Abstract:Objective: To assess the long-term outcome of percutaneous recanalization in a large case series of patients with Budd-Chiari syndrome(BCS). Methods: Between July 1988 and August 2013, 161 consecutive Chinese patients with BCS were treated with percutaneous recanalization. Cumulative survival rates were assessed by Kaplan-Meier method, and independent predictors of survival were calculated with the Cox regression model. Results: Percutaneous recanalization was technically successful in 153 of the 161 patients(95%). Two patients died 16 h and 72 h respectively after operation because of disseminated intravascular coagulation(DIC) and severe hemoptysis, respectively. One hundred and forty-one out of the remaining 153 patients with BCS were successfully followed up. Patients with stent placement had a similar rate of reocclusion with those with percutaneous angioplasty(PTA) alone(P>0.1). Among 85 patients in patency group, as compared to 56 patients in reocclusion group, 6 versus 26 died: 0 versus 12 of liver failure, 0 versus 8 of variceal bleeding, and 6 versus 6 of reocclusion-unrelated diseases. Reocclusion was associated with a shorter survival(P<0.001). Out of 56 patients experiencing reocclusion, thirty received further intervention. Eight of these thirty patients had died of liver failure(n=2), neoplasm(n=4), and other fatal reocclusion-unrelated diseases(n=2). Conclusion: In patients with BCS treated with percutaneous recanalization, stent placement should be cautious for its similar reocclusion rate with PTA alone, and reocclusion has a major impact on morbidity and mortality. For patients experiencing reocclusion, revision of reocclusion is recommended for its corresponding prognosis improvement.
王巧争1,张 伟2,陈晓伟1,徐 克1. 布-加综合征的介入治疗:141例患者的远期疗效分析[J]. 中国临床医学影像杂志, 2019, 30(8): 586-590.
WANG Qiao-zheng1, ZHANG Wei2, CHEN Xiao-wei1, XU Ke1. Percutaneous recanalization for Budd-Chiari syndrome: long-term outcomes in 141 Chinese patients. JOURNAL OF CHINA MEDICAL IMAGING, 2019, 30(8): 586-590.
[1]Valla DC. Primary Budd-Chiari syndrome[J]. J Hepatol, 2009, 50(1): 195-203.
[2]Plessier A, Rautou PE, Valla DC. Management of hepatic vascular diseases[J]. J Hepatol, 2012, 56(Suppl 1): S25-S38.
[3]Slakey DP, Klein AS, Venbrux AC, et al. Budd-Chiari syndrome: current management options[J]. Ann Surg, 2001, 233(4): 522-527.
[4]Langlet P, Valla DC. Is surgical portosystemic shunt the treatment of choice in Budd-Chiari syndrome?[J]. Acta Gastroenterol Belg, 2002, 65(3): 155-160.
[5]Garcia-Pagan JC, Heydtmamn M, Raffa S, et al. TIPS for Budd-Chiari syndrome: long-term results and prognostics factors in 124 patients[J]. Gastroenterology, 2008, 135(3): 808-815.
[6]Plessier A, Sibert A, Consigny Y, et al. Aiming at minimal invasiveness as a therapeutic strategy for Budd-Chiari syndrome[J]. Hepatology, 2006, 44(5): 1308-1316.
[7]Seijo S, Plessier A, Hoekstra J, et al. Good long-term outcome of Budd-Chiari syndrome with a step-wise management[J]. Hepatology, 2013, 57(5): 1962-1968.
[8]Xue H, Li YC, Shakya P, et al. The role of intravascular intervention in the management of Budd-Chiari syndrome[J]. Dig Dis Sci, 2010, 55(9): 2659-2663.
[9]Cheng D, Xu H, Lu ZJ, et al. Clinical features and etiology of Budd-Chiari syndrome in Chinese patients: a single-center study[J]. J Gastroenterol Hepatol, 2013, 28(6): 1061-1067.
[10]Wu T, Wang L, Xiao Q, et al. Percutaneous balloon angioplasty of inferior vena cava in Budd-Chiari syndrome-R1[J]. Int J Cardiol, 2002, 83(2): 175-178.
