Gastric coronary vein embolization treatment

  Indications: 1. Patients with acute portal hypertensive hemorrhage for whom medical treatment is ineffective. Patients with ruptured esophagogastric fundic vein hemorrhage, who are in critical condition, poor general condition, and with grade C liver function, often have difficulty in undergoing other surgeries, but can undergo this procedure. Surgical trauma and damage to liver function can be avoided.  2. Patients with rebleeding after multiple surgeries for portal hypertension. Such patients often have heavy adhesions in the proximal gastric and cardia areas, which makes reoperation difficult. And the interventional operation is less traumatic.  3.Preventive surgery. Patients with previous history of gastrointestinal bleeding in portal hypertension and enhanced CT examination suggesting significant esophagogastric fundic varices, although there is no active bleeding, this method is feasible to prevent bleeding.  4, acute portal hypertensive hemorrhage has been performed three lumen two capsule tube hemostasis after stabilization, this method is feasible to stop bleeding, while partial splenic artery embolization can be performed to achieve the purpose of flow disconnection and hemostasis.  Complications: 1. Ectopic embolism: The incidence of ectopic embolism is about 1.5%. Including portal vein embolism, pulmonary embolism, pulmonary artery microembolism, jump ectopic cerebral embolism, etc.  2, liver failure.  3.Post-embolization cardia syndrome: gastric mucosal erosion, ulcer bleeding.  4.Splenic abscess and reactive pleural effusion may occur in combined splenic artery embolization.  Pre-operative preparation: 1. Conservative medical treatment for acute bleeding, if necessary, three-lumen tube compression to stop bleeding.  2.Fast during acute bleeding and 4 hours before surgery for elective patients.  3.Emergency or elective patients should be examined for blood routine, blood coagulation routine, complete set of biochemistry, electrocardiogram, CT of upper abdomen, and enhanced CT of upper abdomen and color Doppler to measure the width and flow rate of portal vein and odd vein if available.  4.Inject luminal 0.1, dexamethasone 10mg and dulcolax 75mg half an hour before surgery. Postoperative management: 1.Close cardiac monitoring, monitor bleeding and hematocrit changes.  2. Postoperative braking: bed rest for more than 8 hours for simple percutaneous transhepatic gastric coronary vein embolization, and appropriate bed activity 24 hours after bleeding stabilization. The lower limb on the puncture side should be braked for 12 hours for those who have operated venous cannulation.  3.Symptomatic treatment: transfusion support, lowering portal pressure, anti-infection and other medical treatment. Patients with splenic artery embolization should strengthen anti-infection.  4.Retest blood routine and biochemical complete set after 1 week.  Treatment: Generally around $8,000, and around $10,000 to $12,000 for those who need special materials or simultaneous combined splenic artery embolization.