Department of Radiology, Institute of Radiation Medicine, Clinical Research Institute, Seoul National University College of Medicine, Seoul National University Medical Research Center, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
Cardiovasc Intervent Radiol. 2012 Dec;35(6):1388-95. doi: 10.1007/s00270-011-0311-y. Epub 2011 Dec 10.
To evaluate the safety and feasibility of percutaneous transsplenic access to the portal vein for management of vascular complication in patients with chronic liver diseases.
Between Sept 2009 and April 2011, percutaneous transsplenic access to the portal vein was attempted in nine patients with chronic liver disease. Splenic vein puncture was performed under ultrasonographic guidance with a Chiba needle, followed by introduction of a 4 to 9F sheath. Four patients with hematemesis or hematochezia underwent variceal embolization. Another two patients underwent portosystemic shunt embolization in order to improve portal venous blood flow. Portal vein recanalization was attempted in three patients with a transplanted liver. The percutaneous transsplenic access site was closed using coils and glue.
Percutaneous transsplenic splenic vein catheterization was performed successfully in all patients. Gastric or jejunal varix embolization with glue and lipiodol mixture was performed successfully in four patients. In two patients with a massive portosystemic shunt, embolization of the shunting vessel with a vascular plug, microcoils, glue, and lipiodol mixture was achieved successfully. Portal vein recanalization was attempted in three patients with a transplanted liver; however, only one patient was treated successfully. Complete closure of the percutaneous transsplenic tract was achieved using coils and glue without bleeding complication in all patients.
Percutaneous transsplenic access to the portal vein can be an alternative route for portography and further endovascular management in patients for whom conventional approaches are difficult or impossible.
评估经皮经脾途径门静脉入路治疗慢性肝病血管并发症的安全性和可行性。
2009 年 9 月至 2011 年 4 月，对 9 例慢性肝病患者尝试经皮经脾途径门静脉入路。在超声引导下用 Chiba 针进行脾静脉穿刺，然后引入 4 至 9F 鞘。4 例呕血或便血患者行静脉曲张栓塞治疗。另外 2 例患者行门腔分流栓塞术以改善门静脉血流。3 例移植肝患者行门静脉再通术。经皮经脾入路采用弹簧圈和胶封闭。
所有患者均成功完成经皮经脾脾静脉置管术。4 例胃或空肠静脉曲张患者采用胶和碘油混合物行胃或空肠静脉曲张栓塞术。2 例门腔分流患者采用血管塞、微弹簧圈、胶和碘油混合物栓塞分流血管，效果良好。3 例移植肝患者行门静脉再通术，但仅 1 例成功。所有患者均采用弹簧圈和胶成功完全封闭经皮经脾入路，无出血并发症。
经皮经脾途径门静脉入路可作为传统方法困难或不可能的患者进行门静脉造影和进一步血管内治疗的替代途径。
