En 腔静脉支架植入术知情同意书.docVIP

Modern Hospital Guangzhou Informed Consent of Superior/Inferior Vena Cave Balloon Dilatation (+Stent Implantation) Patient name： Sex： Age： Case No： Brief description of disease and treatment recommendations I am aware that I have been diagnosed with and recommended to undergo under anesthesia. Superior/Inferior vena cave stenosis or occlusion could lead to venous return obstacle. Superior vena cave lesion could lead to head and neck swelling. Inferior vena cave could lead to hepatic congestion, portal hypertension and return obstacle of veins of lower extremity etc. Main symptoms are abdominal distension, ascites, edema of both lower extremities and venous ulcer etc. Other Potential risks and handling: I have been informed that this procedure carries potential risks. However, certain uncommon risks are not included hereinto. The method of surgery should be individualized based on medical condition. I have been informed that I am entitled to discuss with my physician regarding the surgery and any associated special questions. 1．I understand that all anesthetic procedures carry potential risks. 2．I understand that all drugs might cause unwanted side effects, including mild symptoms such as nausea and rashes, serious anaphylactic shock, and even life-threatening events. 3．I understand the risks associated with this procedure and corresponding measures taken: Common risks for interventional diagnosis and treatment 1）Anesthetic accident; Cardiovascular and cerebrovascular accidents (myocardial infarction, c