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Comparative study of predilation with stent filter for Budd-Chiari syndrome with old IVC thrombosis: a nonrandomized
Yan-Li Wang1, Peng-Xu Ding, Yong-Dong Li
1Department of Intervention, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, China.
Insights
The predilation approach for treating Budd-Chiari Syndrome (BCS) with inferior vena cava (IVC) thrombosis shows better intermediate-term outcomes compared to the stent filter approach, with fewer complications and lower costs.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Thrombosis Management
Background:
- Budd-Chiari Syndrome (BCS) with inferior vena cava (IVC) thrombosis presents a significant clinical challenge.
- Effective treatment strategies are crucial for improving patient outcomes and preventing recurrence.
Purpose of the Study:
- To compare the intermediate-term efficacy and safety of the predilation approach versus the stent filter approach for treating old IVC thrombosis in BCS patients.
- To evaluate technical success, clinical outcomes, complications, and costs associated with each treatment method.
Main Methods:
- A prospective study involving 59 BCS patients with old IVC thrombosis, randomized into two groups: stent filter (n=33) and predilation (n=26).
- Both groups underwent thrombolysis, with Group A receiving a stent filter and Group B undergoing predilation before thrombolysis.
- Follow-up included color Doppler ultrasound, cavagraphy, and clinical assessments at multiple intervals.
Main Results:
- Both stent filter placement and predilation were technically successful with no immediate complications.
- Predilation resulted in significantly lower overall complications and costs compared to the stent filter approach.
- No significant differences were observed in clinical findings, ultrasound results, or primary patency rates between the groups.
- Complete IVC thrombus resolution was achieved in all patients without pulmonary embolism; reobstruction occurred in three patients.
Conclusions:
- The predilation approach offers superior intermediate-term results for BCS patients with old IVC thrombosis compared to the stent filter approach.
- Predilation is associated with fewer complications and lower costs, making it a potentially preferred treatment strategy.
Purpose:
To evaluate whether predilation approach yield intermediate-term results were better than those with stent filter approach.
Materials And Methods:
59 BCS patients with old IVC thrombosis were selected for the treatment with a stent filter (n = 33, group A) or predilation (n = 26, group B) before thrombolysis, and subsequently underwent color Doppler ultrasound follow-up at our hospital. Data relating to the technical success, color Doppler ultrasound results, cost, mortality, morbidity, and final clinical results were collected prospectively and follow-ups were performed 1, 3, 6, and 12 months after the procedures, and annually thereafter.
Results:
Sent filter placement, thrombolysis and predilation were technically successful in all patients, with no procedure-related complications. Stent migration upward occurred in two patients, and removal of the stent filter was technically successful in 32 of 33 patients in group A. Inferior vena cavagrams performed before dilation with a 30-mm balloon catheter demonstrated that the IVC thrombus had completely resolved in all patients without pulmonary embolism. Reobstruction of the IVC without thrombosis was observed in three patients. Short of higher overall complications and costs in group A when compared to group B, there were no other differences in the clinical and color Doppler ultrasound findings, and primary patency rate between the two groups. All patients are alive with no recurrence of thrombosis at the time of this report.
Conclusions:
BCS patients with old IVC thrombosis treatment with predilation approach yielded intermediate-term results that were better than those with the stent filter approach.
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