节段性狭窄闭塞Budd—Chiari综合征的介入治疗

研究了下腔静脉节段性狭窄闭塞及合并肝静脉阻塞和血栓形成Ｂｕｄｄ－Ｃｈｉａｒｉ综合征的介入治疗。本组１２例，男１１例，女１例；年龄１９－５０岁，平均２８．８岁。１２例中１０例为下腔静脉肝段闭塞，２例为狭窄，狭窄闭塞长度为２．０－１５．５ｃｍ，平均５．６ｃｍ；并有１－３支不等肝静脉阻塞１０例。     

双隔膜性Budd—Chiari综合征的介入治疗

本文报告６例下腔静脉双膈膜性Ｂｕｄｄ－Ｃｈｉａｒｉ综合征的介入治疗结果，其中５例表现为下腔静脉长段阻塞，１例为短段阻塞，取得了满意的临床效果。由于采取了分次破膜，明显降低开通的开通的难度和风险。作者认为：血管内支架植入可有效地双隔膜性ＢＣＳ术后再狭窄，提高远期疗效。     

经皮血管内支架置入术治疗腔静脉狭窄

作者用自制Ｚ型和螺旋型自张式金属支架对５例腔静脉狭窄者进行治疗。其中上腔静脉狭窄２例，下腔静脉狭窄３例，术后管腔直径平均由３．４５ｍｍ增加至１６ｍｍ，所有５例均进行了定期随访复查，随访时间平均１３．６个月（６￣１９个月）。３例于术后症状、体征消失，１例由于存在肝静脉阻塞，其症状仅部分缓解；１例支架由上腔静脉脱落并移位至肺动脉主干内及左肺动脉。作者还详细讨论了支架置入术中出现意外的原因。认为支架置入     

经皮上腔静脉成型术治疗上腔静脉阻塞综合征

目的　探讨经皮上腔静脉支架成型术治疗上腔静脉阻塞综合征的方法及临床价值。方法　上腔静脉阻塞综合征患者 1 5例 ,包括肺癌伴纵隔淋巴结转移 1 0例 ,非霍奇金淋巴瘤 3例 ,食管癌伴纵隔淋巴结转移 2例 ,均先行右锁骨下静脉或肘静脉穿刺插管至阻塞上段作造影、测压 ,显示阻塞的部位、程度、侧支循环及有无血栓等情况 ,再经右侧股静脉穿刺入路置放上腔静脉支架。结果　 1 5例患者均 1次成功地植入上腔静脉支架 ,1例患者因狭窄范围超过 1 0cm而导入 2枚支架 ,其余均置入 1枚支架。术后造影显示血流恢复通畅 ,手术前后梗阻远端测压从术前的 (30 .5± 2 .3)cmH2 O降到术后的 (8.8±1 .5 )cmH2 O(均为卧位测压 ) ,差异有显著性 (P <0 .0 1 )。术后造影侧支静脉不再显影 ,上腔静脉阻塞症状明显改善 ,随访 6个月 ,除 1例患者因合并血栓经局部溶栓、球囊扩张治疗后症状改善 ,其余患者均无阻塞症状复发。结论　经皮上腔静脉成型术创伤小、恢复快、疗效确切 ,是治疗上腔静脉阻塞综合征的有效方法。     

锁骨下动脉狭窄的经皮血管球囊成形术及内支架治疗

目的 评价并比较经皮血管球囊成形术及内支架治疗对动脉粥样硬化及大动脉炎所致锁骨下动脉狭窄梗阻性病变的治疗效果。方法 １３例锁骨下动脉狭窄梗阻性病变患者,病因为动脉粥样硬化７例,大动脉炎６例。其中锁骨下动脉狭窄８例,完全闭塞５例,均实施了介入治疗。６例单纯行经皮血管球囊成形术,６例置入血管内支架,１例介入治疗失败。结果 １２例行经皮血管内成形术（ＰＴＡ）或血管内支架置入治疗获成功,６例分别置入Ｓｔｒ     

原发性肝癌致下腔静脉阻塞的介入治疗

目的研究介入治疗肝癌所致下腔静脉梗阻的疗效及方法。方法6例患者,临床主要症状有腹胀、腹壁静脉曲张和下肢浮肿等。均为肝右叶病变压迫侵蚀下腔静脉所致的狭窄阻塞。治疗方法采用先溶栓,而后球囊扩张和内支架植入。结果6例患者狭窄阻塞的下腔静脉均开通成功,下腔静脉血流通畅,压力由术前的4.0kPa(1kPa=7.5mmHg)降至2.1kPa,无严重并发症。结论采用介入方法开通由于肝癌所引起的下腔静脉狭窄阻塞,疗效肯定,可提高患者的生活质量,延长患者的生存时间。     

