复杂类型布-加综合征的介入治疗ppt课件

1、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 Hospital General definition Classification Pathological change Clinical manifestation Therapy .inverventional therapy is the first choice.In

2、terventional Radiology Department of Wuhan Union Hospital IVC . long segment occlusion . combining with thrombosis HV . segement occlusion . widespread occlusion Occlusion of HV & IVCInterventional Radiology Department of Wuhan Union HospitalInterventional Radiology Department of Wuhan Union Hos

3、pital Anatomy of IVC ：pre-operation Angiography： two-way & multiple directions Puncture：resisting force & directions Track of guide wire Dilatation Endovascular stentInterventional Radiology Department of Wuhan Union HospitalFigure 1. (a,b) A-P and LP angiography show the occlusion segment l

4、ength is 8.2cm. (c,d) Using TIPS puncture needle reconstrcuted the occlusion segment. a b c d Interventional 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 Departm

5、ent of Wuhan Union Hospital D.D. of thrombus: per-operation Fresh thrombus：thrombolysis &suction &/. micro-caliber puncture Organized thrombus： mini-caliber puncture & ES & dilatation Thrombolysis & anticoagulation: postoperationInterventional Radiology Department of Wuhan Union

6、HospitalFigure 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 successfullyd.a b c d Interventional Radiology Depa

7、rtment of Wuhan Union HospitalFigure 3. The images of MRI show the long segment organization 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 th

8、e 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 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 wal

9、l of IVC.Interventional Radiology Department of Wuhan Union Hospital Clinical manifestation：aggravated、 serious、 ascits、liver function failure image characteristic Therapia： .Puncture HV from IVC or HV .Percutaneous puncture HV .Endovascular stentInterventional Radiology Department of Wuhan Union Ho

10、spitala 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 HospitalFigure 6. Percutaneous puncture the occlusion H

11、V under US guiding. (a)diagram.(b)in operation . a b Interventional Radiology 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.

12、a b c d e f Interventional Radiology Department of Wuhan Union Hospital Clinical manifestation: serious Risks of operation：bleeding、 infection Therapia . Puncture HV from IVC . Angiography of HV . Endovascular stentInterventional Radiology Department of Wuhan Union HospitalFigure 8. (a) Fine needle

13、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 HospitalFigure 9. The same patient. (a,b)lagre amount ascits before operation(T2WI imge of MRI).(c)f

14、rog belly (peroperative). (d) ascits dismissed (post-operative).a b c d Interventional Radiology Department of Wuhan Union Hospital Therapy：transjuguar intrahepatic portosystemic stent shunt, TIPSS Theoretical disputable Reconstruction, not recanalization*Xu PQ, Ma XX, Ye xx, et al. Surgial Treatmen

15、t of 0 cases of Budd-Chiari 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 operat

16、ion.a b c d e f Interventional 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 HospitalOcclusio

17、n of HV & IVC Three tunnels Recanalized 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.acIVC 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 Hospitalconclusion Peroperati