Applicability of Different Endovascular Methods for Treatment of Refractory Budd–Chiari Syndrome

Abstract

The study's objective was to evaluate the applicability of different endovascular methods for treatment of refractory type of Budd-Chiari syndrome (BCS) under specific scenarios frequently encountered in patients. The treatment methods were evaluated in 197 patients with the following four types of refractory BCS: lesions of the inferior vena cava (IVC) including a special shape diaphragm (e.g., a knife- or a vertically shaped diaphragm, etc.), occlusion of the long segment of IVC, IVC obstruction combined with thrombosis, and occlusion of the hepatic vein. The choice of endovascular treatment depended on the degree of difficulty to puncture the membrane after spatial orientation. There was a need to adjust the curvature of the device to fit the natural angle of IVC. When IVC lesions were combined with thrombosis, the treatment was adjusted depending on the freshness of the thrombus. Different routes were used to rupture the membrane and expand the lesion. The majority of patients recovered without complications. The few complications observed were the following: 1 case of death due to a postoperative stress ulcer, 1 case of a successfully treated pericardial tamponade, 1 case of stent migration, and 3 cases of failure to stent and re-occlusion that occurred in the follow-up period. To conclude, BCS is preferably treated via endovascular intervention; however, the particular choice depends on individual circumstances.

Use of Accessory Hepatic Vein Intervention in the Treatment of Budd–Chiari Syndrome

“…The average diameter of AHV stems in our patients was 8.0 ± 2.6 mm, which is also comparable with that (7.3 ± 3.9 mm) in the MRA study [12]. The purpose of management of BCS is improving patients' symptoms and liver function [5][6][7][8]. Most previous studies have demonstrated that HV recanalization is suitable for patients with short segmental obstruction of HV [7][8][9].…”

“…The purpose of management of BCS is improving patients' symptoms and liver function [5][6][7][8]. Most previous studies have demonstrated that HV recanalization is suitable for patients with short segmental obstruction of HV [7][8][9]. However, HV recanalization is difficult with a high failure rate in patients with long segmental obstruction or diffuse obstruction of HV [7][8][9].…”

“…AHV recanalization was performed if the obstruction length of AHV was shorter than that of each of the three main HVs. Stent insertion was required if more than 30 % residual stenosis was present after balloon dilation [7].…”

“…In Western countries, anticoagulation and TIPS provide excellent outcomes in most patients [4][5][6]. In Asia, recanalization is used as the first line treatment [7][8][9].…”

“…To date, most studies concentrated on TIPS or HV recanalization in the management of BCS [4][5][6][7][8][9]. In addition to three main HVs, some patients with BCS may have the compensatory accessory hepatic vein (AHV) that connects to the IVC and constitutes the drainage vessel of the liver [10][11][12].…”