不同原因引起的布—加综合征的介入治疗

目的：研究介入治疗对不同原因引起的下腔静脉梗阻的疗效及并发症。材料与方法：患者共１４ 例（ 男１０ 例、女４ 例） ,肝癌引起的下腔静脉梗阻１ 例,白塞氏综合征２ 例,不明原因１１ 例。１４ 例均植入金属支架,１３ 例为１ 次,１ 例为３次。结果：１４ 例开通均成功,１３ 例金属支架植入成功,梗阻症状１ ～５ 天内消失。１ 例失败,且并发血胸,２ 例并发肺梗塞。结论：采用介入治疗开通下腔静脉梗阻创伤小、效果好,对于肿瘤引起的下腔静脉梗阻可反复治疗,提高生活质量。     

节段性狭窄闭塞Budd-Chiari综合征介入治疗的临床评价

目的：评价应用穿通术、ＰＴＡ、内支架（ｓｔｅｎｔ）置入及溶栓术治疗节段性狭窄闭塞Ｂｕｄｄ－Ｃｈｉａｒｉ综合征（ＢＣＳ）的临床效果。方法：本组２４例，其中节段性狭窄１４例，闭塞１０例，大部分并有肝静脉不同程度阻塞，下腔静脉血栓形成２例。应用Ｂｒｏｃｋｅｎｂｒｏｕｇｈ穿刺针行下腔静脉闭塞段穿通术，ＰＴＡ和内支架置入；应用Ｒｕｐｓ－１００开通阻塞的肝静脉。结果：２４例下腔静脉均开通成功，同时开通１１支肝静脉，下腔静脉压力平均由术前的３．１４ｋＰａ降至１．１５ｋＰａ，肝静脉压力由术前的２．７５ｋＰａ降至１．９１ｋＰａ。平均随访１３．５个月，２例发生轻度下腔静脉狭窄，但临床症状也有明显改善。结论：在ＢＣＳ介入治疗中，ＰＴＡ应视为首选方法，但对治疗效果不好，尤其是节段性病变应置入内支架，对合并肝静脉阻塞和血栓的要做相应的介入治疗，可明显提高临床效果。术后抗凝治疗是维持开通血管长期通畅的重要手段。     

Budd-Chiari综合征侧支循环的血管造影表现

目的探讨ＢｕｄｄＣｈｉａｒｉ综合征（ＢＣＳ）侧支循环的血管造影表现及与介入治疗的关系。方法回顾性分析了３０例ＢＣＳ的血管造影表现，有膜性狭窄闭塞２２例，节段狭窄闭塞８例，病程４个月至２５年。行下腔静脉和楔嵌肝静脉造影。结果侧支循环分为肝内侧支、肝外侧支及肝内外侧支。肝内侧支有：（１）肝静脉藉包膜下侧支与体循环交通；（２）肝内叶间交通；（３）未确定型。肝外侧支有：（１）腰升静脉－奇静脉及半奇静脉通道；（２）腹壁浅静脉通道；（３）左肾静脉－半奇静脉通道；（４）左肾静脉－膈下静脉通道；（５）门静脉途径。结论侧支循环的解剖学变化取决于阻塞的部位，对ＢＣＳ介入治疗的选择和判断疗效具有重要意义     

多层螺旋CT对布-加氏综合征的诊断价值

目的：探讨螺旋CT对布加氏综合征的诊断价值；方法：搜索经临床及其影像检查证实的布加氏综合征4例，回顾性分析其CT表现。结果：CT动态增强扫描及后处理重建显示肝水平上段下腔静脉狭窄3例；肝水平下腔静脉显示不清1例；肝下段下腔静脉扩张3例；脾大，脾静脉迂曲、扩张3例；奇静脉及半奇静脉扩张4例；食管胃底静脉曲张1例。均显示局部肝静脉和下腔静脉狭窄及范围。结论：多层螺旋CT可明确血管阻塞部位，程度，范围及侧支循环，对诊断具有重要参考价值并指导临床治疗。     

Gianturco self-expanding stents: Clinical experience in the vena cava and large veins

Twenty-five patients with stenosis of the vena cava (21) and other large veins (4) have been treated with self-expanding Gianturco metallic stents. Eighteen patients had superior vena cava syndrome. In 17, the stricture was due to malignant superior vena cava compression recurrent after maximum tolerance radiotherapy and/or chemotherapy. In 16 of these patients there was early symptomatic relief. In 1 patient with a benign posttraumatic superior vena cava stricture, the stenosis was not relieved, and occlusion occurred after 1 month. Stenoses associated with dialysis shunts were relieved in 2 other patients. Two malignant and one benign inferior vena cava stenoses were relieved either until death, or in the benign case, for 30 months. One malignant subclavian vein obstruction occluded after 24 h due to stent misplacement and another with extrinsic mediastinal compression remained patent until death, extensive thrombus having been lysed prior to stent placement. The results of this short series suggest that the Gianturco self-expanding stent in the vena cava and large veins is easy and safe to place, and in most cases produces almost immediate palliation of the distressing effects of venous obstruction, often in a preterminal and inoperable patient.     

