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Liu D, Ren Q, Ye T, Zheng C, Su Y, Xia X. Evaluation of dangerous collateral vessels and thrombus in Budd-Chiari syndrome patients with inferior vena cava obstruction. Abdom Radiol (NY) 2022; 47:869-877. [PMID: 34888706 DOI: 10.1007/s00261-021-03354-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the diagnostic accuracy of preoperative imaging in defining inferior vena cava (IVC) obstruction characteristics, in identifying the presence of a thrombus and dangerous venous collateral. The other goal is to explore the clinical implication of these data in the designing the treatment strategy in Budd-Chiari patients. METHODS This study included 112 patients with IVC obstruction who underwent endovascular treatment between July 2009 and June 2019. Two radiologists independently assessed MSCT and/or MRI imaging data with a 5-point scale to evaluate the diagnostic accuracies relating to obstructive characteristics, dangerous collateral vessels, and thrombus within IVC. RESULTS The diagnostic sensitivities for obstructive characteristics, as determined by the two independent assessors, ranged from 81.25 to 100%. The areas under the receiver operating characteristic curve (ROC) for judging thrombus ranged from 0.87 to 0.975 for the two assessors. Inter-assessor agreement was substantial or excellent with regards to diagnostic accuracy (κ = 0.745-0.927). Twelve cases involving dangerous collateral vessels were identified in the MSCT group of 82 patients (κ = 1); six were identified by digital subtraction venography (DSV) imaging. Eight cases involving dangerous collateral vessels were reported in the MRI group of 32 patients (κ = 1); three were identified by DSV imaging. CONCLUSION Preoperative MSCT and MRI can accurately reveal the obstructive characteristics and risk factors of patients with IVC obstruction and can therefore be used to guide interventional planning so as to minimize complications.
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Affiliation(s)
- Dehan Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277#, Jiefang Road, Wuhan, 430022, Hubei, China
| | - Qianqian Ren
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277#, Jiefang Road, Wuhan, 430022, Hubei, China
| | - Tianhe Ye
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277#, Jiefang Road, Wuhan, 430022, Hubei, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277#, Jiefang Road, Wuhan, 430022, Hubei, China
| | - Yangbo Su
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277#, Jiefang Road, Wuhan, 430022, Hubei, China
| | - Xiangwen Xia
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277#, Jiefang Road, Wuhan, 430022, Hubei, China.
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Bi Y, Yi M, Han X, Ren J. Clinical outcomes of large diameter balloon angioplasty for Budd-Chiari syndrome with inferior vena cava involvement. J Vasc Surg Venous Lymphat Disord 2021; 9:1168-1177. [PMID: 33529721 DOI: 10.1016/j.jvsv.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 01/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We compared the long-term outcomes of small and large diameter balloon angioplasty for Budd-Chiari syndrome (BCS) with inferior vena cava (IVC) involvement in a retrospective cohort study. METHODS Of 119 patients with BCS and IVC involvement, 23 had undergone small diameter balloon angioplasty (diameter, 14-20 mm; group A) and 96 had undergone large diameter balloon angioplasty (diameter, 24-30 mm; group B). The patients were considered cured clinically if the IVC was patent with no symptom or signs evident. RESULTS From January 2010 to December 2016, 119 BCS patients with IVC involvement had undergone balloon angioplasty, with angioplasty successful in all 119 patients. One patient died of pulmonary embolism after dilation in group A. Abdominal pain was the most common complication during dilation and was experienced by significantly more patients in group B (77.1%) than in group A (47.8%; P = .009). Of the 119 patients, 91 (76.5%) were considered cured, with significantly more patients in group B (82.3%) than in group A (52.2%; P = .005). The mean follow-up period was 41.3 ± 2.2 months. In group B, the 1-, 3-, and 5-year primary and secondary patency rates were 82.2% ± 4.2%, 69.8% ± 5.4%, and 54.0% ± 7.0% and 97.5% ± 1.7%, 92.5% ± 3.3%, and 90.2% ± 3.9%, respectively. The patency rates at all follow-up intervals were lower in group A than in group B. The clinical response rate in group B was also significantly greater than that in group A (96.9% vs 78.3%; P = .007). The 1-, 3-, and 5-year survival rates were 100%, 88.7% ± 7.6%, and 88.7% ± 7.6% and 96.5% ± 2.0%, 92.5% ± 3.0%, and 86.0% ± 5.4% in groups A and B, respectively. CONCLUSIONS Large diameter balloon angioplasty is safe and effective for BCS patients with IVC involvement, yielding better patency rates and long-term outcomes compared with small diameter balloon angioplasty.
