Efficacy and Safety of Endovascular Intervention for the Management of Primary Entire-Inferior Vena Cava Occlusion

Zhang, Qingqiao; Huang, Qianxin; Shen, Bin; Sun, Jingmin; Wang, Xiaolong; Liu, Hongtao

doi:10.1007/s00270-014-0980-4

Cited by 10 publications

(6 citation statements)

References 20 publications

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“…Then, a steel needle with a curved head was inserted to penetrate the IVC occlusion from the top to the bottom end via the right jugular approach. 17,18 This dual approach improved the technical success rate and decreased the occurrence of complications, such as IVC perforation and hemopericardium. In most cases of BCS, there was a sufficient distance between the proximal end of the IVC occlusion and the right atrium.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Long-Term Outcomes of Endovascular Management for Membranous and Segmental Inferior Vena Cava Obstruction in Patients With Primary Budd–Chiari Syndrome

Huang

Shen

Zhang

et al. 2016

Circ: Cardiovascular Interventions

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Budd-Chiari syndrome (BCS) is a vascular disorder characterized by obstruction of hepatic venous outflow from the hepatic venules to the entrance of the inferior vena cava (IVC) into the right atrium.1,2 In contrast to Western countries, IVC obstruction is a common cause of BCS in China. This disorder is classified into membranous obstruction of IVC (MOVC; obstructed segment of IVC is ≤1.0 cm) and segmental obstruction of IVC (SOVC; obstructed segment of IVC is >1.0 cm). [3][4][5][6] Treatments for this disorder include medical management, surgical operation, and endovascular intervention. Medical management alone has a limited ability to arrest progression of the disease, as reported in a study of 237 patients, where 72% failed to show a significant survival benefit.7 Surgery has been associated with high mortality rates (≤50%) and complicated by dysfunction rates as high as 32%. 8,9 Endovascular intervention has proven more effective than medical management and is associated with lower rates of mortality than open surgical procedures. [10][11][12] It has become the primary treatment of choice for BCS management in China because of its minimal invasiveness and good efficacy.Although several studies reported the safety and efficacy of endovascular intervention for the management of primary BCS caused by IVC obstruction, [13][14][15][16] few studies compared long-term outcomes of endovascular management between MOVC and SOVC patients. Moreover, there are still controversies about the optimal endovascular strategy for these conditions according to previous reports. 5,[13][14][15][16] Two previous studies showed that balloon dilation alone was sufficient in most BCS patients with MOVC and SOVC, and <3% had recurrence in 3 to 8 years of follow-up.5,13 However, otherBackground-Endovascular management is important for the treatment of primary Budd-Chiari syndrome, which is caused by inferior vena cava (IVC) obstruction. The aims of this study were to compare long-term outcomes of endovascular management for primary Budd-Chiari syndrome patients with membranous obstruction of IVC (MOVC) and segmental obstruction of IVC (SOVC) and explore the optimal endovascular strategy for these conditions. Methods and Results-Clinical data of 265 patients with Budd-Chiari syndrome who received endovascular management (MOVC group, n=136; SOVC group, n = 129) were retrospectively reviewed. Cumulative IVC patency rates were generated by the Kaplan-Meier method and compared by log-rank test. In total, 245 patients were followed up from 3 to 72 months after treatment. The difference of long-term outcomes of balloon dilation alone versus stent placement was not significant in each group. The overall cumulative 1-, 3-, and 5-year primary IVC patency rates were 98.3%, 90.7%, and 83.8% in the MOVC group and 88.3%, 79.1%, and 67.9% in the SOVC group (P=0.007), respectively. The long-term IVC patency rates were lower in the SOVC group than in the MOVC group for patients who underwent balloon dilation alone (P=0.001) and did not significantly d...

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Section: Discussionmentioning

confidence: 99%

“…A steel needle with a curved head 17,18 was advanced through the 5F angiographic catheter via the right jugular approach to penetrate the IVC occlusion from the proximal end under fluoroscopic guidance. The weakest point of the IVC obstruction was carefully probed, rather than using brute force to penetrate it.…”

Section: Endovascular Proceduresmentioning

confidence: 99%

Comparison of Long-Term Outcomes of Endovascular Management for Membranous and Segmental Inferior Vena Cava Obstruction in Patients With Primary Budd–Chiari Syndrome

