Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

"For the situation where the inferior vena cava has been completely blocked, I plan to use the interventional or semi-interventional treatment of Budd-Chiari syndrome, that is, the atrial septal puncture needle is punctured from bottom to top."

"Alternatively, a single-use coronary artery balloon dilation catheter device can also be used to puncture from the right internal jugular vein to the proximal segment of the inferior vena cava from top to bottom."

"No matter which of these two options is selected, the patient's inferior vena cava can be opened."

After listening to Lin Yi's introduction of the readjusted surgical plan.

Wu Jiang expressed his suggestion:

"Brother Yi, I have some suggestions for your reference regarding the operation plan you proposed."

Lin Yi nodded slightly and said:
"Well, you said."

After Wu Jiang thought for a while, he said slowly:
"I think that if the intervention method of Budd-Chiari syndrome is adopted, it is very likely that the patient's inferior vena cava or right atrium will be easily damaged during the puncture process, resulting in bleeding and acute cardiac tamponade."

"Is the risk of this first set of intervention operations too high?"

"Instead, I'm more bullish on the second treatment option."

"It is a one-time-use coronary artery balloon dilatation catheter device, which is punctured from the top to the bottom through the right internal jugular vein to the proximal segment of the inferior vena cava."

"Use the catheter below the lesion as a guide to break through the obstructed lesion and reduce the possibility of puncturing the inferior vena cava."

"It's just... the operation difficulty of this intervention plan is not ordinary..."

"I don't think we can do it at all."

After finishing speaking, Wu Jiang couldn't help sighing.

"If you can't do it, what are you talking about?"

Song Borui couldn't help but look at him and complain.

"This plan is indeed possible, let me do it."

After Lin Yi pondered for a moment, he said directly.

"Can you?"

Wu Jiang couldn't help but looked at him and asked.

"no problem!"

"Just change the first set of surgical plan to place the balloon dilatation catheter device from the patient's right internal jugular vein to the proximal segment of the inferior vena cava, and then puncture from top to bottom."

"As long as everything is under ultrasound guidance during the operation, I think it should be fine."

"After all, we have both the elements of accuracy and stability."

Lin Yi nodded and said.

Hearing Lin Yi's affirmative reply, Wu Jiang and Song Borui no longer had any worries.

Subsequently, the adjusted surgical plan was carried out step by step.

Lin Yi first used a coronary probe to pass through the artery incision for bypass grafting according to the plan.

After the distal and proximal stenosis locations and degrees were detected, the balloon catheter was inserted through the incision of the coronary artery to the stenosis to be expanded for dilation.

Wu Jiang couldn't help admiring Lin Yi's proficiency in interventional therapy.

After the coronary artery balloon was in place, Lin Yi palpated and observed the lesion on the operating table.

After repeated confirmation by color Doppler ultrasound and palpation, the next step is to dilate the coronary artery balloon.

Speaking of dilating coronary artery balloons, they use a relatively common method.

It is to inject lactated Ringer's solution into the balloon with a pressurized syringe, and gradually pressurize to about 10 atmospheres for 60 seconds.

Repeat this 3 times, then remove the fluid in the balloon, and finally remove the catheter.

After completing this step, Lin Yi used the coronary probe to measure the diameter of the stenosis again.

No...

Lin Yi couldn't help shaking his head.

"The embolism is more serious, and the diameter of the tube has increased by less than 50%. It needs to be done again."

Immediately afterwards, Lin Yi expanded again.

After repeated dilatation, he used a coronary probe to measure the diameter of the stenosis.

Wu Jiang looked at his expression from the side, and knew that this time it must be okay.

Afterwards, Lin Yi began to perfuse and flush the debris that might be in the lumen.

Seeing Lin Yi's operation, Wu Jiang sincerely admired it.

"I didn't expect Brother Yi to be so thoughtful..."

At this moment, Lin Yi looked up at the time.The expansion time has passed about 8 minutes...

Lin Yi's heart sank slightly.

The longest time to expand a stenosis is generally controlled within 10 minutes, otherwise it will cause unpredictable damage to blood vessels.

Now there are less than 2 minutes left, he needs to speed up the progress.

Fortunately, this period of embolism expansion is basically almost finished.

A minute and a half later, Lin Yi successfully dilated the narrowed blood vessel to normal diameter.

Wu Jiang wiped Lin Yi's sweat in a timely manner, and then asked cautiously:

"How? How long will it take?"

"This embolism has been expanded, and the most difficult inferior vena cava is below."

Lin Yi responded.

At this stage of the operation, Lin Yi dared not neglect.

Puncture from top to bottom through the right internal jugular vein to the proximal segment of the inferior vena cava according to the previously modified plan.

However, after starting, they couldn't help discovering new problems.

The patient presented with inferior vena cava stenosis plus membranous obstruction with a small hole.

After encountering such a situation, Wu Jiang on the side frowned.

"Brother Yi, are you sure?"

Lin Yi did not answer her question immediately, but kept watching and measuring on the color ultrasound screen repeatedly.

After about 5 minutes, Lin Yi replied:
"No problem, I can put the wire through the narrow or small hole into the right atrium."

"After the puncture is successfully joined, it can also puncture the obstructive lesion."

"Doing this reduces the possibility of puncturing the inferior vena cava, and then I insert the guide wire later and use a balloon to dilate the diseased vessel."

As the patient's blood vessels were expanded by the balloon, Song Borui turned his head and said to Lin Yi:

"The patient's blood pressure has dropped, indicating that the anterior descending artery is unobstructed, the stenosis of the blood vessel at the lesion has been relieved, and the blood flow of the coronary artery has been improved."

"It can be said that interventional surgery has achieved the therapeutic purpose of alleviating myocardial ischemia."

Wu Jiang was worried and tested the pressure again.

The results showed that the patient's pressure decreased and the inferior vena cava was restored to patency.

The patient lay on the operating table and couldn't help saying:

"Doctor, now I feel less chest tightness and breathlessness!"

After listening to the patient's feedback, Wu Jiang breathed a sigh of relief, and said to Lin Yi with a smile:
"Brother Yi, the operation was successful."

"Ah."

Lin Yi nodded.

Immediately afterwards, Lin Yi lowered his head and started to get busy. After all, the interventional surgery has not been completed yet.

He needed to indwell a 5F catheter under the endovascular support, then guide the catheter through the right internal jugular vein, and keep the catheter for local anticoagulation.

After doing all this, he moved his stiff neck and said:
"Operation complete!"

At this moment, the woman on the operating table suddenly exclaimed:

"Doctor, doctor! I can move my leg! Great!"

As she spoke, she moved her legs freely.