Placement of Hemodialysis Catheters Through Stenotic or Occluded Central Thoracic Veins

A method for hemodialysis catheter placement in patients with central thoracic venous stenosis or occlusion is described and initial results are analyzed. Twelve patients, with a mean age of 63.2 years (42–80 years), with central venous stenosis or occlusion, and who required a hemodialysis catheter were reviewed. All lesions were confirmed by helical CT or phlebography. Five patients had stenosis while seven patients were diagnosed with an occlusion of thoracic central veins. All patients were asymptomatic, without sign of superior vena cava syndrome. After percutaneous transstenotic catheterization or guidewire-based recannalization in occlusions, a balloon dilatation was performed and a stent was placed, when necessary, prior to catheter placement. Technical success was 92%. Three patients had angioplasty alone and nine patients had angioplasty with stent placement. Dialysis catheters were successfully inserted through all recannalized accesses. No immediate complication occurred, nor did any patient develop superior vena cava syndrome after the procedure. The mean follow-up was 21.8 months (range, 8–48 months). Three patients developed a catheter dysfunction with fibrin sheath formation (at 7, 11, and 12 months after catheter placement, respectively). Two were successfully managed by percutaneous endovascular approach and one catheter was removed. In conclusion, for patients with central venous stenosis or occlusion and those who need a hemodialysis catheter, catheter insertion can be reliably achieved immediately after endovascular recannalization with acceptable technical and long-term success rates. This technique should be considered as an alternative procedure for placing a new hemodialysis catheter through a patent vein.     

合并静脉血栓形成的布加综合征的介入治疗

目的探讨合并静脉血栓形成的布加综合征的介入治疗。方法回顾性分析我科2005年8月～2012年2月收治的39例合并静脉血栓形成的布加综合征患者的临床资料,其中合并下腔静脉血栓形成18例,合并下肢静脉血栓形成21例。结果 18例经股静脉行置管溶栓术,21例经腘静脉行置管溶栓术,经溶栓治疗后行介入治疗,成功36例,成功率92.3%。26例单纯行下腔静脉球囊扩张术,10例行球囊扩张后置入支架,1例术中出现心包填塞严重并发症,终止手术,转心脏外科开胸行下腔静脉修补术;2例闭塞段较长(>7cm),未开通,放弃介入治疗。33例患者得到随访,平均随访52.6个月。随访期内2例下腔静脉膜性狭窄球囊扩张术后分别于6个月和10个月出现再狭窄,后置入支架,症状改善。其余随访患者下腔静脉通畅,支架无脱落及移位。结论置管溶栓联合血管腔内成形术治疗合并静脉血栓形成的布加综合征微创、有效,中远期效果好,应为首选的治疗方法。     

Endovascular treatment of benign superior vena cava syndrome: venographic patterns and implications for treatment

PURPOSE: We report our experience with the percutaneous treatment of superior vena cava syndromes of benign etiology. MATERIALS AND METHODS: From August 1994 to August 2003 a total of 14 superior vena cava syndromes of benign origin were treated. Previous use of a central venous catheter pending the development of a peripheral arteriovenous fistula for dialysis was believed to be the cause of the obstruction of the superior vena cava in 11 patients. In 2 other cases the cause was attributed to post-radiation mediastinal fibrosis and, in one case, to a previously implanted pacemaker. The superior vena cava syndrome was confirmed by venography. After negotiating the obstruction, a self-expanding stent was selected based on the CT and venographic data. At the end of the procedure, technical success was confirmed by venography, and haemodynamic success by pressure measurements. The follow-up allowed the assessment of the clinical success of the procedure. RESULTS: Technical success was achieved in 13 patients (92.8%); in one case the obstruction could not be negotiated with the wire guide, so the patient was referred for surgery. One self-expanding stent proved sufficient to resolve the central venous obstruction and restore superior vena cava diameter in all cases but one. In one young woman, whose central obstruction was resolved with PTA, was unable to complete the procedure with deployment of a self-expanding stent owing to a supervening asthma attack that could not be treated with the commonly-used drugs. No complications related to the procedure were reported. The symptoms cleared up within 2 weeks, and haemodynamic improvements were already seen within minutes of stent deployment. CONCLUSIONS: Percutaneous treatment is a valuable alternative to surgery as it is able to restore haemodynamic parameters and resolve the clinical picture, ensuring longer functionality to arteriovenous fistulae and an improved quality of life.     