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Affiliation(s)
- Yonghua Bi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengfei Yi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Acute Budd-Chiari syndrome during hepatic vein catheterization. Radiol Case Rep 2020; 15:1853-1857. [PMID: 32817776 PMCID: PMC7426323 DOI: 10.1016/j.radcr.2020.07.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 01/14/2023] Open
Abstract
This case report describes a 4-year-old male with a history of hepatoblastoma, treated with chemotherapy followed by a right extended hepatectomy. Secondary to this, the patient experienced recurrent hepatic vein stenosis. He was treated initially with conventional angioplasty, followed by paclitaxel-coated balloon dilatations in an attempt to prevent episodes of re-stenosis. During the catheterization of the hepatic vein in one of the treatments, hemodynamic instability due to an acute Budd-Chiari syndrome occurred. The hemodynamic compromise became unresponsive to intravascular resuscitation and inotropic support. The patient was then treated with an emergency conventional angioplasty of the hepatic vein, which resulted in a rapid response and eventually in a full recovery. The etiology of this complication remains unclear; however, it may have been secondary to endothelial damage leading to acute thrombosis and/or venous spasm. Conventional angioplasty was successful in managing this complication. Awareness of iatrogenic acute Budd-Chiari syndrome as a potentially fatal complication during hepatic catheterization/dilatation, especially in the posthepatectomy setting, successful management of this complication, and the importance of a multidisciplinary and rapid response, is emphasized.
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Zeng YW, Liu C, Yin MP, Zhao Y, Wang ZW, Zhou PL, Ma YZ, Li CX, Wu G. Sequential interventional therapy for Budd-Chiari syndrome associated with fresh inferior vena cava thrombosis. J Vasc Surg Venous Lymphat Disord 2020; 8:945-952. [PMID: 32418826 DOI: 10.1016/j.jvsv.2020.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 03/09/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Our study aimed to evaluate the safety and efficacy of sequential interventional therapy for Budd-Chiari syndrome (BCS) caused by obstruction of the inferior vena cava (IVC) with fresh thrombus in the IVC. METHODS Full medical records were obtained for 20 patients with BCS associated with fresh IVC thrombus who received sequential interventional therapy from 2014 to 2019 at our hospital. All patients underwent small-diameter percutaneous transluminal angioplasty (PTA) balloon catheter predilation combined with sequential catheter-directed thrombolysis and large-diameter PTA balloon dilation. Ultrasound examinations were performed at 1 week, 1 month, 3 months, and every 6 months thereafter. Therapeutic effects and perioperative and postoperative adverse effects were recorded to assess the safety of the treatment. RESULTS All 20 patients were treated with small PTA balloon catheters (diameter, 10-14 mm) to predilate the occlusive segment of the IVC. Urokinase 400,000 to 600,000 (465,000 ± 93,000) units was administered to patients through the catheter for 6 to 20 (9.7 ± 4.2) consecutive days postoperatively. Ultrasound re-examination showed that the IVC thrombus disappeared completely in 14 patients (70.0%), and a small amount of the old thrombus remained in 6 patients (30.0%). After thrombolysis, all 20 patients received PTA balloon dilation (diameter, 26-30 mm) in the stenosed IVC segment, and blood flow recovered subsequently. No pulmonary embolism or death occurred in the perioperative course. The perioperative survival rate was 100.0%. CONCLUSIONS Sequential interventional therapy for BCS associated with fresh IVC thrombus is safe and effective.
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Affiliation(s)
- Yan-Wei Zeng
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chao Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mei-Pan Yin
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yue Zhao
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhi-Wei Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peng-Li Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yao-Zhen Ma
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chun-Xia Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Gang Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Jiménez Jiménez C, Randial Tagliapetra L, Silva I, Alférez F. Tratamiento endovascular del síndrome de Budd-Chiari, a propósito de un caso. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
El síndrome de Budd-Chiari consiste en la oclusión de la circulación de salida venosa del hígado, desde las sinusoides hepáticas hasta la unión de la vena cava inferior con la aurícula derecha. Esta entidad es muy rara. Las causas son primarias, obstrucción congénita de la vena cava o trombosis espontánea, o secundarias, compresión extrínseca. Si no se trata la obstrucción esta enfermedad, lleva a cirrosis hepática.
Se presenta un caso del síndrome de Budd-Chiari de causa primaria por obstrucción membranosa, tratado por vía endovascular de manera exitosa y con resolución de todos los síntomas. Es el primer reporte en Colombia de este tipo de tratamiento.
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Bi Y, Chen H, Ding P, Ren J, Han X. Comparison of retrievable stents and permanent stents for Budd-Chiari syndrome due to obstructive inferior vena cava. J Gastroenterol Hepatol 2018; 33:2015-2021. [PMID: 29851172 DOI: 10.1111/jgh.14295] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/13/2018] [Accepted: 05/18/2018] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM The aim of this study is to compare long-term outcomes of retrievable stents (RSs) and permanent stents (PSs) for Budd-Chiari syndrome (BCS) due to long-segment obstructive inferior vena cava (IVC). METHODS Between July 2000 and August 2016, 42 patients with BCS due to long-segment obstructive IVC were treated with RSs, and 41 patients were treated with PSs. The RSs were removed eventually after thrombus disappeared. Patients were subsequently followed up by color Doppler sonography or computed tomography scanning. RESULTS All RS placements were successful, and 37 RSs were retrieved 8 to 29 days later. Forty-two stents were implanted in PS group. One failure retrieval of RSs occurred, and two failures of cannulations were found in PS group. Two deaths may be procedure related and died from acute pulmonary thromboembolism perioperatively. One patient developed acute cerebral infarction and recovered after treatment. In PS group, minor complications were found in three patients. The length of IVC lesion segment and length and thickness of IVC thrombus decreased significantly, and diameter of retrocaval IVC and diaphragm IVC increased significantly in both groups. During follow-up, three patients died from liver failure in RS group, and two patients died in PS group. RS group showed a significantly higher primary patency rate than PS group. Cumulative 1-, 3-, and 5-year secondary patency rates were 95.2%, 89.6%, and 89.6% in RS group and 100%, 96.6%, and 96.6% in PS group (P = 0.7109). CONCLUSIONS Retrievable stents are effective for BCS because of long-segment obstructive IVC, with a higher primary patency rate.
