Comparative study of predilation with stent filter for Budd-Chiari syndrome with old IVC thrombosis: a nonrandomized prospective trial

Purpose

To evaluate whether predilation approach yield intermediate-term results were better than those with stent filter approach.

Materials and methods

59 BCS patients with old IVC thrombosis were selected for the treatment with a stent filter (n = 33, group A) or predilation (n = 26, group B) before thrombolysis, and subsequently underwent color Doppler ultrasound follow-up at our hospital. Data relating to the technical success, color Doppler ultrasound results, cost, mortality, morbidity, and final clinical results were collected prospectively and follow-ups were performed 1, 3, 6, and 12 months after the procedures, and annually thereafter.

Results

Sent filter placement, thrombolysis and predilation were technically successful in all patients, with no procedure-related complications. Stent migration upward occurred in two patients, and removal of the stent filter was technically successful in 32 of 33 patients in group A. Inferior vena cavagrams performed before dilation with a 30-mm balloon catheter demonstrated that the IVC thrombus had completely resolved in all patients without pulmonary embolism. Reobstruction of the IVC without thrombosis was observed in three patients. Short of higher overall complications and costs in group A when compared to group B, there were no other differences in the clinical and color Doppler ultrasound findings, and primary patency rate between the two groups. All patients are alive with no recurrence of thrombosis at the time of this report.

Conclusions

BCS patients with old IVC thrombosis treatment with predilation approach yielded intermediate-term results that were better than those with the stent filter approach.     

Suprarenal inferior vena cava filter implantation

Purpose

This study evaluated the feasibility, safety, and efficacy of the suprarenal implantation of a retrievable filter in patients with renal cell carcinoma (RCC) and renal vein thrombosis (RVT) [extending or not extending to the inferior vena cava (IVC)] undergoing surgery.

Materials and methods

Between March 2005 and May 2010, 13 patients (eight men and five women; mean age 67.08 years, range 38?C95) with RCC and RVT associated or not with IVC thrombosis underwent implantation of a retrievable suprarenal IVC filter. All patients underwent computed tomography angiography (CTA), which documented RVT and in some cases its extension to the IVC. The level of IVC involvement by the neoplastic thrombus was evaluated on the basis of the Oto classification. Cavography was performed before and after filter implantation. Surgical resection of RCC was performed in all patients. A CTA scan was performed 1 week before filter removal.

Results

The procedure had 100% feasibility. All filters were correctly deployed in the suprarenal tract of the IVC. There was no evidence of peri-or postprocedural complications. All patients were monitored for clinical symptoms of pulmonary embolism (PE). There was no evidence of PE in the 30 days after the procedure. All suprarenal IVC filters were removed from 30 to 60 days after surgery.

Conclusions

Implantation of a temporary suprarenal IVC filter is an additional and feasible procedure that can prevent immediate and perioperative PE.     

Primary Stent Angioplasty of the Inferior Vena Cava After Liver Transplantation and Liver Resection

Purpose

This study evaluated technical efficacy and safety of stent angioplasty of the inferior vena cava (IVC) after liver transplantation or liver resection and analysis of changes in creatinine levels and patients’ weight.

Methods

Between October 2004 and February 2011, 16 patients (mean age, 52.6 years) with symptomatic IVC stenoses after liver transplantation (n = 10) or liver resection (n = 6) were subjected to stent angioplasty. Enrollment criteria included edema and/or ascites. The smallest diameter of the IVC, serum creatinine values, and patients’ weight were assessed before and after stent placement and respective values were compared. Technical and clinical success, patency rates, related complications, and patients’ survival were analyzed.

Results

Stent placement was technically successful in 16 patients (100 %). Clinical success was achieved in 13 patients (81.25 %), reflecting two patients with early restenosis and one patient suffering from thrombosis distal to the stent. Mean follow-up was 372 days. Primary patencies were 75 % (n = 12). Primary assisted patencies were 93.75 % (n = 15). Serum creatinine levels decreased significantly (p = 0.01) from 1.68 mg/dl before to 1.08 mg/dl after stent placement. Patients’ weight decreased (mean 2.1 %). No angioplasty-related complications occurred.

Conclusions

Stent angioplasty of the IVC is an effective and safe treatment of stenoses after liver transplantation and resection and has a positive effect on creatinine levels.     

Vena-cava-Filter

Clinical/methodical issue

Venous thromboembolism (VTE) is the third most common disease of the cardiovascular system. It is associated with a 30-day lethality in the range of 6 ?% in deep vein thrombosis and 12? % in pulmonary embolism (PE). There are various guidelines with sometimes controversial recommendations regarding the use of inferior vena cava (IVC) filters.

