% (20/31), and 54.8% (17/31), respectively. Transcardiac membranotomy was performed in 27 cases, and the remaining 4 cases were treated by percutaneous transluminal angioplasty using balloon catheters both without operative mortality. Four to sixty months\' follow-up in 29 cases revealed satisfactory results. The authors belief that membranotomy can be successfully performed in cases of MOVC when the stricture is located well above the level of T-9th vertebra, and with a length of less than 2 cm.

PMID: 2150799 [PubMed - indexed for MEDLINE]

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15: Zhonghua Wai Ke Za Zhi 1990 Mar;28(3):130-2, 188 Related Articles, Books  

[Application of digital subtraction angiography in diagnosing and treating portal hypertension].

[Article in Chinese]

Xu HB.

309th Hospital, People\'s Liberation Army.

In order to study the diagnostic and the therapeutic value of digital subtraction angiography (DSA) in portal hypertension, we performed arterioportography 68 times and hepatic venography 11 times on 52 cases with clinically suspected portal hypertension. Seven portal hypertension cases caused by hepatic cancer were treated with transcatheter hepatic artery infusion of anticancerous agent, and one with the stricture of inferior vena cava on hepatic segment was treated by balloon catheter dilatation. Our results showed that, DSA is a safe, reliable and advanced diagnostic technique for portal hypertension, it can also be used as a therapeutic measure in some cases.

PMID: 2379420 [PubMed - indexed for MEDLINE]

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16: Zentralbl Allg Pathol 1984;129(4):371-7 Related Articles, Books  

[Chronic Budd-Chiari syndrome caused by fibrotic stricture of the inferior vena cava].

[Article in German]

Detky G.

Author elaborates the case of a male patient, 49, who had chronic Budd-Chiari syndrome due to stricture caused by a valve in the vena cava inferior, and who bled to death as a result of the rupture of the oesophagus varix. In the 4-year-course of his disease serious portal hypertension and extreme degree of ascites were most characteristic. In the light of special literature author treats the etiology of the disease, its clinical characteristics and diagnostic possibilities. Attention is directed to this rare but operable illness, since literature bears witness to the increasing number of successful operations in this field.

PMID: 6524123 [PubMed - indexed for MEDLINE]

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17: Scand J Thorac Cardiovasc Surg 1979;13(3):259-61 Related Articles, Books  

Rupture of the inferior vena cava during open-heart surgery. Aetiology and surgical management.

Bjork VO, Rodriguez L.

Bleeding during open-heart surgery is a not unusual complication. Rupture of the inferior vena cava during dissection of the heart from adhesions from a previous operation for mitral disease or congenital palliative surgery is a serious and sometimes fatal complication. Its treatment is a challenge even to the most experienced heart surgeon. In two of our three patients, vena cava rupture occurred during open-heart surgery for correction of mitral and aortic valvular disease. In one patient, congenital infundibular stricture of the right ventricle, associated with tricuspid valve insufficiency, was present. In this report, some relevant data were presented from each case and the aetiology of the rupture is discussed.

PMID: 542829 [PubMed - indexed for MEDLINE]

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18: Acta Chir Scand 1978;144(3):133-6 Related Articles, Books  

The iliac compression syndrome.

Jaszczak P, Mathiesen FR.

The iliac compression syndrome is caused by impaired venous drainage of the left leg, secondary to compression or stricture of the left iliac vein at, or just before, its junction with inferior vena cava. Serious potential complications are deep vein thrombosis, pulmonary embolism, venous congestion, and the resultant incapacity. Nine patients in whom the diagnosis was confirmed by iliac phlebography are described. Iliac pressure determinations were made in 7 patients. Four patinets underwent resection, and retroplacement of the right iliac artery behind the left iliac vein. The operative results were good. This rare syndrome should always be considered in the differential diagnosis of peripheral venous disease, as it can be treated in the early stages. If it is left untreated, there is a risk of pulmonary embolism or incapacitating peripheral vascular disease.

PMID: 696150 [PubMed - indexed for MEDLINE]