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Affiliation(s)
- Yonghua Bi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongmei Chen
- Department of Ultrasound, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Pengxu Ding
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Wang CY, Wei LQ, Niu HZ, Gao WQ, Wang T, Chen SJ. Agitation thrombolysis combined with catheter-directed thrombolysis for the treatment of non-cirrhotic acute portal vein thrombosis. World J Gastroenterol 2018; 24:4482-4488. [PMID: 30357003 PMCID: PMC6196336 DOI: 10.3748/wjg.v24.i39.4482] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/13/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the safety and efficacy of agitation thrombolysis (AT) combined with catheter-directed thrombolysis (CDT) for the treatment of non-cirrhotic acute portal vein thrombosis (PVT).
METHODS Nine patients with non-cirrhotic acute PVT who underwent AT combined with CDT were analyzed retrospectively. Portography was carried out via the transjugular intrahepatic portosystemic (commonly known as TIP) or percutaneous transhepatic (commonly known as PT) route, followed by AT combined with CDT. Complications of the procedure, and the changes in clinical symptoms, hemodynamics of the portal vein and liver function were recorded. Follow-up was scheduled at 1, 3 and 6 mo after treatment, and every 6 mo thereafter, or when the patients developed clinical symptoms related to PVT. Color Doppler ultrasound and contrast-enhanced computed tomography/magnetic resonance imaging were performed during the follow-up period to determine the condition of the portal vein.
RESULTS AT combined with CDT was successfully performed. The portal vein was reached via the TIP route in 6 patients, and via the PT route in 3 patients. All clinical symptoms were relieved or disappeared, with the exception of 1 patient who died of intestinal necrosis 9 d after treatment. Significant differences in the changes in portal vein hemodynamics were observed, including the maximum lumen occupancy of PVT, portal vein pressure and flow velocity between pre- and post-treatment (P < 0.05). During the follow-up period, recurrence was observed in 1 patient at 19 mo after the procedure, and the portal vein was patent in the remaining patients.
CONCLUSION AT combined with CDT is a safe and effective method for the treatment of non-cirrhotic acute PVT.
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Affiliation(s)
- Chao-Yang Wang
- Department of Interventional Radiology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technolgy, Luoyang 471000, Henan Province, China
| | - Le-Qun Wei
- Department of Interventional Radiology, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang 471000, Henan Province, China
| | - Huan-Zhang Niu
- Department of Interventional Radiology, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang 471000, Henan Province, China
| | - Wan-Qin Gao
- Department of Interventional Radiology, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang 471000, Henan Province, China
| | - Tong Wang
- Department of Interventional Radiology, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang 471000, Henan Province, China
| | - Shun-Jun Chen
- Department of Interventional Radiology, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang 471000, Henan Province, China
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Bi Y, Chen H, Ding P, Zhou P, Han X, Ren J. Excellent long-term outcomes of endovascular treatment in budd-chiari syndrome with hepatic veins involvement: A STROBE-compliant article. Medicine (Baltimore) 2018; 97:e12944. [PMID: 30412110 PMCID: PMC6221688 DOI: 10.1097/md.0000000000012944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This study aimed to evaluate the long-term efficacy and safety of percutaneous transhepatic balloon angioplasty (PTBA) and transjugular intrahepatic portosystemic stent-shunt (TIPSS) in the treatment of Budd-Chiari syndrome (BCS) with hepatic veins involvement. Between June 2008 and August 2016, a total of 60 BCS patients with hepatic vein involvement in our department were enrolled in this study. Thirty-three cases underwent hepatic vein balloon angioplasty in PTBA Group and 27 cases underwent TIPSS. Data were retrospectively collected, and follow-up observations were performed. TIPSS Group showed significantly higher thrombotic/segmental obstruction and peripheral stenosis/obstruction compared with PTBA Group. The success rates were 93.9% and 100.0% in PTBA Group and TIPSS Group, respectively. The mean portal vein pressure decreased significantly after stenting. Except for 1 patient died from repeated hemorrhage, other sever complications had not been observed in both group. Twenty-six patients and 21 patients were clinically cured in PTBA Group and TIPSS Group, respectively. The primary patency rates were 89.7%, 79.3%, and 79.3% for short-term, mid-term and longterm in PTBA Group, which were significantly higher than TIPSS Group for long-term follow up. The second patency rates were 100.0%, 96.6% and 96.6% for short-term, mid-term and long-term in PTBA Group, which were similar to TIPSS Group (P = 1.0000). In conclusion, PTBA and TIPSS are safe and effective in the treatment of BCS with hepatic veins involvement, with an excellent long-term patency rate of hepatic vein and TIPSS shunt. TIPSS can be used to treat patients with all 3 hepatic veins lesion and failure PTBA.
