Multi-detector Row CT Angiography For The Evaluation Of Thetherapeutic Effect Of Percutaneous Transhepatic Variceal Embolization With Cyanoacrylate For Esophageal Varices

Background&aim:Esophageal varices bleeding is very commen in Liver cirrhosis portal vein high pressure; The rate of bleeding and mortality is also high. In the Consensus on prevention and treatment of EVB, It is necessary to Stop the bleeding in the first time (primary prevention)and reblooding(secondary prevention). Interventional therapy is very important in clinical treatment because of the merit of fewer traumas, less complication,rapid recuperation and high effective. Percutaneous transhepatic varicral embolization(PTVE) as a method of interventional therapy has been applied and studied deeply. Traditional PTVE can not embolize vessel well and the rate of bleeding is also high in polstoperation. Permanent Embolic agents (HE glue) is applied in reformative PTVE.It has good curative effect in preventing rebleeding and recurrence. The effect of PTVE is closely related with hemodynamics of Collateral circulation of portal system.So it is important to evaluate Collateral circulation of portal system. Traditional portal phlebography is invasive and it is limited to Stereovision. Multi slice spiral CT and Portal vein imaging as an non-invasive method has been extensive used in clinic. Multi slice spiral CT allows isotropic scanning because of quick scan and thin layer scanning. High definition imagery and3D image postprocessing are superior function. After Image reconstruction and three-dimensional reconstruction via computers,we can obtain high quality images of portal vein, clear observation of esophageal and gastric varices and communicating branch of spatial anatomical relationship of blood. So our purpose of this study is to explore the long-term curative effect and changes of gastroesophageal varices in patients with portal collateral circulation hemodynamics after PTVE application of multi-slice spiral CT portography.Methods:The subjects of this prospective study were156patients who underwent percutaneous transhepatic variceal embolization for esophageal varices.We observe PTVE before and after operation of esophageal and gastric varices and portal vein branch according multi-slice spiral CT portography.Patients were divided into three groups according to the filling range of cyanoacrylate in esophageal varices and their feeding vessels:Esophageal gastric fundus group, gastric cardia group and coronary vein group.We performed chart reviews and prospective follow-up using multi-detector row computed tomography images, angiography, and gastrointestinal endoscopy.Results:Preoperative esophageal and gastric varices and collateral vessels in spiral CT and portal imaging was been shown very well.Paraesophageal varices, esophageal gastric fundus and cardia peripheral vein and perforating vein wall in Esophageal gastric fundus group (82cases) was filled well and continued detention by TH gel according follow-up of spiral CT dynamic.BUT the gel decreased in the patients of esophageal and gastric fundus esophageal varices after the operation of reformative PTVE. Spiral CT scan showed that gastric cardia peripheral vein and perforating vein wall within the TH glue was filling good and continuous deposition in the Gastric cardia group (49cases), and no tissue was glued depigmentation. esophagus seen scattered in a small amount of tissue adhesive deposition, but TH adhesive deposition disappeared in the stomach mucosa half a year after operation.According CT scan Coronary vein group (25cases)showed that the main branch of gastric coronary vein was embolized well in TH gel.There was no loss. It showed that variceal disappearance rates in three groups of were80.4%,40.8%,0%, recurrence rates were13.4%,41.9%,100%respectively ((P<0.01) combined with enhanced-CT. Portal vein imaging shows that three groups of neovascularization, variceal recurrence rates were10.98%,30.6%and100%(P<0.01) respectively.Three groups of PTVE after embolization, rebleeding rate were8.5%,22.4%,72%respectively (Kaplan-Meier=P=0.000, OR3.560), the mortality rates were17%,30.6%and76%(Kaplan-Meier=P=0.02, OR2.822).Cox regression analysis showed the embolization area and Child grading are independent factors of rebleeding and survival rate.Conclusion:Spiral CT scanning and imaging evaluation is very useful to evaluate completeness of Embolism. It can predict the esophageal and gastric variceal recurrence accurately, and effective embolization can reduce recurrence.