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Kuka WP, Nduati PK, Mwirigi A, Opio CK. Budd-Chiari syndrome and extensive inferior vena cava thrombosis
treated with sequential interventional radiology and transjugular intrahepatic
portosystemic shunting: A case report from Kenya. SAGE Open Med Case Rep 2023; 11:2050313X231161190. [PMID: 36968991 PMCID: PMC10031605 DOI: 10.1177/2050313x231161190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/14/2023] [Indexed: 03/24/2023] Open
Abstract
Budd-Chiari syndrome is a rare disease characterized by the obstruction of
hepatic venous outflow. Stepwise treatment options aimed to relieve obstruction
and prevent complications of Budd-Chiari syndrome are medical therapy,
interventional recanalization, and surgery. Aggressive interventions for
complicated Budd-Chiari syndrome are placement of a transjugular intrahepatic
portosystemic shunt, surgical shunting, or liver transplantation. Although
literature suggests differences in the presentation and management between
Europe and Asia, cases documenting successful use of stepwise management of
Budd-Chiari syndrome in Sub-Saharan Africa are scarce. A 47-year-old male on
treatment for chronic hepatitis B presented with abdominal pain and distension
for 2 weeks and findings of gross ascites without stigmata of chronic liver
disease. Laboratory investigations performed showed anemia, elevated
transaminases, coagulopathy, and renal dysfunction. Abdominal ultrasound and
computed tomography abdominal scan revealed filling defects in intrahepatic
veins and inferior vena cava extending to bilateral renal and external iliac
veins. Extensive workup for thrombophilia and myeloproliferative disorders was
negative. The diagnosis was hepatic dysfunction secondary to inferior vena cava
obstruction due to a thrombus in the setting of extensive inferior vena cava
thrombosis, and heparin was initiated. However, due to lack of recanalization
with anticoagulation, we performed aspiration thrombectomy, balloon angioplasty,
and local thrombolysis. Transjugular intrahepatic portosystemic shunt procedure
was subsequently done due to hepatic venous congestion and refractory ascites.
He was discharged on oral anticoagulation. Imaging exams performed 4 months
later showed patent inferior vena cava and transjugular intrahepatic
portosystemic shunt, good flows in the portal vein and resolution of
ascites.
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Affiliation(s)
- Werimo Pascal Kuka
- Department of Medicine, The Aga Khan
University Hospital, Nairobi, Nairobi, Kenya
- Werimo Pascal Kuka, Department of Medicine,
The Aga Khan University Hospital, Nairobi, 4th Floor East Tower Block, Third
Avenue Parklands, P.O. Box 30270, Nairobi 00100, GPO, Kenya. Emails:
;
| | - Paul Kareithi Nduati
- Department of Imaging and Diagnostic
Radiology, The Aga Khan University Hospital, Nairobi, Nairobi, Kenya
| | - Anne Mwirigi
- Department of Hematology and Oncology,
The Aga Khan University Hospital, Nairobi, Nairobi, Kenya
| | - Christopher K Opio
- Department of Medicine, The Aga Khan
University Hospital, Nairobi, Nairobi, Kenya
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Rana A, Jaganathan S, Ray B, Krishnan V. Improving Outcomes in Catheter-Directed Thrombolysis for the Management of Acute Budd-Chiari Syndrome: A Case Report. Cureus 2023; 15:e35976. [PMID: 37041895 PMCID: PMC10083000 DOI: 10.7759/cureus.35976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 03/12/2023] Open
Abstract
Traditionally catheter-directed thrombolysis is performed for recanalization of hepatic vein thrombosis in acute Budd-Chiari syndrome. Successful recanalization of the hepatic veins requires a continuous infusion of the thrombolytic agent for an adequate duration due to increased resistance to blood flow in the setting of luminal thrombosis. Here, we describe a case of acute Budd-Chiari syndrome in a young female in whom prolonged catheter-directed thrombolysis of the right hepatic vein was performed for a duration of 84 hours using alteplase as the thrombolytic agent. This was followed by angioplasty and stent placement. We observed that prolonged catheter-directed thrombolysis was associated with a progressive reduction in clot burden with improved luminal patency of the hepatic vein and improved outcome of subsequent angioplasty and stenting. There was a rapid improvement in liver function tests after the procedure and liver enzymes returned to baseline within a week. A follow-up ultrasound scan showed normal blood flow and a patent lumen of the right hepatic vein. In the absence of complications, prolonged catheter-directed thrombolysis in acute Budd-Chiari syndrome can achieve adequate recanalization of the hepatic veins and improved long-term clinical outcomes. This may obviate the need for other invasive procedures like TIPS (transjugular intrahepatic portosystemic shunt)/DIPS (direct intrahepatic portosystemic shunt) and liver transplantation.
