Objective To evaluate endovascular treatment of segmental occlusive Budd-Chiari syndrome(BCS). Methods We retrospectively analyzed the clinical data of segmental occlusive BCS of 45 cases. Inferior vena cava (IVC) puncture, percutaneons transluminal angioplasty (PTA) and stent implant were performed, respectively. Three-dimensional digital subtraction angiography (3D-DSA) was used to evaluate the IVC lesion from multi-angles and to identify the best work angle in complex BCS cases during endovascular treatment. Results IVC puncture and dilation was successful in 43 cases. The pressure of IVC decreased from (35. 3 ± 3.9)cm H2O to (9.5 ± 2. 0) cm H2O (t = 43. 68, P < 0. 01). The puncture failed in 2 cases and the patients were converted to veno-atrial graft shunt. Acute pericardial tamponade developed during PTA in one case. Postoperatively 35 cases were followed-up for 3 months to 46 months and the follow-up rate was 77. 8%. IVC stent thrombosis was identified in one case necessitating veno-atrial graft shunt 15 months post-operatively. There were no stent migration and hepatic venous obstruction in the remaining cases. The case of pericardial tamponade was cured and discharged after IVC repair. Symptoms disappeared except for intercostal neuralgia during 6 months follow-up. There were no pulmonary embolism and death. Conclusions Good medium and long term result could be achieved after endovascular treatment of segmental occlusive BCS. 3D-DSA is helpful for endovascular treatment of BCS.

Objective To evaluate endovascular treatment of Budd-Chiari syndrome(BCS)with occlusion of hepatic veins.Methods Retrospective analysis on the clinical materials of 32 BCS cases with occlusion of hepatic veins was made.Four cases received inferior vena cava(IVC)angioplasty or stent implant and splenorenal shunt;Transfemoral vein or transjugular hepatic vein angioplasty was performed in 10 cases,and percutaneous transhepatic recanalization combined with transjugular and/or transfemoral vein angioplasty of hepatic veins was performed in 16 cases,respectively.Two cases failed therapy attempt.Results A failure to find the main hepatic vein in percutaneous transhepatic venography lead to the abandent of therapy in 2 cases.Hepatic vein angioplasty and IVC angioplasty was successful in the other 30 cases.The pressure of hepatic vein decreased from(43±8)cm H_2O to(16±4)cm H_2O(t=21.23,P<0.01).The symptoms were obviously relieved,ascites disappeared,abdominal distension palliated,chest and abdominal wall varicose veins collapsed one week after endovascular treatment.During perioperative procedure,2 cases with liver puncture bleeding were cured by laparotomy.The follow-up duration was 5 months to 65 months and mean(26.0±2.0)months.There was no stent migration and hepatic vein restenosis and occlusion.Chest and abdominal wall varicose veins disappeared and esophagus phlebeurysma were ameliorated as shown by esophageal barium series.There were no pulmonary embolism and death.Conclusions The procedure of endovascular treatment of BCS with occlusion of hepatic veins is simple,mini-traumatic and effective.

Objective To compare different incidence between lateral position and horizontal position in the Burr holes irrigation drainage(BHID).The BHID is wildly known as the most frequently used neurosurgical treatment of chronic subdural hematoma(CSDH).Methods A total of 80 cases were selected which were undergone BHID during January 2010 and December 2015,and the incidence of intracranial pneumatocele was compared after operation.All of cases came from the Second People′s Hospital of Tai Zhou City.Results There were 5 cases(out of 50,10%)having moderate intracranial pneumocephalus but no numerous intracranial pneumocephalus in lateral position,while 26 cases(out of 30 cases,87%)in horizontal position emerging moderate amount or more intracranial pneumatocele.And there were 8 cases'numerous pneumatocele in the horizontal postion group.There was no tension pneumothorax emerging in both groups.Both groups had statistical difference (χ2 =46.43,P <0.01.Conclusion BHID in lateral postion is a simple and effective method for CSDH,and it is conducive to reduce postoperative intracranial pneumatosis.That is worthy of application and promotion.