Recently, the Radiation Interventional Treatment Department of Chongqing Fifth People's Hospital (abbreviated as: Fifth Hospital of the City) successfully performed interventional minimally invasive surgical treatment for a patient with complex Bugat syndrome under DSA (digital subtraction angiography). The operation was completed by Zhang Yu's team, deputy director and deputy chief physician of the Radiation Interventional Treatment Department. This operation is the first case of complex Bugat syndrome surgery successfully completed under intervention in the Fifth Hospital of the Municipal Hospital and even in the Nan'an District of .
Deputy Director of the Radiation Interventional Treatment Department Zhang Yu's team was undergoing surgery
5 months ago, Jiang Gao (pseudonym), a male patient who was working outside the city, suffered from progressively aggravated abdominal distension and accompanied by edema of both lower limbs, abdominal wall varicocele . He visited many hospitals and diagnosed him with Bugat's syndrome after improving the relevant examinations. However, because the patient had a large number of thrombosis in the inferior vena cava occlusion section, he failed to perform surgical treatment.
In September 2022, the patient was admitted to the General Surgery Department of the Fifth Hospital of the Municipal People's Hospital for edema due to both lower limbs with "Bugath's syndrome". Zhang Yu conducted a full preoperative evaluation of the patient, conducted intra-department discussions, formulated surgical treatment plans, improved relevant preoperative examinations, and decided to perform interventional minimally invasive surgical treatment for the patient.
surgery in part, allowing the patient to recover health
Zhang Yu led the team to consider that if the inferior vena cava is directly opened, a large number of venous thrombosis in the abdominal wall will fall off, causing a high risk of pulmonary artery embolism, and in severe cases, the patient's life is endangered. The operation is difficult and risky, so he decided to treat the diagnosis and treatment plan for two operations. After the consent of the patient and his family, the first interventional surgery was performed on September 21, and thrombolysis was performed for 2 days to reduce the thrombogenic load. The second interventional surgery was performed on September 23. Intraoperative angiography showed that the patient's thrombosis was significantly reduced compared with the previous one, but there were still some thrombosis. After repeated thrombosis was re-extracted during the operation, after confirming that the risk of thrombosis was low, a transfemoral rupture combined with membrane rupture was performed, and the inferior vena cava occlusion segment was successfully opened, and the balloon dilation and stent insertion were successfully opened. After the operation, the patient's blood reflux in the inferior vena cava was unobstructed, and the inferior vena cava pressure was reduced from 29cmH2O to 14cmH2O. After the operation, the patient felt that the swelling and discomfort in the abdomen and lower limbs was significantly reduced than before. No thrombus was found to fall off to the pulmonary artery after the follow-up examination, the inferior vena cava was unobstructed, and the stent position and adherence were good. After the patient was observed and treated in the ward after surgery, he was evaluated and was discharged from the hospital. Jiang Gao recovered and was discharged from the hospital on September 29.
"We have seen this disease in many hospitals, but none of them have undergone surgical treatment. Thinking of the fact that there are elderly people and young people, as the pillar of the family, I am so sick now, so I don't know what to do. Now you have solved the problem that has troubled us for so long through minimally invasive surgery. I really thank you. We can finally feel at ease." The patient's family expressed their gratitude to Director Zhang Yu's team.
Preoperative CT showed inferior vena cava occlusion, local calcification and distal thrombosis. After the stent is placed, the inferior vena cava is unobstructed.
Before surgery, contrast inferior vena cava was interrupted (occlusion)
opened the inferior vena cava, the inferior vena cava was unobstructed after balloon dilation and stent placement, and collateral blood vessels disappeared.
interventional surgical treatment, as the preferred solution for Bugats syndrome, has little trauma and good results, but also puts higher technical requirements for medical staff. This interventional operation, through the joint efforts of the Radiation Intervention Treatment Team, successfully implemented the minimally invasive interventional treatment of a patient with complex Bugat syndrome, marking a new step in the treatment of interventional in peripheral vascular diseases in the Radiation Intervention Treatment Department.
