Method and safety analysis of interventional treatment of Budd-Chiari syndrome in 1 246 patients

Abstract

Objective To analysis the method and safety of interventional treatment of Budd-Chiari syndrome (BCS). Methods The retrospective cross-sectional study was adopted. The clinicopathological data of 1 246 patients with BCS who underwent interventional treatment at the Beijing Shijitan Hospital of Capital Medical University between October 1993 and February 2015 were collected. According to the classification and level of BCS and clinical symptoms of patients, percutaneous vena cava and hepatic vein balloon angioplasty, inferior vena cava or hepatic vein or collateral vessels stent angioplasty, vena cava and hepatic vein combined with stent angioplasty, hepatic vein angioplasty combined with percutaneous transhepatic embolization of coronary vein of stomach, transjugular intrahepatic portosystemic shunt (TIPS) combined with inferior vena cava (hepatic vein) stent angioplasty and TIPS were conducted. Observation indicators included (1) results of surgical treatment, (2) surgery-related complications, (3) changes of pre- and post-operative vascular pressures. Measurement data with normal distribution were presented as ±s, and repeated measures data were analyzed by the repeated measures ANOVA. Results (1) Results of surgical treatment: 1 241 of 1 246 patients with BCS received successful interventional treatment, including 163 undergoing percutaneous inferior vena cava or hepatic vein balloon angioplasty, 61 undergoing double balloon angioplasty, 611 undergoing inferior vena cava or hepatic vein or collateral vessels stent angioplasty, 85 undergoing inferior vena cava and hepatic vein combined with stent angioplasty, 13 undergoing hepatic vein angioplasty combined with percutaneous transhepatic embolization of coronary vein of stomach, 58 undergoing TIPS combined with inferior vena cava stent angioplasty, 7 undergoing TIPS combined with hepatic vein stent angioplasty and 243 undergoing TIPS. Five patients didn't receive successful interventional treatment, including that occlusion in the length of inferior vena cava cannot be opened in 2 patients, partial occlusion of hepatic vein cannot be opened in 2 patients, and unsuccessful TIPS due to total occlusion of hepatic vein was in 1 patient. (2) Surgery-related complications: 1 patient died of liver puncture pleural bleeding and respiratory circulatory failure. Four patients had severe complications, including 1 with abdominal bleeding, 1 with pericardial effusion due to partial stents of inferior vena cava migrated to right atrium, 1 with acute occlusion of hepatic vein stent and 1 with pericardial effusion due to punch through the right atrium and pericardium, and they were cured by symptomatic treatment. (3) Changes of pre- and post-operative vascular pressures: pressures of portal vein, inferior vena cava and hepatic vein from pre-operation to post-operation were (3.8±0.7)kPa to (2.3±0.6) kPa, (2.9±0.4)kPa to (1.7±0.5)kPa, (2.6±0.4)kPa to (1.4±0.3)kPa, respectively, showing statistically significant differences between the pre-operation and post-operation (F= 3.26, 2.58, 2.79, P<0.05). Conclusion According to the classification, degree and clinical symptoms of BCS, it is safe and effective to choose different interventional treatment of BCS, with a satisfactory efficacy. Key words: Budd-Chiari syndrome; Interventionnal Radiology