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InterventionalTherapyofcomplexBudd-ChiariSyndromeInterventionalRadiologyDepartmentofWuhanUnionHospital复杂类型布-加综合征的介入治疗Interventional1InterventionalRadiologyDepartmentofWuhanUnionHospitalPart1：overviewGeneraldefinitionClassificationPathologicalchangeClinicalmanifestationTherapy

.inverventionaltherapyisthefirstchoice.InterventionalRadiologyDepar2InterventionalRadiologyDepartmentofWuhanUnionHospitalPart2：complexBCSIVC.longsegmentocclusion.combiningwiththrombosisHV.segementocclusion.widespreadocclusionOcclusionofHV&IVCInterventionalRadiologyDepar3InterventionalRadiologyDepartmentofWuhanUnionHospitalPart3：therapy&casesreportInterventionalRadiologyDepar4InterventionalRadiologyDepartmentofWuhanUnionHospitalIVC：longsegementocclusionAnatomyofIVC：pre-operationAngiography：two-way&multipledirectionsPuncture：resistingforce&directionsTrackofguidewireDilatationEndovascularstentInterventionalRadiologyDepar5InterventionalRadiologyDepartmentofWuhanUnionHospitalFigure1.(a,b)A-PandLPangiographyshowtheocclusionsegmentlengthis8.2cm.(c,d)UsingTIPSpunctureneedlereconstrcutedtheocclusionsegment.abcdInterventionalRadiologyDepar6InterventionalRadiologyDepartmentofWuhanUnionHospitalFigure1.Thesamepatient.UsingballoondilatedtheocclusionsegmentandreleaseZ-shapeESinIVC(e～h).efghInterventionalRadiologyDepar7InterventionalRadiologyDepartmentofWuhanUnionHospital

IVC：occlusion&thrombosisD.D.ofthrombus:per-operationFreshthrombus：thrombolysis&suction&/.micro-caliberpunctureOrganizedthrombus：mini-caliberpuncture&ES&dilatationThrombolysis&anticoagulation:postoperationInterventionalRadiologyDepar8InterventionalRadiologyDepartmentofWuhanUnionHospitalFigure2.AngiographyofIVCshowsthegiantfillingdefectinIVC(a)andcontrastmediumcontaminatedthethrombus(b).UsingUKinjectionfromthecathetertwodayslater,thereisnosignofthrombus(c)andpuncturetheocclusionsegmentsuccessfully（d）.abcdInterventionalRadiologyDepar9InterventionalRadiologyDepartmentofWuhanUnionHospitalFigure3.TheimagesofMRIshowthelongsegmentorganizationthrombusinIVC(b,arrowhead).abInterventionalRadiologyDepar10InterventionalRadiologyDepartmentofWuhanUnionHospitalFigure4.(a,b)AngiographyshowslongsegmentocclusionandtheirregularfillingdefectinIVC,whichreachsthelevelofleftrenalveinoutlet(arrowhead).Puncturetheocclusionanddilateditwithballoon(c,d).abcdInterventionalRadiologyDepar11InterventionalRadiologyDepartmentofWuhanUnionHospitalefghFigure4.(e,f)UsingabiggerballoondilatedtheocclusionsegmentandreleaseZ-shapeEStofixthethrombusonthewallofIVC.InterventionalRadiologyDepar12InterventionalRadiologyDepartmentofWuhanUnionHospitalHV：segementocclusionClinicalmanifestation：aggravated、serious、ascits、liverfunctionfailureimagecharacteristicTherapia：.PunctureHVfromIVCorHV.PercutaneouspunctureHV.EndovascularstentInterventionalRadiologyDepar13InterventionalRadiologyDepartmentofWuhanUnionHospitalaFigure5.(a)TheangiographyfromIVC.(b)TheangiographyafterpercutaneouspuncturetheocclusionHV.(c)Angiographythroughcatheterafterballoondilatation.(d)ReleaseES.bcdInterventionalRadiologyDepar14InterventionalRadiologyDepartmentofWuhanUnionHospitalFigure6.PercutaneouspuncturetheocclusionHVunderUSguiding.(a)diagram.(b)inoperation.

abInterventionalRadiologyDepar15InterventionalRadiologyDepartmentofWuhanUnionHospitalFigure7.(a)AngiographyformIVC.(b)percutaneouspuncturetheocclusionHVunderUSguiding.(c,d)guidewiretrackandballoondilatation.(e,f)withoutocclusionsignsafteroperation.abcdefInterventionalRadiologyDepar16InterventionalRadiologyDepartmentofWuhanUnionHospitalHV：largeamountascitsClinicalmanifestation:seriousRisksofoperation：bleeding、infection…Therapia

.PunctureHVfromIVC.AngiographyofHV.EndovascularstentInterventionalRadiologyDepar17InterventionalRadiologyDepartmentofWuhanUnionHospitalFigure8.(a)FineneedlepunctureHVandangiographyforguiding.(b～d)trytopuncturetheocclusionHVcannotsucceedfromjugularway.(e,f)femoralwaysucceed.abcdefInterventionalRadiologyDepar18InterventionalRadiologyDepartmentofWuhanUnionHospitalFigure9.Thesamepatient.(a,b)lagreamountascitsbeforeoperation(T2WIimgeofMRI).(c)frogbelly(peroperative).(d)ascitsdismissed(post-operative).abcdInterventionalRadiologyDepar19InterventionalRadiologyDepartmentofWuhanUnionHospitalHV：widespreadocclusionTherapy：transjuguarintrahepaticportosystemicstentshunt,TIPSSTheoreticaldisputableReconstruction,notrecanalization**XuPQ,MaXX,Yexx,etal.SurgialTreatmentof1360casesofBudd-ChiariSyndrome:20-yearExperience.HepatobiliaryPancreatDisint,2004,3(3):391-394.InterventionalRadiologyDepar20InterventionalRadiologyDepartmentofWuhanUnionHospitalFigure10.(a)PercutaneouspuncturePVforguiding.(b,d)ReconstructiontheshuntbetweenPVandHV.(e,f)Angiographyafteroperation.abcdefInterventionalRadiologyDepar21InterventionalRadiologyDepartmentofWuhanUnionHospitalFigure11.

(a)DirectlypunctureintoIVCfromrPV.(b～d)ReconstructiontheshuntbetweenPVandHV.(e)SchematicdiagramofdirectlypunctureIVC.abcdeInterventionalRadiologyDepar22InterventionalRadiologyDepartmentofWuhanUnionHospitalOcclusionofHV&IVCThreetunnelsRecanalizedIVCfirstlyES:.UseZ-shapestentinIVC.ReleaseESinporperorder：IVCfirstlyorHVfirstlyInterventionalRadiologyDepar23I