Key figures
- Location: 11th Floor, No.3 ?Building
?
Introduction
The Department of Vascular Interventional Radiology of the Third Affiliated Hospital of Sun Yat-sen University was one of the first few dedicated interventional radiology teams in China. We started to perform interventional radiological procedures in the 1980s and the Department of Interventional Radiology was founded in 1993. Our team constitutes professor level consultant, associate professor level consultants, consultants, and fellows. One of our consultants is also a Ph.D. supervisor (Dr. Mingsheng Huang). As a hub of the interventional radiology society in south China, and an important center in the country, we are also responsible for graduate education in the field of interventional radiology as well as training of young radiologists from around the country. We are recognized by the Ministry of Health (Order number [2012]87-89) as authorized educational base of general radiological intervention and peripheral arterial radiological intervention.
?
Diagnosis and Treatment
Interventional radiologists work under guidance of medical imaging equipment. We would first construct an access to all the tubular (vessels, billiary tract, urinary tract and others) and hollow structures in human body by Seldinger technique.
?
Afterwards, with help of very fine wires and tubes called guide-wires and catheters, we can reach almost every corner inside human body through an incision almost never longer than 5mm on the skin. When we reach an area of interest, we can either inject a special type of liquid called “contrast” to delineate local functional structures and thus help make diagnosis, or we can use clogging devices including metal plugs, coils, polyvinyl alcohol particles, gell-foam, glue and lipiodol or supporting devices including drainage catheters, balloon catheters, stents and grafts to treat pathological processes.
?
As part of a major liver center in South China, we routinely manage a large amount of patients with liver malignancy by various interventional radiological techniques including Trans-Arterial ChemoEmbolization (TACE), radiofrequency ablation, microwave ablation, radioactive seed implantation, and others. We are also actively participating in research works surrounding the treatment of liver malignancy, including publishing clinical studies on prestigious international academic periodicals.
?
Among the above mentioned procedures, TACE is most commonly applied. It is performed when the tip of a microcatheter is advanced into the hepatic segmental or specific tumour-feeding artery. An emulsion of 2–20 mL of lipiodol and chemotherapeutic agents were administered into the feeding vessels. If the flow of the tumourfeeding artery was still fast after the 20 ml upper limit was reached, we used a gelatine sponge or polyvinyl alcohol particles to embolize the vessel until we could observe a significantly sluggish flow. In patients with an arterioportal shunt (APS), an embolization with 300–1000 μm polyvinyl alcohol particles was performed to occlude the shunt via superselective catheterization prior to infusion of the lipiodol emulsion. Presently, with the advance of material science, we are also using more advanced materials for chemoembolization including microsphere loaded with doxorubicin or blank microsphere.
?
We are also specialized and renowned for pTIPS treatment of symptomatic portal hypertension, especially patients also inflicted with portal thrombosis, cavernous transformation of portal vein, hepatic venous occlusion, artery-vein fistula and/or malformation in portal venous system, and liver atrophy, and are not suitable for traditional TIPS procedure. Previously, success rate of TIPS procedure in these patients has been reported in large series studies to be around 65%, with a lowest reported rate of 35%. In our department, performing pTIPS technique, we have reached a success rate of 99% in more than 200 patients.
The following are technical details of pTIPS procedure:
?
Step 1: Pecutaneous access and recannalization of PV.?
A 22 gauge (G) Chiba needle was used for transhepatic access of branches of RPV (Section 5, S5, or section 6, S6). Percutaneous entry points were determined pre-procedurally based on study of patients’ CT images. A 0.018 inch guidewire was then advanced into portal venous system, over which the puncture tract was pre-dilated with a PTC set. A portogram was performed during the process with the inner plastic coaxial dilator in the set if there was severe PVT and/or CTPV.
?
A 0.035 inch angled tip glidewire was then introduced, and the puncture set was replaced with a 6F sheath. Using standard catheter-guidewire techniques same as that during treatment of peripheral artery diseases, a 4 French (F) KMP catheter was advanced together with the glide-wire into patent segments of SV or SMV (as far as splenic hilum or distal mesenteric venous branches in cases of diffuse PVT/PVTT). The glide-wire was then exchanged for an angled-tip standard wire which was left in the portal venous system serving as safety wire.
?
Step 2: Access of systemic vein from portal venous system. ?
A 9F vascular sheath was placed in right internal jugular vein (RIJ) by Seldinger’s technique through which a 7F long sheath was advanced into hepatic vein or IVC. After a venogram, the long sheath was left in place to serve as target.
?
According to published data from our previous investigation of the spatial relationship between hepatic vein and portal vein, we designed a 20cm long 20 G modified puncture needle with a 40°angled tip at the distal 1 cm. The modified puncture needle was advanced through the portal sheath towards the long sheath in hepatic vein/IVC. After access of systemic vein from portal vein, a 0.018 inch guide wire was introduced into IVC through the modified needle.
?
Step 3: Through-and-through access.
The metal stiffener in a Dawson-Mueller Drainage set (COOK, Bloomington, USA) was advanced over the 0.018 inch guide wire to dilate the puncture sites on portal vein and hepatic vein as well as the parenchymal track. The stiffener was exchanged for a 4F KMP catheter over the 0.018 inch guide wire which in turn was exchanged for a 0.035 inch glide wire. This wire was snared out from jugular sheath with a 25-mm-diameter loop Amplatz gooseneck snare to gain through-and-through access.
?
A 6X40mm angioplasty balloon catheter was then advanced over the through-and-through wire from the portal access to dilate the intrahepatic shunt track. While retracting the balloon catheter, the long sheath from the jugular access was advanced tailing the balloon into the portal vein.
?
Once the long sheath was placed in the portal venous system, the through-and-through wire was extracted to be reintroduced from the jugular access and advanced into the portal venous system alongside the safety wire. Shunt creation was then completed in a fashion similar to standard TIPS procedure from jugular access.
?
During the procedure, depending on the circumstances, we may also perform varices embolization and portal vein reconstruction.
?
Our team also has extensive experience in neurological interventional radiology, vascular interventional radiology, oncological interventional radiology and gynaecological interventional radiology. Some of the important diseases that we have special interests in were: cerebral aneurysm, carotid artery stenosis, intracranial artery stenosis, intracranial artery dissection, congenital intracranial vascular malformation, acute ischemic stroke , aortic aneurysm, aortic dissection, peripheral arterial diseases (PAD), diabetic foot, deep vein thrombosis, varicose vein of lower limb, hepatocellular carcinoma, portal vein cavernoma, portal vein thrombosis, symptomatic portal vein hypertension, Budd-chiari syndrome, complications post orthotopic liver transplantation (OLT), primary liver malignancy and liver metastases, obstructive jaundice and fibroids.
?
Facilities and Apparatus
Our team currently works in two sites: the Third Affiliated Hospital of Sun Yat-sen University and the Lingnan Hospital of Sun Yat-sen University. Combined we have 4 working digital substracted angiography (DSA) machines and 44 beds in two wards for in-hospital patients. By kind permission of the diagnostic radiology teams in these two hospitals, we are also able to use the Computed Tomography (CT) for various percutaneous procedures.