[11]Xu K, Feng B, Zhong H, et al. Clinical application of interventional techniques in the treatment of Budd-Chiari syndrome[J]. Chin Med J(Engl), 2003, 116(4): 609-615.
[12]Zhang CQ, Fu LN, Xu L, et al. Long-term effect of stent placement in 115 patients with Budd-Chiari syndrome[J]. World J Gastroenterol, 2003, 9(11): 2587-2591.
[13]Li T, Zhang S, Pang Z, et al. Feasibility and midterm outcomes of percutaneous transhepatic balloon angioplasty for symptomatic Budd-Chiari syndrome secondary to hepatic venous obstruction[J]. J Vasc Surg, 2009, 50(5): 1079-1084.
[14]Yang XL, Cheng TO, Chen CR. Successful treatment by percutaneous balloon angioplasty of Budd-Chiari syndrome caused by membranous obstruction of inferior vena cava: 8-year follow-up study[J]. J Am Coll Cardiol, 1996, 28(7): 1720-1724.
[15]Han GH, Qi XS, Zhang W, et al. Percutaneous recanalization for Budd-Chiari syndrome: an 11-year retrospective study on patency and survival in 177 Chinese patients from a single center[J]. Radiology, 2013, 266(2): 657-667.
[16]Ciesek S, Rifai K, Bahr MJ, et al. Membranous Budd-Chiari syndrome in Caucasians[J]. Scand J Gastroenterol, 2010, 45(2): 226-234.
[17]Ebrahimi M, Modaghegh MH, Esmaeilzadeh A. Presentation of hospital outcomes and different treatment methods of patients with Budd-Chiari syndrome: a report from two tertiary hospitals in Iran[J]. Med Princ Pract, 2011, 20(3): 287-290.
[18]Hatab H, Mohammed F, Stockwell R, et al. Membranous Budd-Chiari syndrome in a well-anticoagulated patient[J]. BMJ Case Rep, 2010, 10: 212-214.
[19]DeLeve LD, Valla DC, Garcia-Tsao G. Vascular disorders of the liver[J]. Hepatology, 2009, 49(5): 1729-1764.
[20]Janssen HL, Garcia-Pagan JC, Elias E, et al. Budd-Chiari syndrome: a review by an expert panel[J]. J Hepatol, 2003, 38(3): 364-371.
[21]Zhang QQ, Xu H, Zu MH, et al. Strategy and long-term outcomes of endovascular treatment for Budd-Chiari syndrome complicated by inferior vena caval thrombosis[J]. Eur J Vasc Endovasc Surg, 2014, 47(5): 550-557.
[22]Eapen CE, Velissaris D, Heydtmann M, et al. Favourable medium term outcome following hepatic vein recanalisation and/or transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome[J]. Gut, 2006, 55(6): 878-884.
[23]Hirooka M, Kimura C. Membranous obstruction of the hepatic portion of the inferior vena cava: surgical correction and etiological study[J]. Arch Surg, 1970, 100(6): 656-663.
[24]Kage M, Arakawa M, Kojiro M, et al. Histopathology of membranous obstruction of the inferior vena cava in the Budd-Chiari syndrome[J]. Gastroenterology, 1992, 102(6): 2081-2090.
[25]Mancuso A, Fung K, Mela M, et al. TIPS for acute and chronic Budd-Chiari syndrome: a single-centre experience[J]. J Hepatol, 2003, 38(6): 751-754.
[26]徐浩,祖茂衡,李国均,等. 肝静脉阻塞型Budd-Chiari综合征的介入治疗[J]. 中国医学影像技术,2004,20(10):1588-1591.
[27]祖茂衡. 布加综合征的影像诊断与介入治疗[M]. 北京:科学出版社,2004:212-224.
[28]丁鹏旭,张文广,韩新巍,等. 改良式TIPS治疗肝静脉广泛阻塞型布加综合征的近期疗效[J]. 介入放射学杂志,2011,20(2):138-141.
[29]Langlet P, Escolano S, Valla D, et al. Clinicopathological forms and prognostic index in Budd-Chiari syndrome[J]. J Hepatol, 2003, 39(4): 496-501.