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Long-Term Outcomes of Endovascular Interventions in More than 500 patients with Budd-Chiari Syndrome. J Vasc Interv Radiol 2020; 32:61-69.e1. [PMID: 33218919 DOI: 10.1016/j.jvir.2020.08.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/29/2020] [Accepted: 08/31/2020] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To assess and compare the long-term outcomes of various endovascular interventions in patients with Budd-Chiari syndrome (BCS). MATERIALS AND METHODS In this single-center retrospective study, 510 consecutive patients with BCS who had undergone a total of 618 endovascular procedures from January 2001 to December 2019 were included. Details of the type of endovascular intervention, technical success, clinical success, patency rate, complications, and survival outcomes were analyzed. RESULTS The overall technical success rate was 96% (593 of 618 procedures; 500 in treatment-naïve patients and 93 repeat interventions for recurrent disease). Endovascular procedures included recanalization procedures (angioplasty and stent placement) in 355 patients (71%) and transjugular intrahepatic portosystemic shunt (TIPS) creation in 145 (29%). Major postprocedure complications occurred in 14 patients (2.8%). Vascular/stent restenosis occurred in 95 patients (19%), and successful repeat intervention was performed in 82 of those 95 (86.3%). An additional 11 of these 82 (13.4%) underwent a third intervention for restenosis. In the recanalization and TIPS groups, the 1- and 5-y cumulative patency rates were 87% and 74% and 95% and 68%, respectively. The 1- and 5-y survival rates were 96% and 89% and 90% and 76%, respectively. CONCLUSIONS Endovascular interventions for BCS are feasible and safe in the majority of patients, with excellent short- and long-term patency and survival rates.
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Abstract
Budd-Chiari syndrome (BCS), or hepatic venous outflow obstruction, is a rare cause of liver disease that should not be missed. Variable clinical presentation among patients with BCS necessitates a high index of suspicion to avoid missing this life-threatening diagnosis. BCS is characterized as primary or secondary, depending on etiology of venous obstruction. Most patients with primary BCS have several contributing risk factors leading to a prothrombotic state. A multidisciplinary stepwise approach is integral in treating BCS. Lifelong anticoagulation is recommended. Long-term monitoring of patients for development of cirrhosis, complications of portal hypertension, hepatocellular carcinoma, and progression of underlying diseases is important.
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Wang Q, Li K, He C, Yuan X, Luo B, Qi X, Guo W, Bai W, Yu T, Fan J, Wang Z, Yuan J, Li X, Zhu Y, Han N, Niu J, Lv Y, Liu L, Li J, Tang S, Guo S, Wang E, Xia D, Wang Z, Cai H, Wang J, Yin Z, Xia J, Fan D, Han G. Angioplasty with versus without routine stent placement for Budd-Chiari syndrome: a randomised controlled trial. Lancet Gastroenterol Hepatol 2019; 4:686-697. [PMID: 31279647 DOI: 10.1016/s2468-1253(19)30177-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Angioplasty recanalisation is recommended as the first-line interventional procedure for Budd-Chiari syndrome, but subsequent restenosis is common. We aimed to test whether use of routine, non-selective stenting in angioplasty could improve patency and treatment efficacy with adequate safety in Budd-Chiari syndrome. METHODS We did a randomised controlled trial, for which patients aged 18-75 years with Budd-Chiari syndrome with membranous obstruction or short-length stenosis (≤4 cm), and a Child-Pugh score of less than 13 were considered eligible. Patients were excluded if they had obstruction not amenable to angioplasty, were recommended to be treated with transjugular intrahepatic portosystemic shunt or liver transplantation, or had contraindications for angioplasty. Eligible patients were randomly assigned (1:1) to an angioplasty-only group or an angioplasty plus routine stenting group, with use of a web-based allocation system (Pocock and Simon's minimisation method, stratified by obstruction features and Child-Pugh score). Recanalisation procedures were done within 24 h of randomisation. The statistician and investigators responsible for data collection data and endpoint assessment were masked to group allocation. The primary outcome was the proportion of patients free of restenosis, analysed in the intention-to-treat population. The study is registered on ClinicalTrials.gov (NCT02201485) and is completed. FINDINGS Between July 28, 2014, and Sept 29, 2017, 88 (59%) of 150 screened patients were enrolled and assigned either the angioplasty-only group (n=45) or the angioplasty plus routine stenting group (n=43). During a median follow-up period of 27 months (IQR 19-41), the angioplasty plus routine stenting group had significantly higher proportion of patients free of restenosis (42 [98%] of 43 patients) than did the angioplasty-only group (27 [60%] of 45 patients; p<0·0001). In the survival analysis, 3-year restenosis-free survival was 96·0% (95% CI 88·6-100·0) in the routine stenting group versus 60·4% (46·4-78·7) in the angioplasty-only group (log-rank p<0·0001). The hazard ratio for restenosis was 0·04 (95% CI 0·01-0·31) in favour of routine stenting, with an absolute risk reduction of 35·6% (95% CI 24·2-55·0). Two (5%) patients in the angioplasty plus routine stenting group and one (2%) patient in the angioplasty-only group died during follow-up. One (2%) patient from the angioplasty plus routine stenting group had puncture site haematoma, which was not related to stenting. No stent fracture or migration occurred. Anticoagulation-related adverse events occurred in five (11%) patients from angioplasty alone group and five (12%) patients from angioplasty plus routine stenting group. INTERPRETATION Routine stenting with angioplasty is superior to angioplasty alone for preventing restenosis in patients with Budd-Chiari syndrome with short-length stenosis and is safe to use as part of first-line invasive treatment. Further validation is needed in similar settings and other regions in which different characteristics of Budd-Chiari syndrome are more prevalent. FUNDING National Natural Science Foundation of China, National Key Technology R&D Programme, Optimised Overall Project of Shaanxi Province, Boost Programme of Xijing Hospital.
