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Interventional Treatment Strategy for Primary Budd–Chiari Syndrome with Both Inferior Vena Cava and Hepatic Vein Involvement: Patients from Two Centers in China

Abstract

Objective

This retrospective study evaluated interventional treatments (recanalization, balloon dilation, and/or stent placement) for Budd–Chiari syndrome (BCS), caused by combined obstruction of the inferior vena cava (IVC) and hepatic veins (HVs).

Methods

Before and after interventional therapy, patients with BCS (n = 162; asymptomatic 105.2 ± 103.3 mo; follow-up 15 [6–24] mo) underwent imaging studies (color Doppler ultrasound, CT, or MRI), and inferior vena cavography and manometry. Venous lesions were characterized by occlusion features, and presence of thrombosis and peripheral collateral vessels.

Results

One, 2, and 3 main HV occlusions were observed, respectively, in 25 (15.4%), 61 (37.7%), and 76 (46.9%) patients. Eighty-three (51.2%), 98 (60.5%), and 104 (64.2%) patients had, respectively, large accessory HVs, venous collaterals formed between the HVs, or venous communicating branches between the HV and the peritoneal veins. The middle, left, and right HV was patent in 32 (19.8%), 35 (21.6%), and 44 (27.2%) patients. Recanalization of both hepatic and caval occlusions was successful in 96% (51/53) of those attempted; recanalization of IVC occlusion was successful in 97% (106/109). Among 157 patients successfully treated, 146 were cured and 11 showed clinical improvement. Clinical symptoms were relieved in 82.4% after the initial intervention, and 94.2% after the second intervention.

Conclusion

Recanalization and balloon angioplasty was effective for the management of BCS with concurrent HV and IVC occlusions. The majority of patients required only IVC recanalization. The outcome of patients treated only by IVC intervention was similar to that of patients given combined HV and IVC intervention.

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Abbreviations

BCS:

Budd–Chiari syndrome

CI:

Confidence interval

HV:

Hepatic vein

IVC:

Inferior vena cava

MRI:

Magnetic resonance imaging

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Acknowledgements

This project was supported by the Natural Science Foundation of Anhui Province (Grant No. 1708085QH218).

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Correspondence to Chuan-ting Li.

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All authors declare that they have no conflict of interest.

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All procedures were performed in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

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Informed consent was obtained from all individual participants included in the study.

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Cheng, Dl., Xu, H., Li, Cl. et al. Interventional Treatment Strategy for Primary Budd–Chiari Syndrome with Both Inferior Vena Cava and Hepatic Vein Involvement: Patients from Two Centers in China. Cardiovasc Intervent Radiol 42, 1311–1321 (2019). https://doi.org/10.1007/s00270-019-02267-w

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Keywords

  • Budd–Chiari syndrome
  • Interventional treatment
  • Hepatic veins
  • Survival rate