Standard radiological methods

Implantation of IVC filters is a standard therapy in selected patients with an estimated 259,000 filters implanted in 2012.

Methodical innovations

Optionally retrievable filters are increasingly being used in clinical routine practice. Future developments will include biodegradable and drug-eluting filters.

Performance

When compared to anticoagulation as the reference therapy of VTE, IVC filters will significantly reduce the frequency of symptomatic PE; however, there is no advantage in overall survival for either therapy.

Achievements

Despite different guidelines in clinical routine practice the use of IVC filters appears to depend on the individual clinical experience and assessment of the interventionalist.

Practical recommendations

Nowadays retrievable filters should be used although there are relevant differences between the various devices. As a matter of principle all IVC filters should be removed as soon as adequate anticoagulation can be established.     

Complex Retrieval of Embedded IVC Filters: Alternative Techniques and Histologic Tissue Analysis

Purpose

We evaluated the safety and effectiveness of alternative endovascular methods to retrieve embedded optional and permanent filters in order to manage or reduce risk of long-term complications from implantation. Histologic tissue analysis was performed to elucidate the pathologic effects of chronic filter implantation.

Methods

We studied the safety and effectiveness of alternative endovascular methods for removing embedded inferior vena cava (IVC) filters in 10 consecutive patients over 12?months. Indications for retrieval were symptomatic chronic IVC occlusion, caval and aortic perforation, and/or acute PE (pulmonary embolism) from filter-related thrombus. Retrieval was also performed to reduce risk of complications from long-term filter implantation and to eliminate the need for lifelong anticoagulation. All retrieved specimens were sent for histologic analysis.

Results

Retrieval was successful in all 10 patients. Filter types and implantation times were as follows: one Venatech (1,495?days), one Simon-Nitinol (1,485?days), one Optease (300?days), one G2 (416?days), five Günther-Tulip (GTF; mean 606?days, range 154?C1,010?days), and one Celect (124?days). There were no procedural complications or adverse events at a mean follow-up of 304?days after removal (range 196?C529?days). Histology revealed scant native intima surrounded by a predominance of neointimal hyperplasia and dense fibrosis in all specimens. Histologic evidence of photothermal tissue ablation was confirmed in three laser-treated specimens.

Conclusion

Complex retrieval methods can now be used in select patients to safely remove embedded optional and permanent IVC filters previously considered irretrievable. Neointimal hyperplasia and dense fibrosis are the major components that must be separated to achieve successful retrieval of chronic filter implants.     

Endovascular Treatment of Veno-Occlusive Behcet’s Disease

Purpose

To retrospectively evaluate the outcome of endovascular treatments for patients with chronic veno-occlusive disease in different vascular beds secondary to Behcet’s disease (BD). There are few case reports on the subject, and this is the largest study to date.

Materials and Methods

From January 2001 through October 2009, chronic venous occlusions were treated in 10 patients (all male [age range 18–76?years]) with BD using percutaneous transluminal angioplasty and/or stent placement. All patients were symptomatic and had chronic iliofemoral deep venous thrombosis (DVT; n?=?5), central venous occlusion (n?=?3), or Budd–Chiari syndrome (BCS; n?=?2). All patients met criteria of the International Study Group on Behcet’s Disease.

Results

Two of five patients with DVT had unsuccessful recanalization attempts. Three patients had successful recanalization with stent placement. All three veins were occluded within 1?month with unsuccessful reinterventions. Three patients with chronic central venous occlusion had successful recanalization with percutaneous transluminal angioplasty (n?=?1) and stent placement (n?=?2). Two patients had reocclusion with successful reintervention. Two BCS patients had successful treatment with stent placements. Overall technical success was 69%, and no procedural complications were encountered. None of the patients with chronic DVT had patent veins; however, all patients with central venous occlusion or BCS had patent veins on color Doppler ultrasonography at follow-up ranging from 3 to 48?months after intervention.

Conclusion

Endovenous treatment for chronic iliofemoral DVT due to BD had a poor outcome. However, long-term outcome after endovenous treatment for upper-extremity central venous occlusion and BCS syndrome was good.     

Role of IVC Filters in Endovenous Therapy for Deep Venous Thrombosis: The FILTER-PEVI (Filter Implantation to Lower Thromboembolic Risk in Percutaneous Endovenous Intervention) Trial

Objectives

The purpose of this study was to evaluate the necessity of and recommend indications for inferior vena cava (IVC) filter implantation during percutaneous endovenous intervention (PEVI) for deep venous thrombosis (DVT).

