Percutaneous recanalization for combined-type Budd-Chiari syndrome: strategy and long-term outcome
Yu-Fei Fu1, Yu Li2, Yan-Feng Cui3
1Department of Radiology, Xuzhou Central Hospital, 199 South Jie-fang Road, Xuzhou, 221009, China. fuyufei1985@163.com.
Insights
Percutaneous recanalization is a feasible treatment for combined Budd-Chiari syndrome (BCS). A tailored strategy involving inferior vena cava (IVC) and hepatic vein (HV) recanalization, based on accessory HV status, ensures high success and survival rates.
Area of Science:
- Interventional Radiology
- Hepatology
- Vascular Surgery
Background:
- Combined-type Budd-Chiari syndrome (BCS) presents complex venous obstruction.
- Effective treatment strategies for combined-type BCS are crucial for patient outcomes.
- Percutaneous recanalization offers a minimally invasive approach to restore venous flow.
Purpose of the Study:
- To evaluate the feasibility and long-term outcomes of percutaneous recanalization for combined-type BCS.
- To define an effective treatment strategy based on patient-specific venous anatomy.
- To assess the technical and clinical success rates of the recanalization procedure.
Main Methods:
- A cohort of 62 symptomatic combined-type BCS patients underwent percutaneous recanalization between December 2007 and August 2014.
- Inferior vena cava (IVC) recanalization was the primary intervention.
- Hepatic vein (HV) recanalization was selectively performed based on the presence of a patent accessory hepatic vein (AHV) and symptom persistence.
Main Results:
- Technical success was achieved in 60 out of 62 patients (96.8%).
- Clinical success was observed in all 60 successfully treated patients.
- Cumulative 1-, 2-, and 4-year survival rates were 98.3%, 96.5%, and 92.7%, respectively, with three deaths during follow-up.
Conclusions:
- Percutaneous recanalization is a suitable and effective treatment modality for combined-type BCS.
- A strategy differentiating between single IVC recanalization (for patients with patent AHV) and combined IVC-HV recanalization (for others) optimizes outcomes.
- This approach leads to high rates of technical and clinical success and favorable long-term survival.
Purpose:
To investigate the feasibility, strategy, and long-term outcome of percutaneous recanalization for combined-type Budd-Chiari syndrome (BCS).
Methods:
From December 2007 to August 2014, consecutive symptomatic combined-type BCS patients were treated by percutaneous recanalization in our centers. Inferior vena cava (IVC) recanalization was the first-stage treatment for all patients. Recanalization of one hepatic vein (HV) was the second-stage treatment for the selected patients. If the patient had the compensatory and patent accessory HV (AHV), we observed this patient for 7 days after IVC recanalization. If the symptoms of portal hypertension improved, HV recanalization was not needed. Otherwise, HV recanalization was performed. If the patient had no patent AHV, HV recanalization was performed 3 days after IVC recanalization. Data on technical success, clinical success, and follow-up were analyzed, respectively.
Results:
Sixty-two symptomatic combined-type BCS patients were enrolled. Technical success of percutaneous recanalization was achieved in 60 patients. Among them, 52 patients had the patent AHV and underwent single IVC recanalization, and 8 patients had no patent AHV and underwent combined IVC and HV recanalization. Clinical success was achieved in all of the 60 patients. Three patients died during the follow-up. The cumulative 1-, 2-, and 4-year survival rates were 98.3%, 96.5%, and 92.7%, respectively.
Conclusion:
Percutaneous recanalization is suitable for most combined-type BCS patients. Treatment strategy can be made according to the situation of AHV. If the patient has the patent AHV, single IVC recanalization is enough. Otherwise, combined IVC and HV recanalization should be performed.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care