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Affiliation(s)
- Yonghua Bi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
| | - Hongmei Chen
- Department of Ultrasound, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Pengxu Ding
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
| | - Pengli Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
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Bi Y, Yu Z, Ding P, Ren J, Zhou P, Han X. Long-Term Outcomes of Endoluminal Sharp Recanalization of Occluded Inferior Vena Cava in Budd-Chiari Syndrome. J Laparoendosc Adv Surg Tech A 2018; 29:309-315. [PMID: 30036126 DOI: 10.1089/lap.2018.0385] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To report the long-term results of endoluminal sharp recanalization of occluded inferior vena cava (IVC) in patients with the Budd-Chiari syndrome (BCS). PATIENTS AND METHODS Seventy-two consecutive patients with BCS and IVC occlusion underwent endoluminal recanalization of the IVC occlusion during a 6-year period. BCS with occlusive IVC was detected by reviewing patient history and color Doppler ultrasonography. Data on technical success, morbidity, mortality, complications, and color Doppler sonographic outcome were collected and analyzed. RESULTS Seventy-seven recanalizations were performed in 72 patients. Technical success (patent IVC with good blood flow) was achieved in 70 (97.4%) patients. No perioperative death was observed. Six complications were found during recanalization, and 10 complications were found for total interventional procedures. The complication rates were 7.8% and 7.3% for recanalization and total procedure, respectively. Bleeding of access veins was the most common complication, and 2 patients showed slight rupture of IVC. The postoperative IVC diameter and blood speed of IVC increased significantly. Fifty-seven patients (79.2%) were clinical cured, and 2 patients (2.8%) showed no improvement. The 1-year, 3-year, and 5-year primary patency rates were 92.5%, 86.8%, and 77.3%, respectively. The second patency rates were 100.0%, 97.8%, and 91.8% for 1, 3, and 5 years, respectively. There were 2 deaths during follow-up. CONCLUSION Endoluminal sharp recanalization of occluded IVC in patients with BCS is safe and effective with good long-term outcomes.
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Affiliation(s)
- Yonghua Bi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zepeng Yu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pengxu Ding
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pengli Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Ding PX, He X, Han XW, Zhang Y, Wu Y, Liang XX, Liu C. An Individualised Strategy and Long-Term Outcomes of Endovascular Treatment of Budd-Chiari Syndrome Complicated by Inferior Vena Cava Thrombosis. Eur J Vasc Endovasc Surg 2018; 55:545-553. [PMID: 29478911 DOI: 10.1016/j.ejvs.2017.12.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/15/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim was to evaluate individualised treatment and long-term outcomes of endovascular treatment of Budd-Chiari syndrome (BCS) complicated by inferior vena cava (IVC) thrombosis. METHODS Between April 2005 and December 2015, 108 consecutive patients with BCS complicated by IVC thrombosis underwent endovascular treatment. According to the type, size, extent, and degree of organisation of the thrombus, agitation thrombolysis (n = 7), agitation thrombolysis combined with retrieval stent filter (n = 5), pre-dilation (n = 32), retrieval stent filter (n = 56), or direct large balloon dilation (n = 8) was performed. Peri- and post-operative follow-up data were recorded. RESULTS The endovascular treatment was technically successful in 107 of the 108 patients (99.1%). The incidence of thrombosis related complications was 7.4% (8/108). Major and minor complications occurred in four patients. The mean follow-up duration was 61.7 ± 39.3 months (range 3-140 months). The cumulative 1, 2, 5, and 10 year primary patency rates were 91%, 88%, 79%, and 79%, respectively, and the cumulative 1, 2, 5, and 10 year secondary patency rates were 100%, 100%, 97%, and 97%, respectively. The cumulative 1, 5, and 10 year survival rates were 95%, 86%, and 81%, respectively. Serum albumin and total bilirubin values were independent predictors of survival. CONCLUSIONS For patients with BCS complicated by IVC thrombosis, an individualised endovascular treatment strategy based on the type, size, extent, and degree of organisation of the thrombus is associated with long-term patency of the IVC and favourable survival and complication rates.
