Necessity and indications of invasive treatment for Budd-Chiari syndrome
Yang Fu1, Yu-Ling Sun, Xiu-Xian Ma
1Department of General Surgery, First Affiliated Hospital, Zhengzhou University School of Medicine, Zhengzhou 450052, China.
Insights
Budd-Chiari syndrome management can be individualized. Some patients with rich collaterals may not need invasive treatment, while others may require intervention if their condition worsens.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Hepatology
Background:
- Budd-Chiari syndrome is characterized by the development of collateral vessels.
- The diagnostic and therapeutic role of these collaterals in management strategies has not been evaluated.
- This study investigates the indications, feasibility, and necessity of invasive treatment for Budd-Chiari syndrome.
Observation:
- Twenty-nine patients with Budd-Chiari syndrome were divided into two groups: 18 underwent radiological intervention (Group A) and 11 received no invasive treatment (Group B).
- Hemodynamic parameters were assessed using percutaneous angiography.
- Group A patients underwent successful inferior vena cava (IVC) balloon angioplasty with or without stenting, and some also had hepatic vein angioplasty.
Findings:
- Invasive treatment in Group A significantly reduced mean IVC pressure (29.3+/-9.2 to 15.1+/-4.6 mmHg).
- Group B patients had lower initial IVC pressure (12.9+/-2.4 mmHg) compared to pre-treatment Group A, with no significant difference from post-treatment Group A.
- Follow-up showed good survival in both groups; one patient in Group A required re-canalization, and one in Group B developed a meso-caval shunt due to deterioration.
Implications:
- The "early diagnosis and early treatment" approach is not universally applicable to all Budd-Chiari syndrome patients.
- Patients with adequate collateral compensation may achieve satisfactory survival without invasive procedures.
- Invasive treatment should be considered for patients whose condition deteriorates during regular follow-up.
Background:
The development of collaterals in Budd-Chiari syndrome has been described and these collaterals play an important role in the presentation of this disease. These collaterals are diagnostic and their use in management strategy has never been evaluated. This study aimed to investigate the indications, feasibility and necessity of invasive treatment for patients with Budd-Chiari syndrome and to determine whether such a strategy is necessary for optimal management.
Methods:
Twenty-nine patients who had been treated at our unit were enrolled in this study. Based on physical and biochemical examination, and hemodynamic compensation by collaterals, 18 patients underwent radiological intervention (group A), while the other 11 had no invasive treatment (group B). The related hemodynamic parameters were acquired when percutaneous angiography was performed.
Results:
In group A, all patients underwent successfully inferior vena cava (IVC) balloon angioplasty with or without stenting. Four patients also underwent hepatic vein angioplasty. In these patients, the mean IVC pressure before and after treatment was statistically different (29.3+/-9.2 vs 15.1+/-4.6 mmHg, P<0.01). The mean IVC pressure was much lower in group B than in group A (12.9+/-2.4 vs 29.3+/-9.2 mmHg, P<0.01), but there was no difference from that of the patients after radiological treatment (12.9+/-2.4 vs 15.1+/-4.6 mmHg, P>0.05). Median follow-up was 32.3 months (mean 21.3 months; range 3-61 months). In the course of follow-up, the patients in group A survived with good systemic status except for re-stenosis in one patient who underwent re-canalization of the IVC. In group B, 10 patients had good systemic status except one patient who had a meso-caval shunt because of deterioration.
Conclusions:
The rationale of "early diagnosis and early treatment" is not suitable for all patients with Budd-Chiari syndrome. Satisfactory survival can be achieved in some patients without invasive treatment, who are completely compensated by rich collaterals. Nonetheless, a positive treatment procedure should be performed if the patient's situation worsens in the course of regular follow-up.
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