Background

PEVI has emerged as a powerful tool in the management of acute proximal DVT. Instrumentation of extensive fresh thrombus is potentially associated with iatrogenic pulmonary embolism (PE). The true frequency of this complication has not been studied in a randomized fashion. We evaluated IVC filter implantation during PEVI for DVT.

Methods

A total of 141 patients with symptomatic proximal DVT undergoing PEVI for symptomatic DVT were randomized to receive an IVC filter (70 patients) or no filter (71 patients; control group). The anticoagulation and PEVI regimen were similar between the two groups. Patients with development of symptoms suggestive of PE underwent objective testing for PE.

Results

PE developed in 1 of the 14 symptomatic patients in the filter group and 8 of the 22 patients in the control group (P?=?0.048). There was no mortality in any group. Three patients (4.2%) in the control group had transient hemodynamic instability necessitating resuscitory efforts. Predictors of iatrogenic PE were found to be PE at admission; involvement of two or more adjacent venous segments with acute thrombus; inflammatory form of DVT (severe erythema, edema, pain, and induration); and vein diameter of?≥7?mm with preserved architecture.

Conclusions

IVC filter implantation during PEVI reduces the risk of iatrogenic PE by eightfold without a mortality benefit. A selective approach may be exercised in filter implantation during PEVI.     

Endovascular Iliocaval Stent Reconstruction for Inferior Vena Cava Filter–Associated Iliocaval Thrombosis: Approach,Technical Success,Safety, and Two-Year Outcomes in 120 Patients

Purpose

To report technical success, outcomes, and patency of iliocaval stent reconstruction for inferior vena cava (IVC) filter–bearing iliocaval thrombosis.

Value of blood flow velocity on color Doppler ultrasonography for optimization of delay in scanning time on computed tomography venography in patients with Budd–Chiari syndrome and inferior vena cava obstruction

Purpose

To prospectively determine the value of blood flow velocity in the inferior vena cava (IVC) on color Doppler ultrasonography for the optimization of the delay in scanning time after contrast injection during computed tomography (CT) venography in patients with Budd–Chiari syndrome (BCS) with IVC obstruction.

Methods

We enrolled 122 consecutive BCS patients with IVC obstruction. All patients underwent color Doppler ultrasonography, CT venography, and digital subtraction angiography (DSA) in that order prior to treatment. The delay in scanning time during CT venography was set at 120, 180, 240, and 300 s after contrast injection. The correlation between delay in CT scanning and IVC blood flow velocity on color Doppler ultrasonography was explored. Image quality was classified as good, moderate, or poor. Patients with good CT image quality were considered to have an optimal delay in scanning time.

Results

Delays in scanning time of 120, 180, 240, and 300 s yielded good-quality images in 2, 7, 49, and 64 patients, respectively. The corresponding IVC blood flow velocities in these patients were 16.10 ± 0.42 cm/s (range 15.8–16.4 cm/s), 12.90 ± 1.58 cm/s (range, 11–15 cm/s), 7.53 ± 1.35 cm/s (range 5–10 cm/s), and 1.95 ± 1.75 cm/s (range 0–5.5 cm/s).

Conclusion

IVC blood flow velocity on color Doppler ultrasonography could serve as a useful tool for the optimization of the delay in scanning time during CT venography to ensure good-quality images for the diagnosis of BCS with IVC obstruction.

     

三维对比剂增强MR血管成像诊断布加综合征的价值

目的观察三维对比剂增强MR血管成像（3DCEMRA）上布加综合征（BCS）的各种表现,并初步评价该项新技术的价值。方法33例BCS患者行3DCEMRA检查。23例为继发性BCS,分别继发于肝细胞癌（21例）、右肾上腺癌（1例）或血栓性静脉炎（1例）。10例为原发性BCS。观察肝静脉、下腔静脉（IVC）和门静脉的开放性,观察有无肝内外侧支、肝实质病变和门静脉一体静脉间曲张静脉。10例患者行下腔静脉造影术,2例行肝右静脉穿刺造影术,把3DCEMRA所获的诊断结果与造影相对照。结果3DCEMRA可显示BCS的各种表现。肝静脉表现包括：癌栓形成（19例）、肿瘤压迫（2例）、肝静脉未显示（4例）和局限性狭窄（4例）。IVC表现为严重狭窄或闭塞（10例）、肿瘤直接侵犯（2例）、癌栓形成（3例）、血栓性静脉炎（1例）和隔膜形成（3例）。9例显示肝内侧支形成,其中2例显示“蜘蛛网”征象。所见的肝外侧支包括扩张的奇静脉和半奇静脉（13例）,以及左肾一膈下一心包膈静脉侧支（2例）形成。2例患者发现门静脉左支闭塞,10例患者发生门静脉．体静脉间静脉曲张。3DCEMRA发现的肝实质病变有：尾叶增大（7例）、不均匀强化（18例）和并发肿瘤（18例）。12例3DCEMRA诊断结果均与造影结果一致。结论3DCEMRA能显示BCS的各种征象,并能帮助提供正确诊断。     