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Affiliation(s)
- P-X Ding
- Department of Intervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
| | - X He
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - X-W Han
- Department of Intervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Y Zhang
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Y Wu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - X-X Liang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - C Liu
- Department of Intervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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11
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Agitation thrombolysis and catheter-directed thrombolysis for normotensive patients with acute pulmonary thromboembolism. Radiol Med 2018; 123:338-344. [DOI: 10.1007/s11547-017-0848-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 12/17/2017] [Indexed: 10/18/2022]
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12
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Zhang WG, Liu DM, Han XW, Ren JZ, Zhou PL, Wang ZG. Endovascular Treatment of an Unusual Membranous Obstruction of the Inferior Vena Cava in Budd-Chiari Syndrome Complicated by Mural Portal Vein Thrombosis. Ann Vasc Surg 2017; 44:419.e13-419.e17. [PMID: 28483616 DOI: 10.1016/j.avsg.2017.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/04/2017] [Accepted: 04/23/2017] [Indexed: 11/27/2022]
Abstract
We describe the case of a patient with Budd-Chiari syndrome who presented with an unusual membranous obstruction of the inferior vena cava complicated by massive portal vein thrombosis (PVT). The patient underwent percutaneous transluminal balloon angioplasty through the right groin and was prescribed oral warfarin for 6 months. Treatment resulted in the complete disappearance of the PVT. This therapeutic strategy should be considered in the management of other cases of this rare, complex disease.
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Affiliation(s)
- Wen-Guang Zhang
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dong-Mei Liu
- Department of Radiation Oncology, Henan Province Cancer Hospital, Zhengzhou, China
| | - Xin-Wei Han
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Jian-Zhuang Ren
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peng-Li Zhou
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhong-Gao Wang
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Outcome of the Z-expandable metallic stent for Budd-Chiari syndrome and segmental obstruction of the inferior vena cava. Eur J Gastroenterol Hepatol 2016; 28:972-9. [PMID: 27172449 DOI: 10.1097/meg.0000000000000640] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Treatment of segmental obstruction of the inferior vena cava (SOIVC) with Z-expandable metallic stents (Z-EMS) is controversial and data on long-term follow-up are lacking. We aimed to evaluate the long-term outcomes of the use of a Z-EMS for Budd-Chiari syndrome (BCS) patients with SOIVC. MATERIALS AND METHODS Between August 2004 and December 2014, 37 consecutive BCS patients with SOIVC were referred for Z-EMS treatment and subsequently underwent follow-up in our department. Data were collected retrospectively and follow-up observations were made 1, 2, 2-5, and 5-10 years postoperatively. RESULTS Percutaneous transluminal balloon angioplasty and Z-EMS placement were technically successful in all patients. Major procedure-related complications occurred in four of 37 patients (10.81%). Follow-up for 61.89±41.45 months in 37 patients indicated portal hypertension in one patient 4 months after stent placement and symptoms were resolved by transjugular intrahepatic portosystemic stent shunting. Hepatocellular carcinoma was observed in four patients and five patients died during follow-up. Reocclusion of the inferior vena cava occurred in four patients (10.81%, 4/41) and all reocclusions were managed by percutaneous transluminal balloon angioplasty. Cumulative 1-, 2-, 2-5-, and 5-10-year primary patency rates were 94.60% (35/37), 93.33% (28/30), 88.89% (24/27), and 85.0% (17/20), respectively. Cumulative 1-, 2-, 2-5-, and 5-10-year secondary patency rates were 100% at all time-points. CONCLUSION These data suggest that Z-EMS implantation is an efficacious, safe, and curative approach for BCS with SOIVC because satisfactory long-term outcomes were achieved. Long-term follow-up is required to ascertain stent patency and hepatocellular carcinoma occurrence.
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Meng X, Lv Y, Zhang B, He C, Guo W, Luo B, Yin Z, Fan D, Han G. Endovascular Management of Budd-Chiari Syndrome with Inferior Vena Cava Thrombosis: A 14-Year Single-Center Retrospective Report of 55 Patients. J Vasc Interv Radiol 2016; 27:1592-603. [PMID: 27397618 DOI: 10.1016/j.jvir.2016.04.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 04/16/2016] [Accepted: 04/17/2016] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To evaluate safety and efficacy of balloon dilation and stent placement combined with thrombus aspiration and thrombolysis to treat patients with Budd-Chiari syndrome (BCS) with inferior vena cava (IVC) thrombosis. MATERIALS AND METHODS Charts from 55 consecutive patients with primary BCS and IVC thrombosis treated between April 2000 and August 2014 were retrospectively analyzed. Transcatheter aspiration and percutaneous recanalization were attempted in all patients, and stents were placed if balloon dilation was successful. Catheter-directed thrombolysis was performed when evident clot burden was present after recanalization. RESULTS Technically successful IVC recanalization was achieved in 53 of 55 patients (96.4%). Technical failures in 2 patients were due to long segment of IVC obstruction. A stent was placed in 47 of 53 patients (88.7%). Thrombus was successfully aspirated in 23 patients, and thrombolytic treatment was administered to 13 patients. Median follow-up was 58 months (range, 8-180 mo). No symptomatic pulmonary embolism occurred. Reocclusion occurred in 8 patients, and 6 of these patients (75%) underwent repeat recanalization by balloon dilation with or without stents. Cumulative 1-, 5-, and 10-year primary patency rates were 94%, 89%, and 66%. Alanine transaminase and alkaline phosphatase levels were independent risk factors for reocclusion. Cumulative 1-, 5-, and 10-year survival rates were 90%, 86%, and 86%. Child-Pugh score and reocclusion were independent predictors of survival. CONCLUSIONS Percutaneous vena caval balloon dilation and stent placement with thrombus aspiration and thrombolytic therapy is safe and effective for treatment of patients with BCS and IVC thrombosis.
