复杂类型布加综合征的介入治疗

复杂类型布-加综合征的介入治疗Interventional Therapy of complex Budd-Chiari Syndrome,华中科技大学同济医学院附属协和医院介入放射科 张泽富,Interventional Radiology Department of Wuhan Union Hospital,Interventional Radiology Department of Wuhan Union Hospital,Part 1： overview,General definition Classification Pathological change Clinical manifestation Therapy .inverventional therapy is the first choice.,Interventional Radiology Department of Wuhan Union Hospital,Part 2： complex BCS,IVC . long segment occlusion . combining with thrombosis HV . segement occlusion . widespread occlusion Occlusion of HV & IVC,Interventional Radiology Department of Wuhan Union Hospital,Part 3： therapy & cases report,Interventional Radiology Department of Wuhan Union Hospital,IVC ：long segement occlusion,Anatomy of IVC ：pre-operation Angiography： two-way & multiple directions Puncture：resisting force & directions Track of guide wire Dilatation Endovascular stent,Interventional Radiology Department of Wuhan Union Hospital,Figure 1. (a,b) A-P and LP angiography show the occlusion segment length is 8.2cm. (c,d) Using TIPS puncture needle reconstrcuted the occlusion segment.,a,b,c,d,Interventional Radiology Department of Wuhan Union Hospital,Figure 1. The same patient. Using balloon dilated the occlusion segment and release Z-shape ES in IVC (eh).,e,f,g,h,Interventional Radiology Department of Wuhan Union Hospital,IVC： occlusion & thrombosis,D.D. of thrombus: per-operation Fresh thrombus：thrombolysis &suction &/. micro-caliber puncture Organized thrombus： mini-caliber puncture & ES & dilatation Thrombolysis & anticoagulation: postoperation,Interventional Radiology Department of Wuhan Union Hospital,Figure 2. Angiography of IVC shows the giant filling defect in IVC (a) and contrast medium contaminated the thrombus(b). Using UK injection from the catheter two days later ,there is no sign of thrombus(c) and puncture the occlusion segment successfully（d）.,a,b,c,d,Interventional Radiology Department of Wuhan Union Hospital,Figure 3. The images of MRI show the long segment organization thrombus in IVC(b, arrow head).,a,b,Interventional Radiology Department of Wuhan Union Hospital,Figure 4. (a,b) Angiography shows long segment occlusion and the irregular filling defect in IVC, which reachs the level of left renal vein outlet(arrow head). Puncture the occlusion and dilated it with balloon(c,d).,a,b,c,d,Interventional Radiology Department of Wuhan Union Hospital,e,f,g,h,Figure 4. (e,f) Using a bigger balloon dilated the occlusion segment and release Z-shape ES to fix the thrombus on the wall of IVC.,Interventional Radiology Department of Wuhan Union Hospital,HV：segement occlusion,Clinical manifestation：aggravated、 serious、 ascits、liver function failure image characteristic Therapia： .Puncture HV from IVC or HV .Percutaneous puncture HV .Endovascular stent,Interventional Radiology Department of Wuhan Union Hospital,a,Figure 5. (a) The angiography from IVC. (b) The angiography after percutaneous puncture the occlusion HV. (c) Angiography through catheter after balloon dilatation. (d) Release ES.,b,c,d,Interventional Radiology Department of Wuhan Union Hospital,Figure 6. Percutaneous puncture the occlusion HV under US guiding. (a)diagram.(b)in operation .,a,b,Interventional Radiology Department of Wuhan Union Hospital,Figure 7. (a)Angiography form IVC.( b) percutaneous puncture the occlusion HV under US guiding. (c,d)guide wire track and balloon dilatation. (e,f) without occlusion signs after operation.,a,b,c,d,e,f,Interventional Radiology Department of Wuhan Union Hospital,HV：large amount ascits,Clinical manifestation: serious Risks of operation：bleeding、 infection Therapia . Puncture HV from IVC . Angiography of HV . Endovascular stent,Interventional Radiology Department of Wuhan Union Hospital,Figure 8. (a) Fine needle puncture HV and angiography for guiding.(bd) try to puncture the occlusion HV cannot succeed from jugular way. (e,f) femoral way succeed.,a,b,c,d,e,f,Interventional Radiology Department of Wuhan Union Hospital,Figure 9. The same patient. (a,b)lagre amount ascits before operation(T2WI imge of MRI). (c)frog belly (peroperative). (d) ascits dismissed (post-operative).,a,b,c,d,Interventional Radiology Department of Wuhan Union Hospital,HV：widespread occlusion,Therapy：transjuguar intrahepatic portosystemic stent shunt, TIPSS Theoretical disputable Reconstruction, not recanalization*,*Xu PQ, Ma XX, Ye xx, et al. Surgial Treatment of 1360 cases of Budd-Chiari Syndrome:20-year Experience. Hepatobiliary Pancreat Dis int, 2004, 3(3):391-394.,Interventional Radiology Department of Wuhan Union Hospital,Figure 10. (a) Percutaneous puncture PV for guiding. (b,d) Reconstruction the shunt between PV and HV. (e,f) Angiography after operation.,a,b,c,d,e,f,Interventional Radiology Department of Wuhan Union Hospital,Figure 11. (a) Directly puncture into IVC from rPV. (bd) Reconstruction the shunt between PV and HV. (e) Schematic diagram of directly puncture IVC.,a,b,c,d,e,Interventional Radiology Department of Wuhan Union Hospital,Occlusion of HV & IVC,Three tunnels Recanalized IVC firstly ES: . Use Z-shape stent in IVC . Release ES in porper order：IVC firstly or HV firstly,Interventional Radiology Department of Wuhan Union Hospital,Figure 12.（ac）IVC was recanalized firstly. (d,e) Puncture the occlusion HV secondly. (f) The angiography after operation.,a,b,c,d,e,f,Interventional Radiology Department of Wuhan Union Hospital,conclusi