Anatomical observations on the renal veins and inferior vena cava at magnetic resonance angiography

Purpose

To describe the renal vein and inferior vena cava (IVC) anatomy found at abdominal magnetic resonance (MR) angiography.

Methods

Gadolinium-enhanced, three-dimensional, time-of-flight MR angiograms of 150 patients were evaluated for the number and configuration of the renal veins, and the number, configuration, and dimensions of the IVC. Data were analyzed with the Student's ttest.

Results

Retroaortic left renal veins were found in 7% of patients, circumaortic left renal veins in 5%, multiple right renal veins in 8%, and duplicated IVCs in 0.7%. The length of the infrarenal IVC averaged 94 mm in females and 110 mm in males (p<0.00001). The length of the infrarenal IVC in patients with circumaortic and retroaortic left renal veins averaged 76 mm and 46 mm, respectively. The mean maximal caval diameter was 23.5±4 mm. No megacavae (diameter of the mid-IVC > 28 mm) were identified.

Conclusion

Variant renal vein and IVC anatomy can be identified at MR angiography.     

Efficacy of Lower-Extremity Venous Thrombolysis in the Setting of Congenital Absence or Atresia of the Inferior Vena Cava

Purpose

A rare but described risk factor for deep venous thrombosis (DVT), predominately in the young, is congenital agenesis or atresia of the inferior vena cava (IVC). The optimal management for DVT in this subset of patients is unknown. We evaluated the efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) followed by systemic anticoagulation in the treatment of acute lower-extremity DVT in the setting of congenital IVC agenesis or atresia.

Materials and Methods

Between November of 2005 and May of 2010, six patients (three women [average age 21?years]) were referred to our department with acute lower-extremity DVT and subsequently found to have IVC agenesis or atresia on magnetic resonance imaging. A standardized technique for PCDT (the Angiojet Rheolytic Thrombectomy System followed by the EKOS Microsonic Accelerated Thrombolysis System) was used for all subjects. Successful thrombolysis was followed by systemic heparinization with transition to Coumadin or low molecular-weight heparin and compression stockings. Subjects were followed-up at 1, 3, and then every 6?months after the procedure with clinical assessment and bilateral lower-extremity venous ultrasound.

Results

All PCDT procedures were technically successful. No venous stenting or angioplasty was performed. The average thrombolysis time was 28.6?h (range 12–72). Two patients experienced heparin-induced thrombocytopenia, and one patient developed a self-limited knee hemarthrosis, No patients were lost to follow-up. The average length of follow-up was 25.8?±?20.2?months (range 3.8–54.8). No incidence of recurrent DVT was identified. There were no manifestations of postthrombotic syndrome.

Conclusions

PCDT followed by systemic anticoagulation and the use of compression stockings appears to be safe and effective in relatively long-term follow-up treatment of patients who present with acute DVT and IVC agenesis or atresia.     

Endovascular treatment with primary stenting of inferior cava vein torsion following orthotopic liver transplantation with modified piggyback technique

Purpose

This study was undertaken to evaluate primary stenting in patients with inferior vena cava torsion after orthotopic liver transplantation performed with modified piggyback technique.

Materials and methods

From November 2003 to October 2010, six patients developed clinical, laboratory and imaging findings suggestive of caval stenosis, after a mean period of 21 days from an orthotopic liver transplantation performed with modified piggyback technique. Vena cavography showed stenosis due to torsion of the inferior vena cava at the anastomoses and a significant caval venous pressure gradient. All patients were treated with primary stenting followed by in-stent angioplasty in three cases.

Results

In all patients, the stents were successfully positioned at the caval anastomosis and the venous gradient pressure fell from a mean value of 10 to 2 mmHg. Signs and symptoms resolved in all six patients. One patient died 3 months after stent placement due to biliary complications. No evidence of recurrence or complications was noted during the follow-up (mean 49 months).

