Endovascular treatment of segmental occlusive Budd-Chiari syndrome

Abstract

Objective To evaluate endovascular treatment of segmental occlusive Budd-Chiari syndrome(BCS). Methods We retrospectively analyzed the clinical data of segmental occlusive BCS of 45 cases. Inferior vena cava (IVC) puncture, percutaneons transluminal angioplasty (PTA) and stent implant were performed, respectively. Three-dimensional digital subtraction angiography (3D-DSA) was used to evaluate the IVC lesion from multi-angles and to identify the best work angle in complex BCS cases during endovascular treatment. Results IVC puncture and dilation was successful in 43 cases. The pressure of IVC decreased from (35. 3 ± 3.9)cm H2O to (9.5 ± 2. 0) cm H2O (t = 43. 68, P < 0. 01). The puncture failed in 2 cases and the patients were converted to veno-atrial graft shunt. Acute pericardial tamponade developed during PTA in one case. Postoperatively 35 cases were followed-up for 3 months to 46 months and the follow-up rate was 77. 8%. IVC stent thrombosis was identified in one case necessitating veno-atrial graft shunt 15 months post-operatively. There were no stent migration and hepatic venous obstruction in the remaining cases. The case of pericardial tamponade was cured and discharged after IVC repair. Symptoms disappeared except for intercostal neuralgia during 6 months follow-up. There were no pulmonary embolism and death. Conclusions Good medium and long term result could be achieved after endovascular treatment of segmental occlusive BCS. 3D-DSA is helpful for endovascular treatment of BCS. Key words: Budd-Chiari syndrome; Angioplasty; Stents; Angiography,digital subtraction; EndovascuLar treatment