Treatment of Budd-Chiari Syndrome Complicated by Inferior Vena Cava Thrombosis: Individualised or Non-reproducible Strategy?

Abstract

I read with interest the paper on endovascular treatment for Budd-Chiari syndrome (BCS) complicated by inferior vena cava (IVC) thrombosis, reporting an individualised strategy mainly based on thrombolysis, retrieval stent filter, and/or balloon dilation.1Ding P.X. He X. Han X.W. Zhang Y. Wu Y. Liang X.X. et al.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: 545-553Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar Despite the known higher prevalence of exclusive IVC thrombosis in China,2Qi X. Han G. Guo X. De Stefano V. Xu K. Lu Z. et al.Review article: the aetiology of primary Budd-Chiari syndrome - differences between the West and China.Aliment Pharmacol Ther. 2016; 44: 1152-1167Crossref PubMed Scopus (50) Google Scholar the study reports 108 patients mainly with both hepatic vein (HV) and IVC thrombosis. However, most underwent only local IVC treatment, so making the overall good outcome difficult to explain.1Ding P.X. He X. Han X.W. Zhang Y. Wu Y. Liang X.X. et al.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: 545-553Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar In fact, the recognised best treatment for BCS is transjugular intrahepatic portosystemic shunt (TIPS).3Mancuso A. An update on management of Budd-Chiari syndrome: the issues of timing and choice of treatment.Eur J Gastroenterol Hepatol. 2015; 27: 200-203Crossref PubMed Scopus (37) Google Scholar Moreover, contrary to the strategy adopted here,1Ding P.X. He X. Han X.W. Zhang Y. Wu Y. Liang X.X. et al.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: 545-553Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar guidelines suggest a stepwise management for BCS: with medical therapy the first line, angioplasty/stenting as second line, TIPS the next step, and liver transplant (LT) the last chance.3Mancuso A. An update on management of Budd-Chiari syndrome: the issues of timing and choice of treatment.Eur J Gastroenterol Hepatol. 2015; 27: 200-203Crossref PubMed Scopus (37) Google Scholar Furthermore, I recently reported an algorithm in which medical therapy is suggested only for patients without signs of portal hypertension, while early interventional treatment is recommended when signs of portal hypertension appear,3Mancuso A. An update on management of Budd-Chiari syndrome: the issues of timing and choice of treatment.Eur J Gastroenterol Hepatol. 2015; 27: 200-203Crossref PubMed Scopus (37) Google Scholar so giving emphasis to the opportunity of early interventional treatment. Overall, the timing of treatment of BCS is of major importance, and TIPS should also be attempted in cases with severe liver disease,3Mancuso A. An update on management of Budd-Chiari syndrome: the issues of timing and choice of treatment.Eur J Gastroenterol Hepatol. 2015; 27: 200-203Crossref PubMed Scopus (37) Google Scholar who were excluded from the present paper.1Ding P.X. He X. Han X.W. Zhang Y. Wu Y. Liang X.X. et al.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: 545-553Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar In conclusion, mainly because of the arbitrary choice of treatment, the promising data reported1Ding P.X. He X. Han X.W. Zhang Y. Wu Y. Liang X.X. et al.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: 545-553Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar here are not easily reproducible. An Individualised Strategy and Long-Term Outcomes of Endovascular Treatment of Budd–Chiari Syndrome Complicated by Inferior Vena Cava ThrombosisEuropean Journal of Vascular and Endovascular SurgeryVol. 55Issue 4PreviewThe 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. Full-Text PDF Open ArchiveResponse to “Re: Treatment of Budd–Chiari Syndrome Complicated by Inferior Vena Cava Thrombosis: Individualised or Non-reproducible Strategy?”European Journal of Vascular and Endovascular SurgeryVol. 56Issue 1PreviewWe thank the author of this letter for his interest in our study. Nevertheless, we would like to clarify some of the concerns raised. Full-Text PDF Open Archive