Mid-and long-term follow-up of endovascular treatment for Budd-Chiari syndrome complicated by inferior vena cava thrombosis

Abstract

Objective To evaluate the mid-and long-term efficacy of endovascular treatment for Budd-Chiari syndrome (BCS) complicated by inferior vena cava (IVC) thrombosis.Methods The clinical data of 145 patients with BCS complicated by IVC thrombosis (89 males and 56 females) age between 15 to 81 years with a mean age of (48.6±12.3) years were analyzed retrospectively.All 145 patients were diagnosed using color Doppler ultrasound,IVC angiography and aspiration of the IVC thrombus.Among them,there were 71 cases of fresh thrombus,36 cases of mixed thrombus and 38 cases of old thrombus.All patients underwent endovascular treatments including thrombus aspiration,transcatheter thrombolysis,percutaneous transluminal angioplasty and/or stent implantation.On follow-up,re-thrombosis and patency of the IVC were evaluated by color Doppler ultrasound.The cumulative primary and secondary patency ratio were assessed with Kaplan-Meier curves.Independent predictors of patency were calculated with the Cox regression model.Results Endovascular treatment was technically successful in 143 of the 145 patients (98.6 ％).Seven of the 145 patients (4.8 ％) suffered from complications.The average duration of follow-up in 143 patients was 3 to 132 (55.9±36.7) months.18 patients were lost to follow-up.Among the remaining 125 patients,3 patients died and IVC reocclusion occurred in 16 patients.Secondary endovascular treatment was performed successfully in 12 patients.The cumulative 1-,5-,and 10-year primary patency rates were 96.3％,84％and 64.6％ respectively.The cumulative 1-,5-,and 10 year secondary patency rates were 99％,96.1 ％ and 91.3 ％ respectively.Segmental occlusion of the IVC and duration of anticoagulant therapy of less than six months were independent risk factors of reocclusion.Conclusion Endovascular treatment for BCS complicated by IVC thrombosis achieved excellent mid-and long-term patency rates. Key words: Budd-Chiari syndrome ; Inferior vena cava thrombosis; Endovascular treatment