Intravenous balloon dilation with internal support angioplasty

Intravenous balloon dilatation plus internal angioplasty for the surgical treatment of Budd-Chiari syndrome. Budd-Chiari syndrome refers to hepatic venous hypertension, central venous and hepatic sinus dilatation, blood stasis or inferior vena cava blood stasis caused by obstruction of the hepatic vein outflow tract or inferior vena cava reflow. Clinical manifestations of portal hypertension such as hepatosplenomegaly Large, esophageal varices bleeding, ascites, hypersplenism, etc., can also be expressed as trunk and lower extremity varicose veins, lower extremity swelling, pigmentation and long-term ulcers. According to the vascular obstruction site, Budd-Chiari syndrome can be divided into inferior vena cava membranous and segmental obstruction, hepatic vein opening or distal extensive obstruction and hepatic vein inferior vena cava mixed obstruction. Due to the complicated classification and more surgical methods, there is no single method for treating Budd-Chiari syndrome of different pathological types. The treatment should be selected according to the pathological type. In recent years, the development of interventional radiotherapy has improved the treatment of Budd-Chiari syndrome. The interventional or interventional surgery has significantly improved the clinical efficacy of Budd-Chiari syndrome. In our inferior vena cava obstruction is the main type of Budd-Chiari syndrome. Intravenous balloon dilatation plus internal angioplasty can effectively relieve the inferior vena cava obstruction, with small trauma, low complications, and significant clinical efficacy. Curing disease: Indication Intravenous balloon dilatation plus internal angioplasty is indicated for capsular or segmental obstruction of the inferior vena cava with hepatic vein patency. Contraindications 1. The distal thrombosis of the inferior vena cava lesion. 2. Hepatic vein and inferior vena cava mixed obstruction. Preoperative preparation In addition to routine examination, color Doppler and MRI angiography or electron beam CT angiography were performed preoperatively to understand the location and extent of vascular occlusion. Surgical procedure 1. According to the Seldinger method, the right femoral vein puncture was performed, and the guide wire and catheter were placed, and the inferior vena cava angiography and pressure measurement were performed respectively. 2. Further determine the extent and location of inferior vena cava obstruction according to inferior vena cava angiography. If the inferior vena cava stenosis or membranous obstruction with small holes, the guide wire is sent to the right atrium through a stenosis or a small hole, and a balloon with a diameter of 20 to 30 mm is used to expand the lesion. 3. If the inferior vena cava is completely obstructed, puncture the obstruction segment. The puncture can be performed by a Brochenbrouch interatrial septum needle from the bottom up or by the Rups-100 device through the right internal jugular vein to the inferior vena cava. puncture. The former is easy to damage the inferior vena cava or right atrium during the puncture to cause bleeding and acute pericardial tamponade; the latter is guided by the catheter under the lesion, the division will wear through the obstructive lesions, reducing the possibility of piercing the inferior vena cava. After successful puncture, the guide wire was placed, and the lesion was dilated with a balloon of 20-30 mm in diameter. 4. After the balloon dilatation trace disappears, the stent is selected according to the length of the lesion, and the lesion is marked by the lesion. The stent is released through the vascular sheath, and the stent should completely cover the lesion and extend to the ends for 1 to 2 cm. 5. Under the internal support, the inferior vena cava angiography and sputum pressure are measured again, the pressure is lowered, and the inferior vena cava is restored smoothly, indicating that the operation is successful. 6. The indwelling 5F catheter is placed under the inner support, the catheter is withdrawn through the right internal jugular vein, and the catheter is reserved for local anticoagulation. complication 1. Acute pericardial tamponade. 2. Acute pulmonary infarction. 3. Acute cardiac insufficiency. 4. Internal support shift.