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Affiliation(s)
- Qiuhe Wang
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Kai Li
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Chuangye He
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xulong Yuan
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Bohan Luo
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xingshun Qi
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wengang Guo
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wei Bai
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Tianlei Yu
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jiahao Fan
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhengyu Wang
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jie Yuan
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiaomei Li
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ying Zhu
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Na Han
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jing Niu
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yong Lv
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Lei Liu
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jing Li
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shihao Tang
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shuai Guo
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Enxing Wang
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Dongdong Xia
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhexuan Wang
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Hongwei Cai
- Department of Medical Statistics, School of Preventive Medicine, Fourth Military Medical University, Xi'an, Shaanxi, China; Information Technology Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jianhong Wang
- Department of Ultrasound, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhanxin Yin
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jielai Xia
- Department of Medical Statistics, School of Preventive Medicine, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Daiming Fan
- State Key Laboratory of Cancer Biology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Guohong Han
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China.
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Bi Y, Chen H, Ding P, Zhou P, Ren J, Han X. Percutaneous Transhepatic Hepatic Vein Angioplasty in Budd-Chiari Syndrome After Transvenous Failure. J Laparoendosc Adv Surg Tech A 2018; 28:1346-1351. [PMID: 29851361 DOI: 10.1089/lap.2018.0156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of percutaneous transhepatic route creation for hepatic vein (HV) angioplasty in Budd-Chiari syndrome (BCS). PATIENTS AND METHODS Between April 2012 and August 2016, a total of 19 BCS patients underwent percutaneous transhepatic route creation for HV angioplasty after transvenous catheterization failure in this study. Color Doppler ultrasonography was required in all patients after admission and during follow-up. Data were retrospectively collected, and follow-up observations were performed. RESULTS Technical and clinical success was achieved in 18 patients. Except for 1 failure of route creation, 19 routes were successfully created in 18 patients, with a technology success rate of 95.0%. Twenty-two balloon angioplasties were performed in 18 patients, with a mean balloon diameter of 13.6 ± 0.5 mm. Blood pressure and length of occlusive HV decreased significantly, and blood flow velocity and diameter of HV increased significantly after procedure. Abdominal distension/pain and ascites decreased significantly after procedure. One procedure-related death occurred, who died of gastrointestinal bleeding 6 days later. Except for the failure case, the rest of 18 patients were successfully followed up. The remaining 18 patients survived during follow-up, with a 5-year survival rate of 94.9%. One patient had a restenosis of HV after 47 days, and had undergone successful dilation. The 5-year primary and second patency rates were 94.1% and 100%, respectively. CONCLUSION Percutaneous transhepatic route creation is safe and effective for HV angioplasty, and can be used to treat BCS patients after transvenous catheterization failure.
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Affiliation(s)
- Yonghua Bi
- 1 Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University , Zhengzhou, China
| | - Hongmei Chen
- 2 Department of Ultrasound, Zhengzhou Central Hospital Affiliated to Zhengzhou University , Zhengzhou, China
| | - Pengxu Ding
- 1 Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University , Zhengzhou, China
| | - Pengli Zhou
- 1 Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University , Zhengzhou, China
| | - Jianzhuang Ren
- 1 Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University , Zhengzhou, China
| | - Xinwei Han
- 1 Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University , Zhengzhou, China
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Fu YF, Xu H, Zhang K, Zhang QQ, Wei N. Accessory hepatic vein recanalization for treatment of Budd-Chiari syndrome due to long-segment obstruction of the hepatic vein: initial clinical experience. Diagn Interv Radiol 2016; 21:148-53. [PMID: 25616271 DOI: 10.5152/dir.2014.14128] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to investigate the feasibility and effectiveness of accessory hepatic vein recanalization (balloon dilatation/stent insertion) for patients with Budd-Chiari syndrome (BCS) due to long-segment obstruction of the hepatic vein. METHODS From March 2010 to December 2013, 20 consecutive patients with BCS, due to long-segment obstruction of three hepatic veins, treated with accessory hepatic vein recanalization (11 males, 9 females; mean age, 33.4±10.9 years; range, 22-56 years) were included in this retrospective study. Data on technical success, clinical success, and follow-up were collected and analyzed. RESULTS Technical and clinical success was achieved in all patients. Each patient was managed with a single accessory hepatic vein recanalization procedure. No procedure-related complications occurred. The diameter of the accessory hepatic vein was 8.45±1.47 mm (6-11 mm) at the stem, and there were many collateral circulations between the hepatic vein and the accessory hepatic vein. The mean pressure of accessory hepatic vein decreased from 47.50±5.59 cm H2O before treatment to 28.80±3.47 cm H2O after treatment (P < 0.001). Abnormal levels of total bilirubin, albumin, aspartate aminotransferase, and alanine transaminase improved after the treatment. During the follow-up, three patients experienced restenosis or stenting of the accessory hepatic vein. CONCLUSIONS In BCS due to long-segment obstruction of the hepatic veins, it is important to confirm whether there is a compensatory accessory hepatic vein. For patients with a compensatory but obstructed accessory hepatic vein, recanalization is a simple, safe, and effective treatment option.
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Affiliation(s)
- Yu Fei Fu
- Department of Interventional Radiology, The Affiliated Hospital of Xuzhou Medical College, Jiangsu, China.
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Garge S, Keshava SN, Moses V. Cannula-Assisted, Transabdominal Ultrasound-Guided Inferior Vena Cava Recanalization in Inferior Vena Cava Occlusion. Curr Probl Diagn Radiol 2016; 46:196-199. [PMID: 27667701 DOI: 10.1067/j.cpradiol.2016.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 07/20/2016] [Accepted: 07/28/2016] [Indexed: 11/22/2022]
Abstract
We describe a novel technique for facilitating recanalization of intrahepatic inferior vena cava (IVC) via the transjugular approach in patients with short segmental hepatic IVC occlusion, where a transjugular liver biopsy cannula provides additional support to the catheter-wire combination and trans-abdominal ultrasound helps in positioning the tip of the cannula at the stump of suprahepatic IVC.