(text/Yang Daofeng, Wang Liming, Radiation Interventional Treatment Department)
Related Knowledge Link
Bugats syndrome is a partial or complete obstruction of the hepatic vein or hepatic segment inferior vena cava caused by various reasons, blood reflux disorders, or/and inferior vena cava hypertension syndrome. In those with inferior vena cava obstruction, the following vena cava symptoms are mainly manifested as varicose veins, pigmentation in both lower limbs, and even the formation of ulcers that cannot heal for a long time. At the same time, the lateral branch circulation is established, and the superficial veins in the chest, abdominal wall and waist and back can be seen dilated and tortuous, partially compensating for the return of the inferior vena cava, and its blood flow is characterized by the upward direction.In patients with advanced stages, symptoms such as ascites. In severe cases, repeated puncture and water release and decompression are required, resulting in the loss of protein , coupled with poor digestive function, and finally the patient suffers from severe malnutrition, infection, rupture and bleeding of esophageal varices or liver and kidney failure, which is life-threatening.
Bugats syndrome is mainly divided into interventional surgical treatment and surgical treatment. Traditional surgical treatment methods require joint chest and abdominal opening, which has great trauma and high risk. Interventional surgery has the advantages of low trauma, high success rate, low recurrence rate and strong repetition. It has become the preferred treatment for Bugats syndrome. Different patients choose safe, reasonable and effective treatment methods based on their different causes, clinical manifestations and clinical typing.
team introduced the
Radiation Interventional Treatment Department was established in 2013 and is the earliest hospital in this area to establish a separate specialty for interventional medicine. There are currently 8 professional medical, technical and nursing staff, including 1 deputy chief physician, 1 postgraduate degree and 4 bachelor's degree.
department has advanced interventional medical equipment: Philips Allura Xper FD20 large vascular DSA machine, Artis zee IIIIfloor large vascular DSA machine, Mark V Provis high-pressure injection machine, Xinguan high-pressure syringe, invasive/non-invasive dynamic ECG monitor (T5, T8), Mindray defibrillator, and multi-function anesthesia machine, which can meet the interventional diagnosis and treatment of cardiovascular and cerebrovascular diseases and surrounding system diseases.
Currently developed technology
systemic multi-section tumors (such as liver cancer , lung cancer, renal cancer , etc.) interventional treatment : mainly through the transcatheter chemotherapy drug perfusion (TAI), transcatheter superselective vascular embolization (TAE), transcatheter selective chemotherapy embolization (TACE), transcatheter selective drug-loading microsphere perfusion chemotherapy embolization (DTACE) and other technologies, primary and secondary abdominal and pelvic malignant tumors, benign gynecological benign and malignant tumors, and other benign and malignant tumors.
venous thrombosis and pulmonary embolism and thrombolysis treatment for
venous thrombosis and pulmonary embolism and thrombolysis treatment; vascular formation of peripheral artery (upper limb, lower limb) stenosis/occlusive lesions, stent implantation, peripheral artery/venous embolization; branch embolization/chemotherapy of external carotid artery, intracardiovascular foreign body removal; hemostasis treatment for major bleeding (hemoptysis, hemopple hemorrhage, stool and other major bleeding in many areas, etc.); interventional treatment for portal hypertension (TIPSS), Bu-Gath syndrome, interventional treatment for hypersplenary function; spermatocorticoid/ovarian varicocele sclerosis embolization.
Non-vascular interventional diagnosis and treatment: multi-site puncture biopsy , catheter drainage and other surgeries, treatment of polycinol sclerosis for liver and kidney cysts, percutaneous gastrostomy, percutaneous injection of anhydrous alcohol and other tumor treatment procedures.
mainly researches 1 joint project of Chongqing Science and Health, publishes more than 10 academic papers (including 1 SCI, 2 CSCD), and 2 patents.