彩色多普勒超声引导下经皮气囊导管成形术治疗Budd-Chiari综合征

目的探讨彩色多普勒超声（ＣＤＵ）引导经皮气囊导管成形术（ＰＴＡ）治疗ＢｕｄｄＣｈｉａｒｉ综合征（ＢＣＳ）的可行性及临床实用价值。方法ＢＣＳ患者９例。其中下腔静脉膜型闭塞５例，节段型闭塞２例和狭窄１例；右肝静脉闭塞１例。在ＣＤＵ的引导和监视下，经右股静脉分别对上述患者静脉狭窄或闭塞段进行穿刺和气囊扩张，并根据静脉内径、血流方向及频谱形态决定扩张程度。结果ＣＤＵ可清晰显示导管、导丝、穿刺针及气囊导管在血管中的位置，正确引导术者进行ＰＴＡ治疗，技术成功率１００％；血管形态和血流动力学是判断ＰＴＡ治疗效果的可靠指标。结论ＣＤＵ是一种引导ＰＴＡ治疗ＢＣＳ的安全、可靠方法     

Subacute and chronic benign superior vena cava obstructions: endovascular treatment with self-expanding metallic stents.

OBJECTIVE: Our purpose is to report our clinical experience with patients who underwent endovascular treatment with Wallstents for subacute or chronic benign obstruction of the superior vena cava (SVC). SUBJECTS AND METHODS: Twelve patients who were an average of 54 +/- 12 years old were referred for treatment of severe SVC syndrome related to implanted central venous catheters (n = 8), postradiation fibrosis (n = 2), a permanent pacemaker (n = 1), or a benign tumor (n = 1). Symptoms were present for an average of 16 weeks (range, 4-48 weeks) before treatment. Diagnosis of SVC obstruction was confirmed with helical CT and pretherapeutic phlebography. Four patients had Stanford's type II stenosis; two, type III; and six, type IV. The mean clinical and radiologic follow-up intervals were 11 months (range, 1-36 months) and 7 months (range, 1 week to 32 months), respectively. RESULTS: Recanalization was successful in all patients. Fifteen stents were implanted in the 12 patients. Stents were placed after percutaneous balloon angioplasty in nine patients, and primary stent placement was attempted in three patients. We immediately achieved a satisfactory SVC diameter in all patients, whose symptoms were relieved completely within 1 week of stent placement. No technical or clinical complications occurred. SVC syndrome recurred in one patient 2 months after stent placement and was treated by placing a second stent. CONCLUSION: Endovascular treatment with stent placement should be considered relevant and safe for refractory benign SVC syndrome. However, a larger series and a longer follow-up period are needed to define the role of stent placement for this syndrome.     

Implanted central venous catheter-related acute superior vena cava syndrome: management by metallic stent and endovascular repositioning of the catheter tip

We describe a case of a 49-year-old woman with stage-IIIB lung adenocarcinoma who experienced an acute superior vena cava syndrome related to an implanted central venous catheter without associated venous thrombosis. The catheter was surgically implanted for chemotherapy. Superior vena cava syndrome appeared after the procedure and was due to insertion of the catheter through a subclinical stenosis of the superior vena cava. Complete resolution of the patient's symptoms was obtained using stent placement and endovascular repositioning of the catheter tip. Received: 24 April 1999; Revised: 8 February 2000; Accepted: 9 February 2000     

血管内支架置入术治疗肺癌引起的上腔静脉综合征

目的:观察血管内支架置入治疗肺癌引起的上腔静脉综合征的疗效。方法:对56例肺癌引起的上腔静脉综合征患者行经股静脉上腔静脉内支架置入治疗。结果:56例患者均成功置入支架,患者症状缓解。8例支架内继发血栓形成,其中1例支架内再次置入支架,7例经溶栓后症状缓解。结论:血管内支架置入术是一种治疗肺癌引起的上腔静脉综合征安全有效的方法。     

Hepatic Veins and Inferior Vena Cava Thrombosis in a Child Treated by Transjugular Intrahepatic Portosystemic Shunt

We report the case of a 9-year-old boy with portal hypertension, due to Budd-Chiari syndrome, and retrohepatic inferior vena cava thrombosis, submitted to a transjugular intrahepatic portosystemic shunt (TIPS) by connecting the suprahepatic segment of the inferior vena cava directly to the portal vein. After 3 months, the withdrawal of anticoagulants promoted the thrombosis of the TIPS. At TIPS revision, thrombosis of the TIPS and the main portal vein and clots at the splenic and the superior mesenteric veins were found. Successful angiography treatment was performed by thrombolysis and balloon angioplasty of a severe stenosis at the distal edge of the stent.