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Affiliation(s)
| | | | - Vinu Moses
- Department of Radiology, Christian Medical College, Vellore, India
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Lu L, Xu K, Han C, Xu C, Xu H, Dai Y, Rong Y, Li S, Xie L. Comparison of 3.0T MRI with 3D LAVA sequence and digital subtraction angiography for the assessment of accessory hepatic veins in Budd-Chiari syndrome. J Magn Reson Imaging 2016; 45:401-409. [PMID: 27388772 DOI: 10.1002/jmri.25381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/22/2016] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To compare 3D liver acceleration volume acquisition (LAVA) and digital subtraction angiography (DSA) for evaluating the presence of accessory hepatic veins (AHV) in Budd-Chiari syndrome (BCS). MATERIALS AND METHODS This was a retrospective study in 228 patients with BCS who underwent 3.0T magnetic resonance imaging (MRI) with the 3D LAVA sequence. Two reviewers noted AHV: openings located in the inferior vena cava (IVC), caliber, and the angle of entering into the IVC. MRI results were compared to DSA. Kappa statistics were calculated to quantify intrareader variability in detecting AHVs. RESULTS On MRI, 63 patients demonstrated no AHV on LAVA images, 70 had one AHV, 62 had two AHVs, 26 patients had three AHVs, six patients had four AHVs, and one patient had five AHVs (P < 0.05 vs. DSA). The mean caliber of the AHVs was 8.3 ± 4.0 mm compared to 9.9 ± 3.2 for DSA (P < 0.001). Among the 301 AHVs, there were 140 with acute angles (46.5%), 71 with right angles (23.6%), and 90 with obtuse angles (29.8%). The prevalence of AHVs on DSA was 54.8% (125/228), while MRI demonstrated 301 AHVs in 165 patients, for a prevalence of 72.4% (165/228) compared to 54.8% for DSA (P = 0.001). The two methods were concordant in only 116/228 (50.9%) patients. The kappa coefficient demonstrated good intrareader consistency for all documented MRI findings of AHVs (κ = 0.626 for caliber and κ = 0.65 for angles). CONCLUSION More AHVs were visible on MRI LAVA sequences than on conventional DSA. LEVEL OF EVIDENCE 4 J. Magn. Reson. Imaging 2017;45:401-409.
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Affiliation(s)
- Li Lu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu Province, China
| | - Kai Xu
- School of Medical Imaging, Xuzhou Medical College, Xuzhou, Jiangsu Province, China
| | - Cuiping Han
- School of Medical Imaging, Xuzhou Medical College, Xuzhou, Jiangsu Province, China
| | - Chao Xu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu Province, China
| | - Huiting Xu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu Province, China
| | - Yue Dai
- Department of Radiology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu Province, China
| | - Yutao Rong
- Department of Radiology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu Province, China
| | - Shaodong Li
- Department of Radiology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu Province, China
| | - Lixiang Xie
- Department of Radiology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu Province, China
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The outcomes of interventional treatment for Budd-Chiari syndrome: systematic review and meta-analysis. ACTA ACUST UNITED AC 2015; 40:601-8. [PMID: 25248791 DOI: 10.1007/s00261-014-0240-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The purpose of this study was to conduct a systematic review with meta-analysis quantitatively assesses the outcomes of interventional treatment for Budd-Chiari syndrome (BCS). We evaluated the published studies on interventional treatment for BCS and reviewed reference lists from retrieved articles. Meta-analysis was applied to calculate the combined rates and their 95% confidence intervals. The risk of bias was assessed by the Egger test. As many as 29 articles on interventional treatment with BCS were selected according to the eligibility criteria and included in the meta-analysis, for a total of 2,255 BCS patients. The pooled results (95 % CI) were 93.7 % (92.6-4.8 %) for successful rate of interventional operation, 6.5 % (5.3-7.7 %) for restenosis rate of interventional treatment, and 92.0 % (89.8-94.3 %) and 76.4 % (72.5-80.4 %) for the survival rate at 1 and 5 years, respectively. The interventional therapy of major BCS patients is safe with successful operation, good patency, and long-term survival. Moreover, a step-wise management of BCS is proposed to manage and cure all BCS patients with personalized treatment.
