ABSTRACT
Objective To investigate the effects from various angles between inferior vein cava (IVC) and right hepatic vein (RHV) on pathogenesis of IVC membranous obstruction for patients with Budd-Chiari syndrome (BCS). Methods The normal 3D solid model of IVC and hepatic veins was reconstructed using MRI angiograms, and the angle between IVC and RHV was 56°. The two models with IVC-RHV angle of 30° and 120° were established, respectively, based on the reconstructed model. The distributions of wall shear stress, static pressure and blood velocity of the 3 models were calculated by numerical simulation. Results The wall shear stresses, static pressure and blood velocity of the 3 models displayed significantly differences. Compared with the normal 56° model, the 30° model showed a higher wall pressure and lower blood velocity, while the 120° model presented a lower wall pressure and blood velocity with turbulence of blood flowing, and such hemodynamic changes would increase the risk of thrombosis. The 56° model had the fastest blood velocity. Conclusions Numerical simulation of the flow in IVC and RHV can promote to discover the pathogenesis of BCS, and help to predict risk of IVC membranous obstruction, and provide theoretical references for BCS treatment.
ABSTRACT
Objective To sum up our clinical experience in interventional treatment of 143 cases of Budd-Chiari syndrome. Methods This study included 92 males and 51 females, aged from 6 to 65 years old with an average of 34.8 years. The pathologic types were composed of complete occlusion of inferior vena cava (IVC) (71), IVC stenosis (36), IVC membrane occlusion with a hole (29), membrane occlusion of hepatic vein (HV) (3), IVC thrombosis (4), and IVC lesions forementioned combined with HV occlusion (14). Therapeutic methods included that I: Percutaneous transinferior vena cava membranotomy and occlusion dilatation (PTA) (77); II: IVC PTA with stent (62); III: Percutaneous transhepatic vein recanalization (3); IV: IVC thrombolysis through a catheter (4); V: Additional operation after intervention (16). Results The range of reduced IVC pressure was (3 ～ 29) cmH 2O with the mean pressure being 12.1 cmH 2O. Complications occurred in 8 cases, including pulmonary embolism (PE), stent migration and HV occlusion after IVC stent (2 cases respectively), cardiac tamponade and hemothorax (1 case repectively). 2 cases died of PE and 3 cases died of hepatic coma after meso-caval shunt,the death rate being 3 5% . A follow-up study showed the recurrence rates were 10.4% in IVC PTA cases and 1.6% in IVC PTA with stent cases respectively, and no recurrence was found in other cases. Conclusions ① PTA is the first choice for localized lesions without fresh thrombus. ② For those with elastic recoil or recurrence, stent is suggested. ③ For those with both IVC lesions and HV occlusion, the additional operation to reduce portal hypertension is needed after IVC intervention.
ABSTRACT
Pathophisiology of Budd-Chiari syndrome is complex and complicated; therefore during the treatment of BCS,both the conditions of inferior vena cava and hepatic veins should be carefully considered. Along with the continuous development of the minimal invasive,reliable efficacy and comparative safety of the interventional therapy,more and more patients are willing to adopt this technology. However,there are still many difficulties that can't be overcomed in the performance. The surgeons,especially the vascular surgeons,should entirely present their knowledge and skill into fulfillment and simultaneously combine with the consideration of the situations of our country to formulate the scientific,reasonable,feasible,safe and efficient treatment plan.