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Interventional endovascular treatment for Budd-Chiari syndrome with long-term follow-up
Tong Qiao1, Chang-jian Liu, Chen Liu
1Department of Vascular Surgery, the Affiliated Drum Tower Hospital of Nanning University Medical College, China.
Insights
Percutaneous transluminal angioplasty (PTA) and stents offer a safe and effective treatment for Budd-Chiari Syndrome (BCS), providing good long-term outcomes. This interventional radiology approach should be considered for symptomatic patients lacking alternative therapies.
Area of Science:
- Interventional Radiology
- Vascular Surgery
- Hepatology
Background:
- Budd-Chiari Syndrome (BCS) involves obstruction of hepatic venous outflow.
- Effective management strategies for BCS are crucial for patient outcomes.
- Percutaneous transluminal angioplasty (PTA) and stenting are minimally invasive options.
Purpose of the Study:
- To report 9-year follow-up results of PTA and stent placement in BCS patients.
- To evaluate the clinical value and applicability of this interventional approach.
- To assess long-term patency and clinical outcomes.
Main Methods:
- 44 consecutive BCS patients underwent PTA and stent placement over 9 years.
- Procedures involved balloon dilation followed by self-expanding stent placement in obstructed IVC or HV.
- Clinical follow-up included symptom assessment, Doppler sonography, and CT scans.
Main Results:
- Technical success rates were 97.2% for IVC and 83% for HV PTA and stenting.
- Significant pressure reductions were observed in IVC and HV post-procedure.
- Most patients experienced symptom relief, with satisfactory short- and long-term results, despite a few restenosis/thrombosis cases.
Conclusions:
- PTA and stent placement demonstrate safety and efficacy in treating BCS.
- The procedure offers good long-term outcomes for BCS patients.
- This approach is a viable therapeutic option for symptomatic BCS patients without adequate alternatives.
Purpose:
To present results of a 9 year followup of percutaneous transluminal angioplasty (PTA) and stents placement in patients with Budd-Chiari Syndrome (BCS) and to evaluate the clinical value and applicability of this approach.
Materials And Methods:
44 consecutive patients with BCS (25 male and 19 female; average age, 42.6 years; age range, 19-77 years) were treated with PTA and stents during a 9-year period. The mean duration of symptoms was 46 months. Underlying active malignancy was the cause of occlusion in 5 patients. 3 patients had a history of taking oral contraceptives. The obstructed inferior vena cava (IVC) or hepatic vein (HV) were first dilated by a percutaneous transluminal balloon, and then a self-expanding stent was placed. Clinical patency was defined as absence or improvement of symptoms. Clinical follow-up was supplemented with colour Doppler sonography, CT scan, or both.
Results:
Technical success was achieved in 97.2% (35/36) IVC and 83% (10/12) HV PTA and stents. Significantly, the IVC pressure decreased from 2.7 kPa (SD = 0.3) to 1.5 kPa (SD = 0.4) and HV pressure dropped from 2.3 kPa (SD = 0.4) to 1.3 kPa (SD = 0.2). The symptoms and signs disappeared or were relieved after operation in most of the patients. A few serious related complications including one stent migration and one pulmonary emboli occurred and were resolved in time. Patients were followed for a mean of 44 months (range 3-102). Short- and long-term results were satisfactory except for 3 patients (9.4%, 1 IVC, 2 HV) who presented with a restenosis or thrombosis and underwent additional therapy. There were 5 deaths owing to underlying malignant disease 3-17 months after the procedures.
Conclusion:
PTA and stent placements proved a safe and effective treatment in BCS and had a good long-term outcome and should be considered in patients who have symptoms or have no adequate alternative therapy.