Conclusions

Primary stenting of inferior vena cava stenosis due to torsion of the anastomoses in patients receiving orthotopic liver transplantation with modified piggyback technique is a safe, effective and durable treatment.     

Suction against resistance: a new breathing technique to significantly improve the blood flow ratio of the superior and inferior vena cava

Objectives

Optimal contrast within the pulmonary artery is achieved by the maximum amount of contrast-enhanced blood flowing through the superior vena cava (SVC), while minimum amounts of non-contrasted blood should originate from the inferior vena cava (IVC). This study aims to clarify whether “suction against resistance” might optimise this ratio.

Methods

Phase-contrast pulse sequences on a 1.5T MRI magnet were used for flow quantification (mean flow (mL/s), stroke volume (Vol) in the SVC and IVC in volunteers. Different breathing manoeuvers were analysed repeatedly: free breathing; inspiration; expiration; suction against resistance, and Valsalva. To standardise breathing commands, volunteers performed suction and Valsalva manoeuvers with an MR-compatible manometer.

Results

Suction against resistance was associated with a significant drop of the IVC/SVC flow quotient (1.63 [range 1.3-2.0] p?p?p?>?0.05).

Conclusions

Suction against resistance caused a significant drop in the IVC/SVC quotient. Theoretically, this breathing manoeuver might significantly improve the enhancement characteristics of CT angiography.

Key Points

? Suction provokes reduction in blood flow in the inferior vena cava. ? Ratio between the inferior and superior vena cava blood flow diminished during suction. ? Manometer used during breathing standardises MR phase-contrast blood flow measurements.     

Catheter-directed thrombolytic therapy for thoracic deep vein thrombosis is safe and effective in selected patients with and without cancer

Objective

To assess the safety, feasibility and efficacy of catheter-directed thrombolysis for thoracic central venous thrombosis in both cancer and non-cancer patients.

Materials and methods

A retrospective case series of 68 patients, including 35 with active cancer and 33 without cancer, was analysed. They all received catheter-directed thrombolysis with alteplase or urokinase for symptomatic acute major thoracic vein thrombosis.

Results

Substantial clot lysis was obtained in 62 out of 68 patients (91%), the results being 88.6 and 93.8% for cancer and non-cancer patients respectively (P?=?0.68). The mean infusion time in patients with and without cancer was 2.11 and 1.84 days respectively (P?=?0.3259). Procedure-related complications occurred in two cancer patients (8.6%) and in seven non-cancer patients (21%) (P?=?0.18). One cancer patient developed a fatal intracranial bleeding. Additional intervention after successful lysis was performed in cancer (n?=?18; 51%) as well as in non-cancer patients (n?=?29; 88%).

Conclusion

Catheter-directed thrombolysis is a feasible and highly effective interventional procedure with an acceptable safety profile in selected patients with and without cancer for the treatment of symptomatic thoracic central venous thrombosis. In most cases, additional endovascular or surgical procedures are required to restore and maintain vessel patency after successful thrombolysis.     

Vascular measurement changes observed using postmortem computed tomography

Purpose

Postmortem vascular changes were quantitatively analyzed in the aorta and vena cava and compared with antemortem findings as a basis for distinguishing between normal postmortem changes and pathological changes.

Materials and methods

Whole-body computed tomography (CT) was performed on 12 individuals before and after death. The scans, performed at seven levels (five for the aorta, two for the vena cava) within the vasculature, allowed various measurements to be made on the same individual before and after death.

Results

Postmortem long-axis diameter, short-axis diameter, and the square of the radius of the aorta were 79.2–85.0 % (mean 81.3 %), 55.6–80.0 % (68.0 %), and 48.5–71.4 % (60.8 %) of the antemortem measurements, respectively. The ante- and postmortem measurements of the long and short axes and the caliber of the aorta were statistically different (p < 0.05). The superior vena cava (SVC) was increased in size: the short-axis diameter and the square of the radius were both statistically different after death. None of the measured parameters of the inferior vena cava (IVC) changed significantly following death.

Conclusion

In postmortem images, the aortic diameter decreased and changes in the size and shape of the SVC were noted. The IVC did not exhibit significant postmortem changes.     

Location of major vessels in prone-positioned patients undergoing percutaneous lumbar sympathectomy

Introduction

The topographic relationship between major vessels and the sympathectomy target is not identical across patients and may not be clear, especially in patients in the prone position. The aim of this study was to provide anatomic data regarding the location of the major vessels (i.e., vena cava and aorta) based on computed tomography (CT) images obtained during lumbar sympathectomy under CT fluoroscopic guidance.