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Affiliation(s)
- Xiangchen Meng
- Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No.169 Changle West Road, Xi'an, Shanxi, China
| | - Yong Lv
- Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No.169 Changle West Road, Xi'an, Shanxi, China
| | - Bojing Zhang
- Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No.169 Changle West Road, Xi'an, Shanxi, China
| | - Chuangye He
- Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No.169 Changle West Road, Xi'an, Shanxi, China
| | - Wengang Guo
- Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No.169 Changle West Road, Xi'an, Shanxi, China
| | - Bohan Luo
- Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No.169 Changle West Road, Xi'an, Shanxi, China
| | - Zhanxin Yin
- Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No.169 Changle West Road, Xi'an, Shanxi, China
| | - Daiming Fan
- Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No.169 Changle West Road, Xi'an, Shanxi, China
| | - Guohong Han
- Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No.169 Changle West Road, Xi'an, Shanxi, China.
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Wang CY, Ren JZ, Han XW, Zhang WG, Zhang QH, Chen PF, Zhao GR. Clinical efficacy of agitation thrombolysis via transjugular access for treatment of acute portal vein thrombosis. Shijie Huaren Xiaohua Zazhi 2016; 24:2225-2230. [DOI: 10.11569/wcjd.v24.i14.2225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the clinical efficacy of agitation thrombolysis via transjugular access for the treatment of acute portal vein thrombosis.
METHODS: Thirteen patients with acute portal vein thrombosis treated from October 2012 to March 2015 at our hospital were analyzed retrospectively. The portal vein was approached via the transjugular intrahepatic portosystemic route, followed by agitation thrombolysis to resolve the thrombi. The need for transjugular intrahepatic portosystemic shunt (TIPS) was based on the presence of portal hypertension, and then a catheter was indwelled into the thrombi. The success rate, thrombolytic therapeutic time and effect, and complications were observed. Computed tomography and Doppler ultrasound were performed to follow the patency of the portal vein and TIPS stent.
RESULTS: Agitation thrombolysis were successfully created in 12 patients. Of 8 patients who underwent TIPS, 1 underwent wide resection due to confirmed extensive intestinal necrosis on postoperative day 2; however, the patient died 9 d later. In the remaining 11 patients, the portal vein was recanalized > 90% as revealed by CT findings. There was a significant difference in lumen occupancy between pre- and post-operation (P < 0.01). The clinical symptoms such as abdominal pain, ascites, and gastrointestinal bleeding were all relieved or disappeared. The complications were mainly as follows: intraoperative subcapsular bleeding in one patient; death due to intestinal necrosis in one patient; hepatic encephalopathy at 3 mo in one patient with TIPS; and hematuria during thrombolysis in one patient. During follow-up, TIPS stent stenosis was noted in one patient at 7 mo and treated by balloon angioplasty.
CONCLUSION: Agitation thrombolysis via transjugular access for the treatment of acute portal vein thrombosis is safe and effective.
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Fu YF, Xu H, Wu Q, Zhang QQ, Cui YF, Wei N. Combined thrombus aspiration and recanalization in treating Budd-Chiari syndrome with inferior vena cava thrombosis. Radiol Med 2015; 120:1094-9. [PMID: 26002723 DOI: 10.1007/s11547-015-0554-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 05/07/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the feasibility, safety, and effectiveness of combined thrombus aspiration and inferior vena cava (IVC) recanalization for Budd-Chiari syndrome (BCS) patients with IVC thrombosis. MATERIALS AND METHODS From March 2011 to October 2014, 17 consecutive BCS patients with IVC thrombosis [male 13, female 4 (mean age 52.6 ± 8.4 years, range 43-72 years)] treated by combined thrombus aspiration and IVC recanalization were enrolled in this retrospective study. An 8F guiding catheter was used as the aspiration catheter. During the treatment, the aspiration catheter was placed from the right femoral vein to the IVC thrombi, and a 20-ml syringe was connected with the aspiration catheter for thrombus aspiration. IVC recanalization was performed after thrombus aspiration. Data on technical success, clinical success, and follow-up were analyzed. RESULTS Technical success was achieved in all patients. After thrombus aspiration, 12 patients had no visible thrombi on IVC venography, while 5 patients were shown to have the IVC mural thrombi. Afterwards, 13 patients were treated by IVC balloon dilation, and 4 patients were treated by IVC stent insertion. No patient experienced dyspnea after treatment. The average IVC pressure decreased from 29.8 ± 3.4 cmH2O to 8.6 ± 2.1 cmH2O (P < 0.001). Clinical success was achieved in all patients. The average follow-up period was 15.3 ± 11.6 months (range 2-44 months). Long-term IVC patency was achieved in 15 of 17 patients. CONCLUSION Combined thrombus aspiration and IVC recanalization can be a safe and effective method for BCS patients with IVC thrombosis.
