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1、复杂类型布复杂类型布-加综合征的介入治加综合征的介入治疗疗Interventional Therapy of complex Budd-Chiari SyndromeInterventional 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张泽富Interventional Radiology Department of Wuhan Union HospitalInterventional Radiology Department of Wuhan Union Hos
2、pitalPart 1： overviewGeneral definitionClassificationPathological changeClinical manifestationTherapy .inverventional therapy is the first choice.Interventional Radiology Department of Wuhan Union HospitalPart 2： complex BCSIVC . long segment occlusion . combining with thrombosisHV . segement occlus
3、ion . widespread occlusionOcclusion of HV & IVCInterventional Radiology Department of Wuhan Union HospitalPart 3： therapy & cases reportInterventional Radiology Department of Wuhan Union HospitalIVC ：long segement occlusionAnatomy of IVC ：pre-operationAngiography： two-way & multiple directionsPunctu
4、re：resisting force & directionsTrack of guide wireDilatationEndovascular stentInterventional Radiology Department of Wuhan Union HospitalFigure 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 In
5、terventional Radiology Department of Wuhan Union HospitalFigure 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 & thrombosisD.D. of thrombus: per-operationFresh thro
6、mbus：thrombolysis &suction &/. micro-caliber punctureOrganized thrombus： mini-caliber puncture & ES & dilatation Thrombolysis & anticoagulation: postoperationInterventional Radiology Department of Wuhan Union HospitalFigure 2. Angiography of IVC shows the giant filling defect in IVC (a) and contrast
7、 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 HospitalFigure 3. The images of MRI show the long segment organizat
8、ion thrombus in IVC(b, arrow head).a b Interventional Radiology Department of Wuhan Union HospitalFigure 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
9、 balloon(c,d).a b c d Interventional Radiology Department of Wuhan Union Hospitale 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 HospitalHV：segement occlusion
10、Clinical manifestation：aggravated、 serious、 ascits、liver function failureimage characteristicTherapia： .Puncture HV from IVC or HV .Percutaneous puncture HV .Endovascular stentInterventional Radiology Department of Wuhan Union Hospitala Figure 5. (a) The angiography from IVC. (b) The angiography aft
11、er percutaneous puncture the occlusion HV. (c) Angiography through catheter after balloon dilatation. (d) Release ES.b c d Interventional Radiology Department of Wuhan Union HospitalFigure 6. Percutaneous puncture the occlusion HV under US guiding. (a)diagram.(b)in operation . a b Interventional Rad
12、iology Department of Wuhan Union HospitalFigure 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
13、HV：large amount ascitsClinical manifestation: seriousRisks of operation：bleeding、 infectionTherapia . Puncture HV from IVC . Angiography of HV . Endovascular stentInterventional Radiology Department of Wuhan Union HospitalFigure 8. (a) Fine needle puncture HV and angiography for guiding.(bd) try to
14、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 HospitalFigure 9. The same patient. (a,b)lagre amount ascits before operation(T2WI imge of MRI).(c)frog belly (peroperative). (d) ascits dismissed (post
15、-operative).a b c d Interventional Radiology Department of Wuhan Union HospitalHV：widespread occlusionTherapy：transjuguar intrahepatic portosystemic stent shunt, TIPSSTheoretical disputable Reconstruction, not recanalization*Xu PQ, Ma XX, Ye xx, et al. Surgial Treatment of 1360 cases of Budd-Chiari
16、Syndrome:20-year Experience. Hepatobiliary Pancreat Dis int, 2004, 3(3):391-394.Interventional Radiology Department of Wuhan Union HospitalFigure 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 Intervention
17、al Radiology Department of Wuhan Union HospitalFigure 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 HospitalOcclusion of HV & IVCThree tunnelsRe
18、canalized IVC firstly ES: . Use Z-shape stent in IVC . Release ES in porper order：IVC firstly or HV firstlyInterventional Radiology Department of Wuhan Union HospitalFigure 12.（ac）IVC was recanalized firstly. (d,e) Puncture the occlusion HV secondly. (f) The angiography after operation.a b c d e f I
19、nterventional Radiology Department of Wuhan Union HospitalconclusionPeroperation: Standard examiation and preparationIn operation . angiograph throughly . US guiding for puncture . PTA & ESPost operation . monitering the vital sign(VS) of patients . Anticoagulation . Follow-upInterventional Radiology Department of Wuhan Union HospitalThank you！
