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Interventional or semi-interventional treatment for Budd-Chiari syndrome
Zhang Xiaoming1, Wang Zhonggao
1Dept. of Vascular Surgery, People Hospital of Beijing University, Beijing 100044.
Insights
Interventional techniques effectively treat Budd-Chiari syndrome, with stenting improving outcomes for inferior vena cava (IVC) lesions. Semi-interventional approaches offer solutions for complex cases and PTA failures.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Hepatology
Background:
- Budd-Chiari syndrome involves hepatic venous outflow obstruction.
- Interventional and semi-interventional techniques are crucial for managing this condition.
- A diverse range of lesions necessitates varied treatment strategies.
Purpose of the Study:
- To evaluate the efficacy of interventional and semi-interventional techniques in 173 Budd-Chiari syndrome patients.
- To compare outcomes of different treatment modalities.
- To identify optimal treatment pathways based on lesion type.
Main Methods:
- 173 patients with Budd-Chiari syndrome underwent various interventions.
- Procedures included percutaneous transinferior vena cava angioplasty (PTA), stenting, thrombolysis, and combined approaches.
- Lesions involved inferior vena cava (IVC) occlusion, stenosis, membranes, and hepatic vein (HV) involvement.
Main Results:
- Immediate success rates were 90.1% for intervention and 100% for semi-intervention.
- IVC pressure significantly decreased post-intervention.
- Recurrence rates varied: 14.5% for IVC PTA, 1.7% for IVC PTA with stent, and 18.2% for combined technique without stent.
Conclusions:
- Percutaneous transinferior vena cava angioplasty (PTA) is a primary treatment for localized lesions.
- Stenting is recommended for cases with elastic recoil.
- Semi-interventional methods are suitable for PTA failure and complex cases, with additional surgery needed for combined IVC and HV lesions.
Objective:
Report the results of interventional or semi-interventional techniques for 173 patients with Budd-Chiari syndrome.
Method:
This group included 120 males and 53 females. The pathologic lesions composed of localized complete occlusion of inferior vena cava (IVC) (78), IVC stenosis (49), IVC membrane with a hole (37), membrane of hepatic vein (HV) (3), IVC thrombosis (4), IVC membrane with thrombosis (2) and IVC lesion with occlusion of HV (32). Treatment methods included that I: Percutaneous transinferior vena cava angioplasty (PTA) (76); II: IVC PTA with stent (59); III: Percutaneous transhepatic vein recanalization (3); IV: IVC thrombolysis through a catheter (4), V: Combined transcardiac and transfemoral venous membranotomy and balloon dilation (22); VI: V and stent (17); VII: Stenting during radical surgery (3); VIII: Additional operation after intervention (23).
Results:
The immediate technique success rate for intervention was 90.1%, for the semi-intervention was 100%. The IVC pressure was reduced from 3 to 29 cmH2O. Complications occurred in 8 cases. The death rate was 2.9%. A follow-up study showed the recurrence rates were 14.5% in IVC PTA group, 1.7% in IVC PTA with stent, 18.2% in combined technique without stent and no recurrence was found in other groups.
Conclusion:
The PTA is the first choice for localized lesions. When elastic recoil occurs, immediate stenting is suggested. The semi-interventional approach is advised for PTA failure and more complicated cases. For those with both IVC lesion and occlusion of HV, the additional operation is needed after IVC intervention.
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