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Affiliation(s)
- Yu-Fei Fu
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| | - Hao Xu
- Department of Interventional Radiology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - Qian Wu
- Department of Nuclear Medicine, Xuzhou Central Hospital, Xuzhou, China
| | - Qing-Qiao Zhang
- Department of Interventional Radiology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - Yan-Feng Cui
- Department of Interventional Radiology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - Ning Wei
- Department of Interventional Radiology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, China.
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Sun J, Zhang Q, Xu H, Huang Q, Shen B, Zu M, Gu Y. Clinical outcomes of warfarin anticoagulation after balloon dilation alone for the treatment of Budd-Chiari syndrome complicated by old inferior vena cava thrombosis. Ann Vasc Surg 2014; 28:1862-8. [PMID: 25014178 DOI: 10.1016/j.avsg.2014.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 05/27/2014] [Accepted: 07/01/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND To evaluate the safety and clinical efficacy of warfarin anticoagulation after balloon dilation alone for the treatment of Budd-Chiari syndrome (BCS) complicated by old inferior vena cava (IVC) thrombosis. METHODS From January 2008 to November 2013, 19 BCS patients complicated with old IVC thrombosis were treated with balloon dilation followed by oral administration of anticoagulant warfarin. Follow-up was performed at 1 week, then 1, 2, 3, 6, and 12 months after balloon dilation, and then annually thereafter. IVC patency and morphologic changes of the old thrombus were examined by ultrasound, and clinical symptoms and signs were determined by clinical examinations during follow-up. RESULTS Successful IVC balloon dilation was achieved in the 19 patients (100%). Inferior vena cavography demonstrated the patency of IVC lumen, and the size of the old thrombus was not altered. The mean pressure gradient between IVC and the right atrium was reduced from 27.5 ± 3.0 cm H2O (range, 22-35) before treatment to 5.4 ± 1.3 cm H2O (range: 2-7) after treatment (t = 41.6, P < 0.05; 1 cm H2O = 0.098 kPa). Patients were followed up as outpatients for an average of 15.9 ± 14.4 months (range, 3-66). Anticoagulation with warfarin was well tolerated in all patients after balloon dilation alone. Of the 19 patients, complete resolution of the old thrombus was achieved in 12 patients and partial resolution was achieved in 7 patients. Color Doppler ultrasound showed that 17 patients had IVC lumen patency, and 2 patients had IVC reocclusion. None of the patients had recurrence of thrombosis, symptomatic pulmonary embolism, and bleeding complications throughout the follow-up period. CONCLUSIONS Our results indicate that warfarin anticoagulation after balloon dilation alone is a safe and effective therapy for BCS patients with old IVC thrombosis.
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Affiliation(s)
- Jingmin Sun
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - Qingqiao Zhang
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China.
| | - Hao Xu
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - Qianxin Huang
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - Bin Shen
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - Maoheng Zu
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - Yuming Gu
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
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Zhang QQ, Xu H, Zu MH, Gu YM, Shen B, Wei N, Xu W, Liu HT, Wang WL, Gao ZK. Strategy and long-term outcomes of endovascular treatment for Budd-Chiari syndrome complicated by inferior vena caval thrombosis. Eur J Vasc Endovasc Surg 2014; 47:550-7. [PMID: 24560649 DOI: 10.1016/j.ejvs.2014.01.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/19/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the strategy and long-term outcomes of endovascular treatment of Budd-Chiari syndrome (BCS) complicated by inferior vena cava (IVC) thrombosis. METHODS The treatment strategy and outcomes of BCS complicated by IVC thrombosis were retrospectively evaluated in a single-center study. The treatment was aimed at the IVC thrombus, not hepatic vein occlusion. All 133 patients with BCS complicated by IVC thrombosis from February 2003 to March 2013 underwent endovascular treatment. For the fresh thrombus group (n=75) recanalization was performed after transcatheter thrombolysis with urokinase. For the mixed thrombus group (n=19) a small balloon pre-dilation of the IVC was performed first, followed by transcatheter thrombolysis using urokinase and a large balloon dilation of the IVC. For the old thrombus group (n=39) a large balloon dilation or/and stent placement was performed directly. Pre- and post-treatment follow-ups were recorded. RESULTS The endovascular treatment was successful in 131 out of 133 patients (98.5%). Thirty seven patients had synchronous hepatic vein occlusion. The incidence of serious complications was 4.5% (6/133). Symptomatic pulmonary embolism occurred in three cases, cerebral hemorrhage in two, and cardiac tamponade in one. The cumulative 1-, 5-, and 10-year primary patency rate was 96.3%, 84.0%, and 64.6%, respectively. The cumulative 1-, 5-, and 10-year secondary patency rate was 99.0%, 96.1% and 91.3%, respectively. Segmental occlusion of the IVC and duration of anticoagulant therapy less than 6 months were independent risk factors for reocclusion. CONCLUSIONS For patients with BCS complicated by IVC thrombosis, an individualized treatment strategy based on the property of the thrombus can result in excellent long-term patency.