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Yoon YI, Hwang S, Ko GY, Ha TY, Song GW, Jung DH, Lee YS, Lee SG. Endovascular stenting of the inferior vena cava in a patient with Budd-Chiari syndrome and main hepatic vein thrombosis: a case report. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2015; 19:35-9. [PMID: 26155275 PMCID: PMC4494094 DOI: 10.14701/kjhbps.2015.19.1.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 02/18/2015] [Accepted: 02/21/2015] [Indexed: 12/02/2022]
Abstract
Endovascular stenting is accepted as an effective treatment for patients with Budd-Chiari syndrome (BCS). We herein present a case of successful endovascular treatment. A 46-year-old woman, who was followed up for 10 years after a diagnosis of BCS, showed progression progressive of liver cirrhosis and deterioration deteriorated of liver function. Three main hepatic veins were thrombosed with complete occlusion of the suprahepatic of the inferior vena cava (IVC); thus, hepatic venous blood flow was draining into the inferior right hepatic veins through the intrahepatic collaterals and passed passing through the subcutaneous venous collaterals. She underwent endovascular stenting of the IVC for palliation. A septoplasty needle was passed through the occluded IVC through into the internal jugular vein access and then to access the femoral vein using a snare wire. Severe elastic recoiling was observed after balloon dilatation; thus, a 28×80 mm stenting was done inserted across the occlusion, and repeat double ballooning was performed. The final venogram shows showed restored IVC inflow. The patient began to lose body weight 1 day after stenting, and edema disappeared within 1 week. She is was doing well at the 6 month follow-up visit with nearly normal liver function and marked resolution of cutaneous venous engorgement. In conclusion, endovascular stenting appeared to be an effective treatment to alleviate portal pressure and to prevent BCS-associated complications; thus, endovascular stenting should be considered before marked hepatic vein stenosis or complete occlusion occurs in patients with BCS.
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Affiliation(s)
- Young-In Yoon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Young Ko
- Department of Diagnostic Imaging, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yong Ha
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Won Song
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hwan Jung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Sang Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Gyu Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Cui YF, Fu YF, Wei N, Zhu HC, Xu H. Retrograde puncture assisted hepatic vein recanalization in treating Budd-Chiari syndrome with segmental obstruction of hepatic vein. Radiol Med 2015; 120:1184-9. [PMID: 26049739 DOI: 10.1007/s11547-015-0557-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 05/29/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed at investigating the feasibility and effectiveness of retrograde puncture assisted hepatic vein (HV) recanalization in management of Budd-Chiari syndrome (BCS) patients with segmental obstruction of HV. MATERIALS AND METHODS From May 2011 to August 2014, 76 BCS patients with obstruction of HV were treated by routine transjugular HV recanalization in our center. Among them, 17 patients with segmental obstruction (obstruction length >1 cm) of HV experienced failure of the routine transjugular HV recanalization and underwent retrograde puncture assisted HV recanalization. Data on technical success, clinical success and follow-up were collected and analyzed retrospectively. RESULTS Retrograde puncture assisted HV recanalization was technically successful in 14 of 17 (82 %) patients. Of these 14 patients, 12 patients underwent HV balloon dilation, and 2 patients underwent HV stent insertion. No procedure-related complications occurred in any of our patient. Clinical success was achieved in all of the 14 patients who experienced technical success. The mean HV pressure decreased from 43.6 ± 6.7 cmH2O before treatment to 18.4 ± 4.8 cmH2O after treatment (P < 0.001). BCS-related symptoms began to improve on the next day following the treatment. During 4-43 months (mean 17.4 ± 10.8 months) of follow-up, three patients experienced re-obstruction of HV. CONCLUSIONS Retrograde puncture assisted HV recanalization is a simple, safe, and effective treatment for BCS patients with segmental obstruction of HV. It can serve as an additional treatment option for patients who experience the technical failure of routine transjugular HV recanalization.
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Affiliation(s)
- Yan-Feng Cui
- Department of Interventional Radiology, The Affiliated Hospital of Xuzhou Medical College, 99 West Huai-hai Road, 221006, Xuzhou, China
| | - Yu-Fei Fu
- Department of Radiology, Xuzhou Central Hospital, 199 South Jie-fang Road, 221009, Xuzhou, China
| | - Ning Wei
- Department of Interventional Radiology, The Affiliated Hospital of Xuzhou Medical College, 99 West Huai-hai Road, 221006, Xuzhou, China
| | - Hong-Chao Zhu
- Department of Interventional Radiology, The Affiliated Hospital of Xuzhou Medical College, 99 West Huai-hai Road, 221006, Xuzhou, China
| | - Hao Xu
- Department of Interventional Radiology, The Affiliated Hospital of Xuzhou Medical College, 99 West Huai-hai Road, 221006, Xuzhou, China.
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Taslakian B, Faraj W, Khalife M, Al-Kutoubi A, El-Merhi F, Saade C, Hallal A, Haydar A. Assessment of surgical portosystemic shunts and associated complications: The diagnostic and therapeutic role of radiologists. Eur J Radiol 2015; 84:1525-1539. [PMID: 25963504 DOI: 10.1016/j.ejrad.2015.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 04/16/2015] [Accepted: 04/21/2015] [Indexed: 02/07/2023]
Abstract
Surgical portosystemic shunting, the formation of a vascular connection between the portal and systemic venous circulation, has been used as a treatment to reduce portal venous pressure. Although the use of portosystemic shunt surgery in the management of portal hypertension has declined during the past decade in favour of alternative therapies, and subsequently surgeons and radiologists became less familiar with the procedure, it remains a well-established treatment. Knowledge of different types of surgical portosystemic shunts, their pathophysiology and complications will help radiologists improve communication with surgeons and enhance their understanding of the diagnostic and therapeutic role of radiology in the assessment and management of these shunts. Optimal assessment of the shunt is essential to determine its patency and allow timely intervention. Both non-invasive and invasive imaging modalities complement each other in the evaluation of surgical portosystemic shunts. Interventional radiology plays an important role in the management of complications, such as shunt thrombosis and stenosis. This article describes the various types of surgical portosystemic shunts, explains the anatomy and pathophysiology of these shunts, illustrates the pearls and pitfalls of different imaging modalities in the assessment of these shunts and demonstrates the role of radiologists in the interventional management of complications.
