A 61-year-old man with a history of septic portal vein thrombosis presented with an enlarging duodenal varix. Prominent atrophic changes of the intrahepatic and extrahepatic portal veins were observed on computed tomography. Balloon-occluded retrograde transvenous obliteration (BRTO) of the varix was performed, approaching from the right jugular vein, using 50% glucose and 5% ethanolamine oleate as a sclerosant. During venography, flow to the hepatic hilum was observed, which suggested a hepatopetal flow directly through the varices. Complete occlusion of the varix was obtained without complications. Neither recurrence nor new varix formation was observed during the 5-year follow-up period. Gradual re-enlargement of the main trunk of the portal vein was also observed.
Purpose: To determine the prognostic factors of transcatheter arterial steroid injection therapy (TASIT) in patients with severe acute hepatic failure, with special reference to computed tomography (CT) findings.
Material and Methods: Fifty-one patients (32 men, 19 women; mean age, 48 years) who underwent TASIT for severe acute hepatic failure at the authors' institution were enrolled. Based on patient outcomes, the patients were divided into effective and ineffective treatment groups. Attenuation of the liver parenchyma and liver volume were calculated from CT data acquired before TASIT. Miscellaneous CT findings, such as heterogeneous enhancement of the liver parenchyma, periportal edema, ascites, gall bladder wall thickening, lymphadenopathy and splenomegaly, were also evaluated. The data were compared between the groups.
Results: The effective and ineffective treatment groups included 39 and 12 patients, respectively. All patients in the ineffective group were diagnosed with fulminant liver failure. Mean attenuation of the liver parenchyma in all patients was 44.0 Hounsfield units (HU). Mean CT value in the liver parenchyma was higher in the effective (44.7 HU) than in the ineffective (40.1 HU) treatment groups; however, the difference was not statistically significant. Of the 15 patients in whom liver parenchyma CT values were > 45 HU, all responded to TASIT. Mean liver volume and miscellaneous CT findings were not significantly different between the effective and ineffective treatment groups.
Conclusion: Relatively preserved attenuation of the liver parenchyma may be a good prognostic factor for severe acute hepatic failure after TASIT.
Background and purpose: Endovascular treatment for ruptured cerebral aneurysms ≤ 3 mm in diameter is controversial because it is associated with a high risk of rupture during the procedure. The aim of this study is to evaluate safety and efficacy of endovascular treatment by selecting an appropriate supporting point and shaping of microcatheter in accordance with the blood vessel running for ruptured small anterior communicating aneurysms.
Material and Methods: Thirteen patients with ruptured small anterior communicating artery aneurysms who underwent endovascular treatment at our hospital or affiliated hospitals during the past 10 years were included. There were 3 men and 10 women, with a mean age of 69.8 (40-94) years. The mean major axis diameter was 2.5 (1.9-3.0) mm. All endovascular treatment procedures were performed by selecting an appropriate supporting point and shaping of microcatheter in accordance with the vessel running.
Technical success rate, immediate angiographical results, periprocedural complication within 30 day, and follow-up result were retrospectively assessed.
Results: Technical success rate was 100% (13/13). No periprocedural complication occurred. There were 4 cases of complete occlusion, 8 of neck remnant, and one of body filling. Patients were followed-up for a mean 57.3 (6-112) months, and no rebleeding or recurrent aneurysm was noted.
Conclusions: Endovascular treatment for ruptured small anterior communicating artery by making an appropriate supporting point and shaping of microcatheter in accordance with the blood vessel running seems be safe and efficacy to prevent rebleeding of aneurysm.