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Affiliation(s)
- Q Q Zhang
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China.
| | - H Xu
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - M H Zu
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - Y M Gu
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - B Shen
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - N Wei
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - W Xu
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - H T Liu
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - W L Wang
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - Z K Gao
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
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Zhang Q, Xu H, Zu M, Gu Y, Wei N, Wang W, Gao Z, Shen B. Catheter-directed thrombolytic therapy combined with angioplasty for hepatic vein obstruction in Budd-Chiari syndrome complicated by thrombosis. Exp Ther Med 2013; 6:1015-1021. [PMID: 24137308 PMCID: PMC3797297 DOI: 10.3892/etm.2013.1239] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/12/2013] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to assess the efficacy and safety of catheter-directed thrombolysis combined with angioplasty in the treatment of hepatic vein obstruction in Budd-Chiari syndrome (BCS) complicated by thrombosis. In 14 cases of BCS, the patients with hepatic vein obstruction complicated by thrombosis who underwent catheter-directed urokinase thrombolysis, balloon dilatation and/or stent placement were followed up with an ultrasound examination of the liver. Among the 13 cases of successful treatment, one hepatic vein was recanalized in 12 patients (right hepatic vein, seven cases; left hepatic vein, three cases; middle hepatic vein, one case and accessory hepatic vein, one case) and two hepatic veins (right and left) were recanalized in one patient without serious complications, such as bleeding and pulmonary embolism. There was one patient in whom the treatment was unsuccessful. During an average follow-up period of 24.8±19.6 months, hepatic vein restenosis was observed in one patient in the sixth month after opperation; however, a successful result was obtained following a second balloon dilatation. The remaining 12 patients did not demonstrate any recurrence of restenosis or thrombosis. Catheter-directed thrombolysis combined with angioplasty was observed to be an effective and safe method for the treatment of hepatic vein obstruction in BCS complicated by thrombosis.
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Affiliation(s)
- Qingqiao Zhang
- Department of Interventional Radiology, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu 221006, P.R. China
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Zhang QQ, Zu MH, Xu H, Gu YM, Wang WL, Gao ZK. Combining angioplasty with percutaneous microwave ablation for treating primary Budd-Chiari syndrome associated with hepatocellular carcinoma in two patients: A case report. Oncol Lett 2013; 6:612-616. [PMID: 24137380 PMCID: PMC3789050 DOI: 10.3892/ol.2013.1417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 06/05/2013] [Indexed: 01/29/2023] Open
Abstract
Percutaneous transluminal angioplasty using balloon catheters for Budd-Chiari syndrome (BCS) and transcatheter arterial chemoembolization (TACE) for unresectable hepatocellular carcinoma (HCC) have become increasingly accepted as alternative therapeutic modalities. However, few studies have investigated the clinical efficacy of combining percutaneous microwave ablation with angioplasty for patients with BCS complicated by HCC. In the present study, a safe and effective method for treating BCS associated with HCC is presented. Color Doppler ultrasonography, magnetic resonance imaging (MRI), computed tomography (CT), inferior venacavography, hepatic arteriogram and cytological examinations were used for the diagnosis. A KY2000 microwave system with an emission of 915 MHz was also employed for the treatment. Two patients with BCS associated with HCC that were administered different adjuvant drug treatments underwent percutaneous transluminal angioplasty and percutaneous microwave ablation successfully, with no treatment-related complications. Combining angioplasty with percutaneous microwave ablation may represent an alternative method for the treatment of BCS associated with HCC.
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Affiliation(s)
- Qing-Qiao Zhang
- Department of Interventional Radiology, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu 221006, P.R. China
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Rasheed K. Hydatid cyst of liver complicated with budd-Chiari syndrome and portal vein thrombosis. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2013; 5:242-4. [PMID: 23626964 PMCID: PMC3632032 DOI: 10.4103/1947-2714.109206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Khalid Rasheed
- Department of Internal Medicine, University of Alabama at Birmingham, Health Center Montgomery, Montgomery, Alabama, USA. E-mail:
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Wei Y, Ouyang P, Yang W. High inferior vena cava thrombosis in a 16-year-old postpartum patient: a case report. JOURNAL OF HUAZHONG UNIVERSITY OF SCIENCE AND TECHNOLOGY. MEDICAL SCIENCES = HUA ZHONG KE JI DA XUE XUE BAO. YI XUE YING DE WEN BAN = HUAZHONG KEJI DAXUE XUEBAO. YIXUE YINGDEWEN BAN 2012; 32:149-150. [PMID: 22282263 DOI: 10.1007/s11596-012-0027-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Indexed: 11/28/2022]
Abstract
Postpartum inferior vena cava (IVC) thrombosis is a rare, but potentially life-threatening disorder. Here we reported one case of the youngest woman to date who presented with massive IVC thrombus extending from deep veins of the right leg to the level of the 11th thoracic vertebra, associated with asymptomatic pulmonary embolism.
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Affiliation(s)
- Yong Wei
- Department of Cardiovasology, Shanghai Jiao Tong University, Shanghai, 201600, China
| | - Ping Ouyang
- Department of Cardiovasology, Shanghai Jiao Tong University, Shanghai, 201600, China.
| | - Wanhua Yang
- Department of General Intensive Care Unit, Songjiang Branch to Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, 201600, China
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