Huang

Shen

Zhang

et al. 2016

Circ: Cardiovascular Interventions

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“…Sharp recanalization is a well-described technique for crossing chronic venous occlusions [17] , [18] , [19] . At the time we performed the procedure in early 2014, there had been numerous reports of sharp recanalization of membranous IVC occlusions using the stiff end of a 0.035” guidewire [20] , straight needles [13] , J-type transseptal needles [3] , [9] , [20] , [21] , [22] , custom stainless steel needles with curved heads [23] , [24] , [25] , and the Rosch-Uchida transjugular liver access set (Cook Medical) [26] . We were unsuccessful in crossing the occlusion with multiple guidewires at the time of initial venacavography and elected to use a 21-gauge Chiba needle (Cook Medical) based upon availability, cost, and perceived safety with the delivery method described above; however, other methods of sharp recanalization would have also been appropriate.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous sharp recanalization of a membranous IVC occlusion with an occlusion balloon as a needle target

Rivers-Bowerman

Lightfoot

Meagher

et al. 2017

Radiology Case Reports

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A 50-year-old male with right upper quadrant symptoms and hepatic dysfunction was found to have multiple dilated hepatic veins (HVs) with intrahepatic collateralization and membranous occlusion of the intrahepatic inferior vena cava (IVC) consistent with primary Budd–Chiari syndrome. Venacavograms depicted drainage of the intrahepatic collaterals through a left-sided HV entering the IVC above the level of the occlusion. Sharp recanalization of the membranous IVC occlusion was performed with an occlusion balloon as a needle target under echocardiographic monitoring followed by balloon angioplasty with restoration of IVC patency. Clinical, laboratory, and venographic procedural success has been demonstrated to 9 months with minimal residual stenosis.

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“…Therefore, in the West, anticoagulation or TIPS is effective, while angioplasty merely works in a minority of cases [3][4][5][6][7]. In the Asia-Pacific region, symptomatic BCS with membranous or segmental obstruction accounts for a relatively high proportion, and angioplasty could benefit patients to the greatest extent regardless of stent placement [8,9].…”

Section: Introductionmentioning

confidence: 99%

Establishment and validation of a prediction model for the first recurrence of Budd–Chiari syndrome after endovascular treatment: a large sample size, single-center retrospective study

Wang

Zhang

et al. 2022

Hepatol Int

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Objective To investigate the independent risk factors for the first recurrence after endovascular management in patients with Budd–Chiari syndrome (BCS), and to establish a prediction model for predicting recurrence in target patients. Methods BCS patients who underwent endovascular treatment in the Affiliated Hospital of Xuzhou Medical University from January 2010 to December 2015 were retrospectively examined, with their clinical, laboratory test, and imaging data collected and analyzed. Independent risk factors for recurrence were identified, and a prediction model was established and validated. Results A total of 450 patients met the filtering criteria, and 102 recurred during the follow-up. The median follow-up time was 87 months, ranging from 1 to 137 months. The 1-, 3-, 5- and 10-year cumulative recurrence rate was 9.11% (6.41–11.73%), 17.35% (13.77–20.78%), 20.10% (16.30–23.72%), and 23.06% (18.86–27.04%), respectively. Liver cirrhosis, ascites, thrombosis, and all the main intrahepatic drainage veins obstructed (obstructed HV + AHV) are independent risk factors, while age is an independent protective factor. The prediction model was named MRBET. Based on the model, the risk score of each patient equals (−0.385981 * Age/10) + (0.0404184 * PT) + (0.0943423 * CRE/10) + (0.0157053 * LDH/10) + (0.592179 * LC) + (0.896034 * Ascites) + (0.691346 * Thrombosis) + (0.886741 * obstructed HV + AHV), and those in the high-risk group (risk score ≥ 1.57) were more likely to recur than those in the low-risk group (HR = 6.911, p < 0.001). The MRBET model is also available as a web tool at https://mrbet.shinyapps.io/dynnomapp. Conclusion Liver cirrhosis, ascites, thrombosis, and obstructed HV + AHV are independent risk factors for the first recurrence; age is an independent protective factor. The prediction model can effectively and conveniently predict the risk of recurrence and screen out patients at a high recurrence risk.

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Efficacy and Safety of Endovascular Intervention for the Management of Primary Entire-Inferior Vena Cava Occlusion

Abstract: Endovascular intervention is safe and efficacious for the treatment of primary entire-IVC occlusion.

Cited by 10 publications

References 20 publications

Comparison of Long-Term Outcomes of Endovascular Management for Membranous and Segmental Inferior Vena Cava Obstruction in Patients With Primary Budd–Chiari Syndrome

Comparison of Long-Term Outcomes of Endovascular Management for Membranous and Segmental Inferior Vena Cava Obstruction in Patients With Primary Budd–Chiari Syndrome

Percutaneous sharp recanalization of a membranous IVC occlusion with an occlusion balloon as a needle target

Establishment and validation of a prediction model for the first recurrence of Budd–Chiari syndrome after endovascular treatment: a large sample size, single-center retrospective study

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