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Affiliation(s)
- Bedros Taslakian
- Department of Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020-PO Box: 11-0236, Beirut, Lebanon.
| | - Walid Faraj
- Department of General Surgery, American University of Beirut Medical Center, Riad El-Solh 1107 2020-PO Box: 11-0236, Beirut, Lebanon.
| | - Mohammad Khalife
- Department of General Surgery, American University of Beirut Medical Center, Riad El-Solh 1107 2020-PO Box: 11-0236, Beirut, Lebanon.
| | - Aghiad Al-Kutoubi
- Department of Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020-PO Box: 11-0236, Beirut, Lebanon.
| | - Fadi El-Merhi
- Department of Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020-PO Box: 11-0236, Beirut, Lebanon.
| | - Charbel Saade
- Department of Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020-PO Box: 11-0236, Beirut, Lebanon.
| | - Ali Hallal
- Department of General Surgery, American University of Beirut Medical Center, Riad El-Solh 1107 2020-PO Box: 11-0236, Beirut, Lebanon.
| | - Ali Haydar
- Department of Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020-PO Box: 11-0236, Beirut, Lebanon.
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Sun Z, Jiang J, Li W, Zhang X, Zhang X, He C. New approach to dilation of stenotic lesions through the accessory hepatic vein in Budd-Chiari syndrome. J Vasc Surg Cases 2015; 1:42-45. [PMID: 31724632 PMCID: PMC6849980 DOI: 10.1016/j.jvsc.2014.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/25/2014] [Indexed: 11/28/2022] Open
Abstract
We investigated a new approach to dilation of stenotic lesions through the femoral vein-accessory hepatic vein-intrahepatic communicating branched vein-hepatic vein-inferior vena cava loop in two cases of Budd-Chiari syndrome. For some selected patients, this approach represents an additional method to increase technical success and to decrease complications.
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Affiliation(s)
- Zhanguo Sun
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
| | - Jingjun Jiang
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
| | - Wei Li
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
| | - Xuemin Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
| | - Xiaoming Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
| | - Changshun He
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
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Massie A, Phillips H, Solomon J. Resolution of Budd‐Chiari syndrome secondary to needle foreign body migration in a dog: treatment with surgery and intravascular stenting. VETERINARY RECORD CASE REPORTS 2015. [DOI: 10.1136/vetreccr-2014-000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Anna Massie
- North Houston Veterinary SpecialistsSpringTexasUSA
| | - Heidi Phillips
- Veterinary Clinical MedicineUniversity of IllinoisUrbanaIllinoisUSA
| | - Jeffrey Solomon
- Department of New Product DevelopmentInfiniti Medical LLCMenlo ParkCaliforniaUSA
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Sang HF, Li XQ. Endovascular Treatment of Budd–Chiari Syndrome with Hepatic Vein Obstruction in China. J Laparoendosc Adv Surg Tech A 2014; 24:846-51. [PMID: 25495251 DOI: 10.1089/lap.2014.0095] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hong-Fei Sang
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiao-Qiang Li
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Mitsuoka H, Saito T, Higashi S. Stepwise angioplasty and catheter directed thrombolysis for budd-Chiari syndrome complicated with floating thrombus in inferior vena cava. Ann Vasc Dis 2014; 7:173-7. [PMID: 24995066 DOI: 10.3400/avd.cr.14-00004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/15/2014] [Indexed: 12/27/2022] Open
Abstract
Recently, we experienced a rare case of Budd-Chiari Syndrome. The case was a 57-year-old female patient. Venous return had been severely disturbed by the membranous occlusion of the IVC and a giant floating thrombus. After catheter directed thrombolysis combined with stepwise percutaneous angioplasty, the IVC was recanalized sufficiently and the thrombus was completely resolved.
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Affiliation(s)
- Hiroshi Mitsuoka
- Department of Vascular Surgery, Shizuoka Red Cross Hospital, Shizuoka, Shizuoka, Japan
| | - Takaaki Saito
- Department of Vascular Surgery, Shizuoka Red Cross Hospital, Shizuoka, Shizuoka, Japan
| | - Shigeki Higashi
- Department of Cardiac Surgery, Shizuoka Red Cross Hospital, Shizuoka, Shizuoka, Japan
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Zhang B, Jiang ZB, Huang MS, Zhu KS, Qian JS, Shan H. Effects of percutaneous transhepatic interventional treatment for symptomatic Budd-Chiari syndrome secondary to hepatic venous obstruction. J Vasc Surg Venous Lymphat Disord 2013; 1:392-9. [DOI: 10.1016/j.jvsv.2013.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 05/17/2013] [Accepted: 05/28/2013] [Indexed: 01/28/2023]
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Treatment of Budd-Chiari syndrome with inferior vena cava thrombosis. Exp Ther Med 2013; 5:1254-1258. [PMID: 23596497 PMCID: PMC3627444 DOI: 10.3892/etm.2013.961] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/28/2013] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to evaluate the initial results of 41 patients with Budd-Chiari syndrome (BCS) with inferior vena cava (IVC) thrombosis, with regard to the clinical safety and feasibility of the therapeutic approaches selected according to the classification of the condition. Forty-one patients with BCS and IVC thrombosis were admitted for retrospective analysis. All 41 patients were classified as having one of three types of BCS. Interventional therapy was used successfully in 28 patients (68.3%), 7 patients (17.1%) were given conservative treatment and 6 patients (14.6%) were treated with surgical shunts. The interventional approach was used in 29 patients in total and was successful in 28 patients (all those of types I and II, and 3 of the 4 patients of type III with acute thrombosis; 96.6%). None of these 28 patients had pulmonary embolism, pericardial tamponade or intra-abdominal bleeding. After 1–5 years, 4 patients (9.8%) had a second dilation of the IVC. In the 7 cases treated in a conservative manner, 2 cases succumbed to upper gastrointestinal bleeding and 1 case succumbed to liver and kidney failure. This study indicates that the classification of BCS patients with IVC thrombosis is helpful in selecting a therapeutic approach. Interventional therapy is the first therapeutic choice for BCS patients with IVC thrombosis of type I, type II or type III with acute thrombosis. For the patients of type III with an obsolete thrombus, surgical shunts or conservative treatment are the main therapeutic methods.
