Budd-Chiari综合征:下腔静脉阻塞合并血栓的可回收内支架设计与应用

目的设计可回收内支架以治疗下腔静脉阻塞并血栓型Budd-Chiari综合征(BCS)并观察其临床效果。方法根据下腔静脉合并血栓型BCS病变特点,设计可回收内支架。4例下腔静脉阻塞并血栓型BCS,行钝性破膜小球囊预扩张后置入可回收内支架压迫血栓,再使用大球囊充分扩张闭塞段,完全开通闭塞的下腔静脉。术后给予抗凝溶栓治疗,待血栓消失后经颈内静脉或股静脉将可回收内支架取出。其中下腔静脉节段性闭塞合并血栓者同时在原闭塞段置入“Z”型支架,术后彩超随访。结果4例患者成功介入治疗,血栓短期内消失,可回收内支架顺利取出,术中术后未发生肺动脉栓塞、下腔静脉破裂以及其他并发症。彩超随访3个月,可回收内支架置入部位未见血栓形成、管壁增厚和局部再狭窄。结论应用可回收内支架治疗BCS下腔静脉病变合并血栓安全、有效,对局部血管壁无不良影响,可替代永久内支架置入,值得推广。

The design and application of retrieval stent for Budd-Chiari syndrome with inferior vena cava thrombosis

Objective To design the retrieval stent and study the preliminary treatment effect for Budd-Chiari syndrome (BCS) complicated with inferior vena cava thrombosis. Methods The retrieval stent was designed on the basis of the characteristics of BCS complicated with thrombosis. Four patients with BCS complicated with thrombosis were involved, including recanalization of inferior vena cava through blunt wire penetration after anticoagulation and thrombolytic therapy, then followed by dilation with smaller balloon, and retrievable stent placement, and finally ending by dilation of IVC with larger balloon. All retrieval stents were taken out through internal jugular vein after disappearance of thrombi. Z stent and a retrievable stent were placed at same time for IVC segmental occlusion. Doppler US monitored the course of follow up. Results Technical success was achieved in 4 patients without pulmonary infarction and other complications during and after the procedure. After all thrombi completely disappeared, all retrievable stents were taken out uneventfully. 3 months follow up with color Doppler did not find thrombus formation, wall thickening and local restenosis at the sites of stent placement. Conclusion Treatment of BCS complicated with inferior vena cava thrombosis by retrievable stent is a safe and effective method, without complications on vascular wall, probably could take the place of perminent endovascular stent placement. (J Intervent Radiol, 2006, 15: 533-536)