最新复杂类型布-加综合征的介入治疗精品课件.ppt

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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 Radiology Department of Wuhan Union Hospital General definition Classification Pathological change Clinical manifestation Therapy .inverventional therapy is the first choice.Interventional Radiology Department of Wuhan Union HospitalFigure 2. Angiography o

2、f 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 Hospita

3、lFigure 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 the level of left renal vein ou

4、tlet(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 wall of IVC.Interventional Radio

5、logy 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 Hospitala Figure 5. (a) The ang

6、iography 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 HV under US guiding. (a)diagra

7、m.(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.a b c d e f Interventional Ra

8、diology 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 puncture HV and angiography f

9、or 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)frog belly (peroperative). (d)

10、 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 Treatment of 1360 cases of Budd-Chiar

11、i 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 Interventi

12、onal 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 & IVC Three tunnel

13、s 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.（ac）IVC was recanalized firstly. (d,e) Puncture the occlusion HV secondly. (f) The angiography after operation.a b c d e

14、 f Interventional Radiology Department of Wuhan Union Hospitalconclusion 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-upInterventional Radiology Department of Wuhan Union HospitalThank you！