ObjectivesTo explore the efficacy and influencing factors of transarterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC) combined with portal vein tumor thrombosis (PVTT).Materials and methodsThe clinical data of 3,126 consecutive patients who suffered from advanced HCC and underwent TACE were retrospectively analyzed. A total of 685 patients had a combination of HCC and PVTT. Of these patients, 475 were treated with TACE (Group A) and 210 were given a supportive care (Group B). The local response and overall survival of the two groups were observed and compared, and the influencing factors were examined through Cox regression analysis.ResultsThe median survival time and cumulative survival rate at 6, 12, and 24 months of Group A were higher than those of Group B (P=0.002). Multiple Cox regression analysis revealed that Child–Pugh classes and PVTT grades were the independent prognostic factors affecting a patient’s survival. Stratified analysis demonstrated that the survival time of patients diagnosed with grades I/II PVTT and treated with TACE was superior to that of patients provided with supportive care (P=0.001), but the survival time of patients with grades III/IV PVTT with or without TACE did not significantly differ (P=0.662).ConclusionTACE can significantly improve local response, increase cumulative survival rate, and prolong the survival duration of patients with HCC and grades I/II PVTT, whereas the efficacy of TACE for patients with grades III/IV PVTT should be further verified, although their local responses were improved. Child–Pugh classes and PVTT grades are essential factors influencing patient prognosis.
Central venous catheter is one of the most commonly used vascular therapies in patients receiving hemodialysis and vascular perforation is a rare but serious complication. The present study reports on a case of a 64-year-old female who developed massive hemothorax and hemorrhagic shock after long-term dialysis due to central venous perforation during placement of the central venous catheter. This case was successfully managed by digital subtraction angiography-guided direct injection of coils and cyanoacrylate glue into the sinus tract. In addition, the literature regarding central venous perforation resulting from long-term dialysis catheters was reviewed, risk factors and prevention strategies were summarized and the advantages and disadvantages of various therapeutic approaches were compared.
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