Methods

Thirty-six patients with peripheral arterial occlusive disease or chronic pain syndrome were treated using fluoroscopic CT-guided percutaneous lumbar sympathectomy between April 2006 and March 2010. We analyzed the shortest distances between the sympathectomy target and the major vessels, and the relationship between the location of the major vessels and the vertebral anterior line using CT images obtained during the procedure.

Results

At the L3 level, the shortest distances from the right side target to the inferior vena cava were significantly shorter than the other distances (P?Conclusion Needle insertion for right side sympathectomy at the L3 level may present a higher risk of major vessel puncture than sympathectomy at other sites. CT guidance is recommended for lumbar sympathectomy to reduce the risk of vascular puncture.     

Catheter-directed Thrombolysis with Argatroban and tPA for Massive Iliac and Femoropopliteal Vein Thrombosis

Purpose

Catheter-directed thrombolysis (CDT) is a highly effective approach in the treatment of deep venous thrombosis (DVT). There are no data on the primary use of CDT with argatroban and tissue plasminogen activator (tPA) in patients without heparin-induced thrombocytopenia (HIT). The aim of this study was to evaluate the efficacy and safety of the combined administration of argatroban and tPA during CDT for massive DVT in patients without HIT.

Methods

Thirty-three patients with massive symptomatic iliac and femoropopliteal DVT underwent CDT with tPA and argatroban within 28 ± 6 h of presentation. The dose of tPA was 0.75–1 mg/h through the infusion port and that of argatroban at 0.3–1 μg/kg/min through the side port of the sheath. The patients were evaluated for the efficacy and safety of CDT and recurrent symptomatic venous thromboembolism (VTE) at a mean follow-up of 22 months.

Results

There was no bleeding or iatrogenic pulmonary embolism with the CDT regimen we used. Grade III lysis (complete resolution of thrombus on venography) was achieved in 30 patients (91 %). In 3 patients with additional inferior vena cava filter thrombosis, further thrombectomy of the filter was required. No patient developed recurrent VTE.

Conclusion

Concomitant administration of argatroban and tPA is a highly safe and effective regimen for CDT for massive DVT.     

Transjugular intrahepatic portocaval shunt placed through the strut of an inferior vena cava stent in a patient with Budd–Chiari syndrome: a technical modification

Transjugular intrahepatic portocaval shunt (TIPS) is performed in patients with symptomatic Budd–Chiari syndrome (BCS) who do not have repairable hepatic veins. We report the case of a patient who had an inferior vena cava (IVC) stent placed previously as part of the management for BCS, and who subsequently required TIPS. The TIPS tract was created through the strut of the previously placed IVC stent; the TIPS stent was placed after dilatation of the liver parenchyma as well as the strut of the IVC stent. This novel technique of “strutplasty” of a previously placed stent as part of TIPS has not been reported in the literature.The transjugular intrahepatic portocaval shunt (TIPS) procedure, as well as stent technology, is continually being improved [1–5]. Direct intrahepatic portocaval shunt (DIPS) – a modification of the TIPS procedure – is especially useful when there are occluded hepatic veins or an unfavourable angle between the inferior vena cava (IVC) and the hepatic vein resulting from hydrothorax and hypertrophy of the caudate lobe of the liver [1]. Herein, we report a technical modification of the TIPS procedure in Budd–Chiari syndrome (BCS).     

可回收支架治疗下腔静脉阻塞合并血栓形成的中期疗效

目的 观察可回收支架治疗下腔静脉阻塞(BCS)合并血栓形成的中期疗效.方法 8例下腔静脉合并血栓BCS,采用术中抗凝溶栓治疗后,行钝性破膜小球囊预扩张后植入可回收支架,最后使用大球囊充分扩张闭塞膜.术后给予抗凝溶栓治疗,待血栓消失后经颈内静脉将可回收支架取出.其中下腔静脉节段性闭塞合并血栓患者同时置入"Z"型支架.术后用彩色多普勒随访疗效.结果 8例患者均成功实施了介入治疗,血栓均在短期内消失,可回收支架顺利取出,术中未发生肺动脉栓塞和其他并发症.彩色多普勒超声随访3～12个月,2例下腔静脉狭窄,余6例可回收支架置入部位未见血栓形成、局部再狭窄及管壁增厚等情况发生.结论 使用可同收支架治疗下腔静脉阻塞合并血栓形成疗效满意.