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Recurrent acute Budd–Chiari syndrome after right hepatectomy: US color-Doppler vascular pattern and left hepatic vein stenting for treatment. ACTA ACUST UNITED AC 2012; 38:320-3. [DOI: 10.1007/s00261-012-9927-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mukund A, Gamanagatti S. Imaging and interventions in Budd-Chiari syndrome. World J Radiol 2011; 3:169-77. [PMID: 21860712 PMCID: PMC3158894 DOI: 10.4329/wjr.v3.i7.169] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 07/13/2011] [Accepted: 07/20/2011] [Indexed: 02/06/2023] Open
Abstract
Budd-Chiari syndrome (BCS) consists of a group of disorders with obstruction of hepatic venous outflow leading to increased hepatic sinusoidal pressure and portal hypertension. Clinically, two forms of disease (acute and chronic) are recognized. Mostly the patients present with ascites, hepatomegaly, and portal hypertension. In acute disease the liver is enlarged with thrombosed hepatic veins (HV) and ascites, whereas in the chronic form of the disease there may be membranous occlusion of HV and/or the inferior vena cava (IVC), or there may be short or long segment fibrotic constriction of HV or the suprahepatic IVC. Due to advances in radiological interventional techniques and hardware, there have been changes in the management protocol of BCS with surgery being offered to patients not suitable for radiological interventions or having acute liver failure requiring liver transplantation. The present article gives an insight into various imaging findings and interventional techniques employed in the management of BCS.
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Applicability of Different Endovascular Methods for Treatment of Refractory Budd–Chiari Syndrome. Cell Biochem Biophys 2011; 61:453-60. [DOI: 10.1007/s12013-011-9211-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Eldorry A, Barakat E, Abdella H, Abdelhakam S, Shaker M, Hamed A, Sakr M. Outcome of non surgical hepatic decompression procedures in Egyptian patients with Budd-Chiari. World J Gastroenterol 2011; 17:906-13. [PMID: 21412499 PMCID: PMC3051140 DOI: 10.3748/wjg.v17.i7.906] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 09/29/2010] [Accepted: 10/06/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate outcome of patients with Budd-Chiari syndrome after balloon angioplasty ± stenting or transjugular intrahepatic portosystemic shunt (TIPS).
METHODS: Twenty five patients with Budd-Chiari syndrome admitted to Ain Shams University Hospitals, Tropical Medicine Department were included. Twelve patients (48%) with short segment occlusion were candidates for angioplasty; with stenting in ten cases and without stenting in two. Thirteen patients (52%) had Transjugular Intrahepatic Portosystemic Shunt. Patients were followed up for 12-32 mo.
RESULTS: Patency rate in patients who underwent angioplasty ± stenting was 83.3% at one year and at end of follow up. The need of revision was 41.6% with one year survival of 100%, dropped to 91.6% at end of follow up. In patients who had Transjugular Intrahepatic Portosystemic Shunt, patency rate was 92.3% at one year, dropped to 84.6% at end of follow up. The need of revision was 38.4% with one year and end of follow up survival of 100%. Patients with patent shunts showed marked improvement compared to those with occluded shunts.
CONCLUSION: Morbidity and mortality following angioplasty ± stenting and TIPS are low with satisfactory outcome. Proper patient selection and management of shunt dysfunction are crucial in improvement.
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Xue H, Li YC, Shakya P, Palikhe M, Jha RK. The role of intravascular intervention in the management of Budd-Chiari syndrome. Dig Dis Sci 2010; 55:2659-63. [PMID: 20035404 DOI: 10.1007/s10620-009-1087-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Accepted: 12/01/2009] [Indexed: 12/09/2022]
Abstract
OBJECTIVE To evaluate the efficacy of intravascular intervention in the management of different types of Budd-Chiari syndrome. METHODS Fifty-three patients of BCS were clinically diagnosed and interventionally treated in terms of their signs and symptoms of portal hypertension and occlusive inferior vena cava/or hepatic veins with the combination of Doppler ultrasonography, CT scan, and angiography. The interventional methods applied in this study included percutaneous transluminal angioplasty and IVC stent implantation (PTA+IVC stent); transjugular hepatic veno-stent placement (PTA+HV stent) or transjugular transluminal hepatic veno-inferior vena cava stent placement and transcaval transjugular intrahepatic portocaval shunt. RESULTS The success rate of intravascular interventional therapy was 92.45% (49/53). After interventional therapy, the patients' pleural effusion, ascites, prominent veins formation of bilateral flanks or backs alleviated, hepatomegaly reduced, and the urinary output increased. The longest follow-up case was 13 years with patent stent. Two patients died of pulmonary embolization or pericardial tamponade during surgery. CONCLUSION Intravascular intervention is a safe and effective therapy for most types of BCS.
