Hepatic Vein Orthoplasty Internal Support

Hepatic vein opening and internal support is used 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. Hepatic vein occlusion may be membranous occlusion of the hepatic vein, proximal occlusion of the proximal opening or extensive stenosis or occlusion of the hepatic vein. Hepatic vein occlusion may also involve stenosis or occlusion of the inferior vena cava. Restoring hepatic vein patency can effectively relieve the symptoms of portal hypertension. Treatment of diseases: portal vein sponge Indication 1, membranous occlusion or segmental stenosis or occlusion of the hepatic vein. 2, hepatic vein opening lesions with inferior vena cava lesions need to simultaneously underwent inferior vena cava dilatation and internal support. Contraindications 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. Preoperative preparation 1. Internal hepatic vein formation with internal jugular vein According to the Seldinger method, the right internal jugular vein or femoral vein puncture was performed. The pig tail catheter was placed in the intrahepatic section for inferior vena cava angiography. The position of the left and right hepatic vein openings was initially understood and analyzed, and then the guiding tube such as Cobra catheter, Rups-100 was used. The puncture guide needle is sent into the intrahepatic segment of the inferior vena cava, and the puncture needle is sent through the guiding tube. The right hepatic vein or the left hepatic vein is tried to penetrate the hepatic vein opening site under fluoroscopy. After successful puncture, hepatic venography and pressure measurement are performed respectively. The guide wire and the 8~10mm balloon dilatation tube were placed to expand the hepatic vein. After the lesion was disappeared, the angiography and pressure measurement were performed, and the internal support was selected according to the lesion range. 2, percutaneous transhepatic and transcervical veins for hepatic vein internal support For patients with failed hepatic venous puncture via the internal jugular vein, percutaneous transhepatic and transjugular intra-arterial approach combined with puncture of the hepatic vein can be used for internal support. Percutaneous transhepatic venous portal vein can be performed under the guidance of B-ultrasound or fluoroscopy. The former uses the 21G Chiba needle to test the hepatic vein. The angiography shows the location and extent of hepatic venous lesions and the blood vessels between the hepatic veins. Then the 18G cannula is used. The needle is selectively inserted into the trunk of the hepatic vein and placed into the guide wire to the obstruction of the hepatic vein; if guided by B-ultrasound, it can be directly penetrated into the trunk of the hepatic vein and placed into the guidewire to the obstruction of the hepatic vein. Under fluoroscopy, the venous puncture was performed along the hepatic vein to the inferior vena cava. After successful rupture of the membrane, the guide wire was delivered into the inferior vena cava. The vascular foreign body forceps are placed through the internal jugular vein catheter to the opening of the inferior vena cava hepatic vein, and the guide wire which has been located in the inferior vena cava is captured, and the hepatic vein guide wire is taken out through the internal jugular vein catheter sheath to form a percutaneous skin. Guidewire trajectories through the liver into the hepatic vein, inferior vena cava, right atrium, superior vena cava, and internal jugular vein. The balloon is placed along the guide wire to dilate the hepatic vein obstruction and place the hepatic vein support, and then angiography and pressure measurement. The percutaneous transhepatic catheter was withdrawn and a gelatin sponge was injected into the liver parenchyma to prevent bleeding. Surgical procedure 1. Internal hepatic vein formation with internal jugular vein According to the Seldinger method, the right internal jugular vein or femoral vein puncture was performed. The pig tail catheter was placed in the intrahepatic section for inferior vena cava angiography. The position of the left and right hepatic vein openings was initially understood and analyzed, and then the guiding tube such as Cobra catheter, Rups-100 was used. The puncture guide needle is sent into the intrahepatic segment of the inferior vena cava, and the puncture needle is sent through the guiding tube. The right hepatic vein or the left hepatic vein is tried to penetrate the hepatic vein opening site under fluoroscopy. After successful puncture, hepatic venography and pressure measurement are performed respectively. The guide wire and the 8~10mm balloon dilatation tube were placed to expand the hepatic vein. After the lesion was disappeared, the angiography and pressure measurement were performed, and the internal support was selected according to the lesion range. 2, percutaneous transhepatic and transcervical veins for hepatic vein internal support For patients with failed hepatic venous puncture via the internal jugular vein, percutaneous transhepatic and transjugular intra-arterial approach combined with puncture of the hepatic vein can be used for internal support. Percutaneous transhepatic venous portal vein can be performed under the guidance of B-ultrasound or fluoroscopy. The former uses the 21G Chiba needle to test the hepatic vein. The angiography shows the location and extent of hepatic venous lesions and the blood vessels between the hepatic veins. Then the 18G cannula is used. The needle is selectively inserted into the trunk of the hepatic vein and placed into the guide wire to the obstruction of the hepatic vein; if guided by B-ultrasound, it can be directly penetrated into the trunk of the hepatic vein and placed into the guidewire to the obstruction of the hepatic vein. Under fluoroscopy, the venous puncture was performed along the hepatic vein to the inferior vena cava. After successful rupture of the membrane, the guide wire was delivered into the inferior vena cava. The vascular foreign body forceps are placed through the internal jugular vein catheter to the opening of the inferior vena cava hepatic vein, and the guide wire which has been located in the inferior vena cava is captured, and the hepatic vein guide wire is taken out through the internal jugular vein catheter sheath to form a percutaneous skin. Guidewire trajectories through the liver into the hepatic vein, inferior vena cava, right atrium, superior vena cava, and internal jugular vein. The balloon is placed along the guide wire to dilate the hepatic vein obstruction and place the hepatic vein support, and then angiography and pressure measurement. The percutaneous transhepatic catheter was withdrawn and a gelatin sponge was injected into the liver parenchyma to prevent bleeding. complication 1, acute pericardial tamponade Perforation of the pericardium when penetrating from the lower to the superior vena cava can lead to acute pericardial tamponade, which is characterized by sweating, difficulty breathing, and shock. The patient should be immediately transferred to the operating room for rescue. Open the pericardium, repair the damaged inferior vena cava, and treat the primary disease. Blocking the upper and lower sides of the lesion can effectively prevent penetrating the pericardium. 2, acute pulmonary infarction The blood under the inferior vena cava diaphragm is in a stagnant state and is prone to thrombosis. Pre-treatment must be clear whether there are floating or fresh thrombus, which is extremely important to prevent fatal pulmonary embolism after inferior vena cava dilatation. Once it happens, the condition is dangerous and the mortality rate is extremely high. 3, acute cardiac insufficiency After the inferior vena cava dilatation and internal support, a large number of stagnant blood reflux increases the pre-cardiac load, and the patient may be characterized by sudden palpitation, shortness of breath, and sitting breathing, and should be treated with cardiac, diuretic, oxygen, and sedatives in time. 4, internal support shift The internal support has a small elastic force, and the support is not fully deployed when released or the inner support diameter is smaller than the diameter of the balloon, which may cause displacement of the inner support, and once displaced to the right atrium, surgical removal is required.

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