Objective To study the interventional therapeutic methods in Budd Chiari syndrome (BCS) complicated with thrombosis. Methods Eighteen patients of BCS complicated with thrombosis, including 2 cases of hepatic vein (HV) occlusion and 16 cases of inferior vena cava (IVC) occlusion, were treated. Therapeutic methods were anti coagulation with Co Danshen and aspirin in 10 cases or the anti coagulation and thrombolysis with urokinase in 8 cases before operation, treatment with PTA and stent during operation,and thrombolysis with urokinase and the anti coagulation after operation. Results Technical success was achieved in all patients without serious complications. The mean blood pressure in IVC dropped from (31 82?0 52)cm H 2O(1 cm H 2O= 0 098 kPa) to (18 17?0 38)cm H 2O immediately after the procedure. The blood pressure in HV dropped from 42 cm H 2O and 41 cm H 2O to 15 cm H 2O and 16 cm H 2O, respectively. All 18 cases were followed up for an average of 38 months (range 6-72 months). The main symptoms and signs completely disappeared in 12 cases and partially alleviated in 6 cases. Conclusion The interventional treatment of BCS complicated with thrombosis was a safe and effective method.

Purpose: Introduce the way of the treatment of deep veinous thrombosis of leg. Meerials and Methods: 26 patients (27 legs) refred for phlebothrombosis of leg, were prove by lower limb Phlebography or ECT. 100～200 thousand unit UK was infused through dorsal veins of sick leg, once or twice per day with 7 days a coure of treatment. Results: 17of 27 legs with phlebothromb0sis, were cured the successful rate 63%, 8 were improved, 30%; 2 were noneffective, 7%. No bleeding occurred 1 case of pulmonary segment embolism. Conclusion The way of the treatment of lower limb deep vein thrombosis by infusion of UK from dorsal veins of sick foot is safe and reliable.

A prospective study was performed to evaluate the diagnostic value of B- mode ultrasonography and inferior vena cavograme and the value of PTA in Budd-Chiari syndrome.One hundred sixty-eight cases including ninety-two men and seventy-six women, age ranged 11～63(mean,34.8 years).Among them 65 were treated with PTA or stent placement.The authors gave a minute and detail description of clinical feature,ultrasono- graphy,inferior vena cava or hepatic venogram,CT and other radiologic demonstration of Budd-Chiari syndrome retrospectively.Four types of Budd-Chiari syndrome were demon- strated based on anatomy,B-mode ultrasonography,inferior vena cavogram and hepa- tovenograme.(1)IVC membranous webs(76 subjects,45.2%),(2)IVC segmental stenosis or occlusion(65 subjects,38.7%),(3)hepatic vein occlusion(10 subjects,6. 1%),(4)mixed type(17 subjects,10%).The treatment of the Budd-Chiari syndrome with percutaneous transluminal balloon dilatation and stent placememnt of inferior vena cava or hepatic vein was safe and satisfied.Its long-term effectiveness(follow up 3-5 years)is al- so satisfactory.

Two patients of Budd-Chiari syndrome,suffering from the anemalons drainage of inferior vena cava into left atrium were reported including one male of 41 years old and female of 42. togectll with labial cyanosis,fingers and toes symptoms of portal hypertension and IVC hypertension. The obstruction of IVC wastreated with balloon catheter hypertension and IVC hypertension the disrotreaed also after PTA.The echo wasn't discovered with Dopple ultrasound after PTA.

Objective To investigate the clinical symptoms and imaging features of Budd-Chiari syndrome with hepatic vein obstruction (HVBCS) and the reasons of mistreatment. Methods Thirteen patients with HVBCS were misdiagnosed and mistreated as inferior vena cava (IVC) obstruction,including 8 patients treated with stent implantation in IVC once and 5 patients with balloon dilatation. After analysis of the clinical symptoms,signs and imaging features; hepatic vein obstruction was further confirmed by digital subtraction angiography (DSA)in all patients. Results All patients had variable degrees of portal hypertension and no apparent symptoms of IVC obstruction. CT or / and MRI showed obvious caudate lobe enlargement and DSA showed IVC narrowing with external compression. All patients were undertaken hepatic vein angiography including 4 with PTV and 9 with hepatic vein stent implantation. All patients' clinical symptoms and signs completely disappeared or markedly improved after the procedure. Conclusion The stenosis of IVC in HVBCS,caused by compression compensatory hypertrophy of hepatic caudate lobe can be cured by hepatic vein angioplasty which is the most correct and effective method.

Objective To explore the relationship between the impact of blood flow (the flow from right atrium and hepatic vein), diaphragm movement and the pathogenesis of membranous obstruction of inferior vena cava(MOVC). Methods Twenty cadavers were involved, measuring widths of inferior vena cava (IVC )at the diaphragmatic hiatus and the thoracic cage; and taking the IVC segment between the diaphragmatic hiatus and hepatic vein for tissue examination of IVC intimal thickness and type I collagen accumulation as group A and comparing with those of IVC above level of renal vein in Group B. Results IVC intimal thickness and type I collagen distribution area of Group A were greater than those of group B, showing statistically significant difference (P

diagnosing of primary hepatocelluar carcinoma , but GP73 combined with AFP detection can significantly improve the diagnostic accuracy , and some primary hepatocelluar carcinoma cases with AFP negative can be avoided missing efficiently by parallel diagnostic test.