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Affiliation(s)
- Hui Xue
- Department of Gastroenterology, First Affiliated Hospital of Medical College, Xi'an Jiao Tong University, Xi'an, China.
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Warfarin anticoagulation before angioplasty relieves thrombus burden in Budd-Chiari syndrome caused by inferior vena cava anatomic obstruction. J Vasc Surg 2010; 52:1242-5. [PMID: 20674242 DOI: 10.1016/j.jvs.2010.05.098] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/20/2010] [Accepted: 05/24/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Pulmonary embolism (PE) is one of the major complications after percutaneous balloon angioplasty (PTBA) for Budd-Chiari's syndrome (BCS). The purpose of this study was to investigate the role of warfarin pre-treatment in the prevention of PE after PTBA in patients with large inferior vena cava (IVC) thrombus. PATIENTS AND METHODS From October 2002 to December 2009, 16 patients with symptomatic membranous or segmental IVC occlusion and large thrombus were treated with warfarin before PTBA. Eleven patients were men and 5 were women. The median age was 36 years, ranging from 21 to 52 years. The median duration of warfarin treatment before PTBA was 7 months, ranging from 3 to 12 months. Fourteen patients had membranous IVC occlusion and 2 had segmental occlusion. All 16 patients had significant thrombi underneath the obstructive lesions. PE diagnosis was based on clinical presentation and pulmonary computerized tomographic angiogram, if indicated. RESULTS In 14 of 16 patients, IVC thrombus was completely or near-completely resolved based on follow-up cavogram and PTBA was performed. In the other 2 patients, residual thrombus was demonstrated by cavogram at 12 months. PTBA and stent placement were carried out. IVC patency in the 16 patients was confirmed by completion cavogram. No major bleeding complication during warfarin pre-treatment aimed to keep international normalized ratio (INR) 2 to 3. There was no clinically significant PE or death in this group during follow-up, ranging from 6 to 40 months (median 21 months). CONCLUSION Spontaneous fibrinolysis of IVC thrombus occurs within 1 year in the majority of the patients treated with warfarin. Pre-treatment with warfarin prevents PE after PTBA in the patients with BCS with IVC membranous or segmental occlusion and large thrombus.
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Li T, Zhai S, Pang Z, Ma X, Cao H, Bai W, Wang Z, Zhang WW. Feasibility and midterm outcomes of percutaneous transhepatic balloon angioplasty for symptomatic Budd-Chiari syndrome secondary to hepatic venous obstruction. J Vasc Surg 2009; 50:1079-84. [PMID: 19703746 DOI: 10.1016/j.jvs.2009.06.049] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 06/09/2009] [Accepted: 06/09/2009] [Indexed: 01/27/2023]
Abstract
OBJECTIVES This study evaluated the feasibility and outcomes of percutaneous transhepatic balloon angioplasty (PTBA) of the hepatic vein in the management of Budd-Chiari syndrome (BCS) secondary to hepatic venous outflow obstruction. METHODS From September 1996 to October 2008, 101 patients (52 males, 49 females) with BCS secondary to occlusion of the hepatic veins were prospectively treated using PTBA of the hepatic vein. Average age was 31.3 years (range, 15-57 years). Nineteen had concurrent inferior vena cava (IVC) obstruction. All the patients presented with symptomatic portal hypertension. PTBA, with or without stenting, was performed after hepatovenography. RESULTS PTBA was successfully performed in 92 of the 101 patients. Sixty-eight patients underwent PTBA of right hepatic vein, followed by stent placement in two. PTBA was performed in 11 patients with left hepatic vein occlusion and in 13 patients with dominant accessory hepatic vein occlusion. The technical success rate was 92 of 101 (91%). Hepatic venous pressure was significantly decreased after balloon angioplasty/stenting (P < .01, paired t test). Symptoms were significantly improved in the 92 patients who had successful PTBA. Three patients had acute hepatic vein thrombosis during or after PTBA. Two patients sustained intraperitoneal bleeding from the transhepatic puncture track, and one had intrahepatic hematoma. Pulmonary embolism developed in one patient during the operation. All complications were managed nonoperatively. There were no perioperative deaths. Within 1 year, 74 of the 101 patients returned for follow-up, and 51 patients had follow-up at 2 years. The primary patency rates were 84% (62 of 74), 78% (58 of 74), and 76% (39 or 51) at 6, 12, and 24 months after PTBA, respectively. The secondary patency rates were 95% (70 of 74), 92% (68 of 74), and 84% (43 of 51) at 6, 12, and 24 months. CONCLUSIONS PTBA of the hepatic vein is a safe and effective treatment of BCS. It is currently the most physiologic procedure, and the risk of postoperative encephalopathy is minimized because portal flow is not diverted. Midterm outcomes are satisfactory. Further investigation of the long-term outcomes is needed.
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Affiliation(s)
- Tianxiao Li
- Department of Interventional Radiology, People's Hospital of Henan Province, Zhengzhou, Henan, Peoples Republic of China.
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Cannula-Assisted and Transabdominal Ultrasound-Guided Hepatic Venous Recanalization in Budd Chiari Syndrome: A Novel Technique to Avoid Percutaneous Transabdominal Access. Cardiovasc Intervent Radiol 2009; 32:1257-9. [DOI: 10.1007/s00270-009-9615-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 05/14/2009] [Accepted: 05/14/2009] [Indexed: 10/20/2022]
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