Overview Buchanan’s syndrome is a syndrome of partial or complete obstruction of the hepatic veins and/or hepatic inferior vena cava, causing inferior vena cava hypertension and portal hypertension. Causes: 1. In Asian people, it is mostly due to septal formation, stenosis, and atresia of the hepatic inferior vena cava and hepatic vein; 2. In Europe and the United States, it is mostly due to hepatic vein embolism (true erythrocytosis, antithrombin III deficiency); 3. Tumor or infectious lesion invades or compresses the hepatic vein or the hepatic segmental inferior vena cava. Pathology, the main pathological changes of Buchanan’s syndrome are intraventricular thrombosis and membranous stenosis. 1, thrombosis susceptibility factors include true erythrocytosis and other myeloproliferative diseases, paroxysmal nocturnal hemoglobinuria, and other related factors such as oral contraceptives, ulcerative colitis, Crohn’s disease, thrombocytosis, cirrhosis, and hepatitis B surface antigen positivity. 2, membrane formation of hepatic segmental inferior vena cava membranous obstruction is considered to be a congenital lesion, but some scholars believe that it is caused by acquired, that is, the result of infection-vein-thrombosis. Pathologic typing Bu-Ka’s syndrome typing is more complex, generally have the following classification: A type of hepatic segmental inferior vena cava membranous obstruction is not accompanied by hepatic vein obstruction; B type of unilateral hepatic vein obstruction (generally more common for the right side); C type of all the hepatic vein obstruction. Type I is membrane type; type II is inferior vena cava occlusion type; type III is mixed type, i.e., both hepatic vein and inferior vena cava occlusion exist at the same time. Clinical manifestations Often manifested as right upper abdominal pain, hepatosplenomegaly and ascites, sometimes accompanied by superficial trunk varicose veins, lower extremity varicose veins and lower extremity edema. If Buerka’s syndrome is not diagnosed and treated in time, it will lead to rupture and bleeding of esophageal varices in portal hypertension, liver dysfunction, coagulation dysfunction, and in the late stage, it will lead to liver failure and hepatic encephalopathy and death. In a few cases, fulminant hepatic failure and hepatic encephalopathy may occur in the early stages of the disease in response to extensive necrosis of the liver and multi-organ damage. Imaging Color Doppler ultrasound is the preferred non-invasive test, CT and MRI can also assist in the diagnosis of the disease, and interventional inferior vena cava and hepatic venography is the best method to diagnose the disease. Diagnosis According to the patient’s clinical manifestations and ultrasound, CT, MRI, DSA examination, the diagnosis is generally not difficult. It is worth noting that cirrhosis, right heart failure, tuberculous peritonitis and ascites caused by cancer are the main diseases to be distinguished. Treatment 1, conservative treatment: for acute thrombosis and the treatment of certain causes of effective, including: ① thrombolysis, anticoagulation and other treatments; ② steroids; ③ cause-specific treatment; ④ traditional Chinese medicine and symptomatic treatment, such as hepatoprotection, diuretic and other main treatment. 2, surgical treatment: the method is roughly divided into six categories: ① indirect decompression surgery, including peritoneal cavity, an internal jugular vein diversion and thoracic catheter, an internal jugular vein re-anastomosis; ② cut off the flow of the surgery (including esophagoscopic sclerotherapy, but only for the esophageal varicose veins, to the basic lesions of the meta-efficacy); ③ all kinds of promotion of collateral circulation of surgery, such as splenopulmonary immobilization; ④ direct decompression surgery, including the type of superior mesenteric vein or inferior vena cava, or both of the former and the right cardiac veins, or the first two at the same time, with the right heart. Or the first two at the same time with the right atrium between the diversion surgery; ⑤ lesion radical resection; ⑥ liver transplantation. Interventional therapy: 1. Retained catheter thrombolysis after inferior vena cava and hepatic vein angiography via femoral vein cannulation: it is suitable for thrombosis of inferior vena cava or hepatic vein, and thrombolysis therapy is usually carried out for 5-7 days, which often achieves the purpose of thrombolysis of the inferior vena cava or hepatic vein in the acute stage. 2. 2. Percutaneous transvenous inferior vena cava plasty and stenting: it is suitable for limited membranous occlusion of inferior vena cava or limited stenosis of inferior vena cava, and the hepatic vein is better if it is patent. Selective stenosis of the middle to long segment of the inferior vena cava can also be applied selectively, but the possibility of unsuccessful and conversion to surgical treatment should be stated before the operation. However, direct rupture dilatation is contraindicated in cases of fresh thrombosis secondary to the distal aspect of the lesion. It should not be applied to those with long segmental inferior vena cava obstruction to the iliac vein. 3, Percutaneous hepatic perforation of hepatic vein, dilatation and stenting. Transjugular intrahepatic portosystemic shunt (TIPSS). 5, Transjugular vein transfemoral vein combined rupture membrane dilatation and internal stenting: when the transfemoral vein rupture membrane is not possible or there is a danger of using this method to carry out the joint operation, not only can safely rupture the membrane, but also can get better dilatation efficacy, and if necessary, stents can be placed. In comparison, conservative treatment is ineffective, surgical treatment is traumatic, high risk and has a long recovery period, while interventional therapy is relatively low risk, minimally invasive (only a 3mm incision in the root of the thigh or neck skin), less painful for the patient, quicker recovery and shorter hospitalization. The economic burden on the patient is small. If possible, interventional therapy should be preferred for the treatment of Buerger’s syndrome, and if necessary, interventional therapy and surgery combined method.