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| The effect of wedged hepatic venography with CO2 during TIPS in the treatment of acute upper gastro-intestinal bleeding in liver cirrhosis |
| LU Wei YANG Chao ZHANG Jiacheng YANG Jian MA Junpeng ZHENG Hao DU Peng JIANG Fuqiang |
| Department of Interventional Medicine, the Sixth Medical Center, Chinese People′s Liberation Army General Hospital, Beijing 100048, China |
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Abstract Objective To investigate the efficacious of wedged hepatic venography with CO2 for guiding portal vein puncture during transjugular intra-hepatic porto-systemic shunt (TIPS) in the treatment of acute upper gastro-intestinal bleeding due to liver cirrhosis. Methods Clinical data of 40 patients with acute upper gastro-intestinal hemorrhage due to rupture of esophageal or gastric varicose veins in liver cirrhosis underwent TIPS in the Sixth Medical Center, Chinese People′s Liberation Army General Hospital from June 2010 to June 2018 were analyzed retrospectively. All patients received wedged hepatic venography before TIPS. Among the patients, 20 cases were performed hepatic venography with CO2 (groups A), and the other 20 cases were performed hepatic venography with Ioversol (group B) according to the admission time. Visualization of the main portal vein and its′ branch in the two groups were evaluated. The frequency, time of portal vein puncture in the two groups were compared. The successful portal vein puncture rate of the two groups were compared. Results There were 17 cases had clear display portal vein trunk and its main branches in group A, and 5 cases had clear display portal vein trunk and its main branches in group B, imaging quality in group A was better than group B, the difference was highly statistically significant (P ＜ 0.01). The average frequency of portal vein puncture in the group A was fewer than the group B, the difference was highly statistically significant (P ＜ 0.01). Time of portal vein puncture in the group A was less than that in the group B, the difference was highly statistically significant (P ＜ 0.01). Successful portal vein puncture rate were both 100% in the two groups, and there was no statistically significant difference (P ＞ 0.05). There were no severe adverse reactions in the two groups. Conclusion Wedged hepatic venography with CO2 is effective in visualization of portal vein and its branches for guiding portal vein puncture during TIPS in the treatment of acute upper gastro-intestinal bleeding in liver cirrhosis. It can guide portal vein puncture, reduce puncture times and shorten puncture time, which is worthy of clinical promotion.
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