Objective To evaluate the safety and efficacy of interventional treatment of occlusion of the entire inferior vena cava (IVC).Methods The clinical data of 6 patients with entire IVC occlusion were analyzed retrospectively.All patients were diagnosed by color Doppler ultrasound and DSA.Venography was performed under local anesthesia via internal jugular vein and femoral vein approach.The occlusion of IVC and hepatic vein were treated with balloon dilatation and/or stent placement.Follow-up examination with color Doppler ultrasound was taken 1,3,6,12 months after treatment and annually thereafter to assess the patency of IVC and hepatic vein.The pressure gradient of hepatic vein-right atrium and IVC-right atrium before and after interventional treatment were compared with paired t test.Results In 5 cases,both IVC and 1 hepatic vein were recanalized successfully.In 1 case,recanalization of IVC failed,but the right hepatic vein was recanalized successfully.The mean pressure gradient of hepatic vein-right atrium decreased from (23.2 ± 2.0) cmH2O (1 cmH2O =0.098 kPa) before treatment to (8.7 ± 3.2) cmH2O after treatment in 6 cases (t =21.6,P ＜ 0.05).The mean pressure gradient of IVC-right atrium decreased from (26.6 ± 2.7) cmH2O before treatment to (9.4 ± 1.1) cmH2O after treatment (t =16.1,P ＜ 0.05).Abdominal pains occurred in 3 patients after stent implantation which disappeared in 24 hours.No other complications such as bleeding and death occurred.During a mean follow-up of(42 ± 27)months (16 to 90 months),hepatic vein patency was maintained in 6 cases and IVC patency was maintained in 5 cases.Conclusion Interventional treatment of occlusion of the entire IVC is a safe and effective method.

Objective To establish a three-dimensional (3D) model of the diaphragm type of Budd-Chiari syndrome (BCS) with perforated membrane,to analyze changes of hemodynamic parameters pre and post percutaneous transluminal angioplasty (PTA) and to analyze any possibly related mechanical factors for postoperative recurrence in BCS.Methods The data on enhanced MRI from patients suffering from BCS with perforated diaphragm of inferior vena cava were reconstructed into a 3D model Computational fluid dynamics (CFD) were applied for numerical simulation based on the model,and the results were expressed as cloud images.Results The total number of model units of the finite element model for preoperative inferior vena cava stenosis was 16 422,and the total number of nodes was 48 170.The total number of model units for postoperative inferior vena cava was 16 539,and the total number of nodes was 51 339.Hemodynamic patterns of the lesion areas were effectively reflected in the 3D flow dynamic model for BCS.By comparing the hemodynamic parameters before and after interventional therapy,the data indicated that there was a gradual decline in wall pressure from the telecentric side.The largest blood flow velocity as well as wall shear stress were observed in the stenotic area of inferior vena cava.Both a large postoperative vascular central velocity and a low increase in local pressure predicted occurrence of vascular restenosis.Conclusions The establishment of a 3D fluid model of inferior vena cava revealed that there were mechanical changes in the location of the lesion.Variations in blood flow patterns exert a far-reaching influence on distribution of hemodynamic parameters,including local blood flow velocity,vascular wall pressure and shear stress.All these might be related to recurrence of BCS after interventional therapy.

Objective To explore the clinical application of 3D-printing model in guiding interventional management of Budd-Chiari syndrome (BCS) and in teaching practice.Methods A patient with typical BCS of inferior vena cava type was selected.By using MR enhanced scanning,the original MRA data of DICOM format were extracted,and then the digital data were extracted and reconstructed to obtain 3D BCS model by Simpleware software.The 3D BCS entity model,using 1 ∶ 1 ratio,was printed out by a 3D printer.An experienced chief physician made a simulated interventional manipulation on this 3D BCS entity model.Results The BCS 3D model was successfully printed.Simulated operation could be easily performed on the 3D-printing model,in this way the chief physician could make a demonstration of interventional procedure of BCS to the junior doctors and medical students.Interventional therapeutic manipulation for BCS could be well demonstrated on the 3D-printing model of BCS,which was very helpful in guiding teaching practice and in promoting the communication between doctors and patients.Conclusion The BCS 3D-printing model can truly reflect the spatial architecture features of the inferior vena cava and the hepatic veins,which are very valuable for the making of surgical plan,for the demonstration of simulation operation,and for teaching practice.Moreover,3D-printing model can stereoscopically display the location and morphology of the lesion,which can improve patient's understanding of the disease,thus,the communication between doctors and patients can be strengthened.