复杂类型布—加综合征的介入治疗.pptVIP

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 Part 1： overview General definition Classification Pathological change Clinical manifestation Therapy .inverventional therapy is the first choice. Part 2： complex BCS IVC . long segment occlusion . combining with thrombosis HV . segement occlusion . widespread occlusion Occlusion of HV IVC Part 3： therapy cases report 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 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 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 HV：large amount ascits Clinical manifestation: serious Risks of operation：bleeding、 infection… Therapia . Puncture HV from IVC . Angiography of HV . Endovascular stent HV：widespread occlusion Therapy：transjuguar intrahepatic portosystemic stent shunt, TIPSS Theoretical disputable Reconstruction, not recanalization* 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 conclusion Peroperation: Standard examiation and preparation In operation . angiograph throughly . US guiding for puncture . PTA ES… Post operation . monitering the vital sign(VS) of patients . Anticoagulation . Follow-up Thank you！ * Interventional Radiology Department of Wuhan Union Hospital Interventional Radiology Department of Wuhan Union Hospital Interventional Radiology Department of Wuhan Union