Percutaneous recanalization for hepatic vein-type Budd-Chiari syndrome: long-term patency and survival

Cui, Yanfeng; Fu, Yu‐Fei; Li, Dechun; Xu, Hao

doi:10.1007/s12072-015-9676-3

Cited by 40 publications

(47 citation statements)

References 20 publications

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“…Recent studies from Asia have shown the effectiveness of percutaneous recanalization in various BCS patients and the survival rates in these patients were comparable to that of a European population undergoing TIPS and orthotopic liver transplantation. 4,[15][16][17][18][19][20][21] In our study we achieved technical success of 91.7% for HV pattern, 100% for IVC pattern and 88.8% for combined HV and IVC pattern of BCS. Clinical success was achieved in 79.2% of patients.…”

Section: Discussionsupporting

confidence: 50%

Budd-Chiari syndrome managed with percutaneous recanalization: Long-term outcome and comparison with medical therapy

Kulkarni

Moorthy

Pullara

et al. 2019

Gastrointestinal Intervention

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Background: To compare the outcomes in a group of patients with Budd-Chiari syndrome (BCS) managed by percutaneous recanalization with a group of patients who were managed by medical therapy alone. Methods: We retrieved the hospital records of 37 patients with BCS admitted to our facility between 2004 to 2017 and identified 24 patients (male:female = 10:14; mean age, 32.7 ± 12.5 years) who underwent percutaneous recanalization. Remaining thirteen patients (male:female = 3:10; mean age, 36.77 ± 14.71 years), were managed by medical therapy. Technical and clinical results, complications, and primary patency of percutaneous recanalization were analyzed. Overall and symptom-free survival rates, the frequency of symptom recurrence, and the number of readmissions for recurrent symptoms were analyzed in both interventional treatment and medical therapy groups. Results: Technical success for recanalization of hepatic vein/inferior venecava by angioplasty ± stenting was achieved in 22 patients (22/24, 91.7%). Clinical success was achieved in 19 patients (19/24, 79.2%). Overall survival for patients who underwent percutaneous recanalization at 1 year and five years was 87.0% and 87.0% and for patients with medical therapy was 90.1% and 45.5%, respectively (P = 0.710). Symptom-free survival for patients who underwent percutaneous recanalization at 1 year and five year was 93.3% and 81.7% and for patients with medical therapy was 26.0% and 0%, respectively (P < 0.001). In the intervention group, 4 patients (4/24, 16.7%) were admitted for recurrent symptoms (median number of readmissions 1, range: 1-2) whereas in medically managed patients 9 patients (9/13, 69.2%) were readmitted (median number of readmissions, 2; range, 1-5) (P = 0.003). Conclusion: There was no statistically significant difference in overall survival of patients managed with percutaneous recanalization and medical therapy. Percutaneous recanalization had definite benefit in terms of fewer recurrent symptoms and hospital admissions, hence should be performed whenever technically feasible.

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Section: Discussionsupporting

confidence: 50%

Budd-Chiari syndrome managed with percutaneous recanalization: Long-term outcome and comparison with medical therapy

Kulkarni

Moorthy

Pullara

et al. 2019

Gastrointestinal Intervention

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“…HVC‐BCS patients have undergone percutaneous recanalisation more frequently as compared to classical BCS patients . Several studies have shown good long‐term efficacy and survival‐benefit of this procedure (Table ) …”

Section: Radiological Interventionmentioning

confidence: 99%

“…Angioplasty has been extensively used in Asia with good long‐term outcomes (Table ) . Han et al published their experience in 168 Chinese BCS patients undergoing successful percutaneous angioplasty with median follow‐up of 30 months .…”

Section: Radiological Interventionmentioning

confidence: 99%

Review article: a multidisciplinary approach to the diagnosis and management of Budd‐Chiari syndrome

Khan

Armstrong

Mehrzad

et al. 2019

Aliment Pharmacol Ther

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Background: Budd-Chiari syndrome (BCS) is a rare but fatal disease caused by obstruction in the hepatic venous outflow tract. Aim: To provide an update of the pathophysiology, aetiology, diagnosis, management and follow-up of BCS. Methods: Analysis of recent literature by using Medline, PubMed and EMBASE databases. Results: Primary BCS is usually caused by thrombosis and is further classified into "classical BCS" type where obstruction occurs within the hepatic vein and "hepatic vena cava BCS" which involves thrombosis of the intra/suprahepatic portion of the inferior vena cava (IVC). BCS patients often have a combination of prothrombotic risk factors. Aetiology and presentation differ between Western and certain Asian countries. Myeloproliferative neoplasms are present in 35%-50% of European patients and are usually associated with the JAK2-V617F mutation. Clinical presentation is diverse and BCS should be excluded in any patient with acute or chronic liver disease. Non-invasive imaging (Doppler ultrasound, computed tomography, or magnetic resonance imaging) usually provides the diagnosis. Liver biopsy should be obtained if small vessel BCS is suspected. Stepwise management strategy includes anticoagulation, treatment of identified prothrombotic risk factors, percutaneous revascularisation and transjugular intrahepatic portosystemic stent shunt to re-establish hepatic venous drainage, and liver transplantation in unresponsive patients. This strategy provides a 5-year survival rate of nearly 90%. Long-term outcome is influenced by any underlying haematological condition and development of hepatocellular carcinoma. Conclusions: With the advent of newer treatment strategies and improved understanding of BCS, outcomes in this rare disease have improved over the last three decades. An underlying haematological disorder can be the major determinant of outcome. Primary BCS is considered a multifactorial disease and multicentre data found a combination of several prothrombotic conditions in 25% to 46% of the patients with BCS, 11,19-21 several times greater than expected in the general population. The discovery of one causal factor should not discourage further investigation to identify other prothrombotic conditions. Multifactorial causes may explain the rarity of BCS. 2 The prothrombotic conditions found in BCS, in particular the classical type, include: Factor V Leiden mutation, prothrombin (PT) gene mutation, protein C deficiency, protein S deficiency, antithrombin deficiency, antiphospholipid syndrome, hyperhomocysteinemia and paroxysmal nocturnal haemoglobinuria. 22 BCS is also associated with systemic inflammatory diseases, such as Behçet's disease, sarcoidosis, vasculitis and other connective tissue diseases. 22 A detailed description of the frequency of inherited/acquired thrombophilias and risk factors found in patients with BCS compared to those with portal vein thrombosis is summarised by Poisson and colleagues. 23

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“…Tracheal stent has been widely used clinically for the treatment of tracheal fistula [4][5][6][7] or tracheal stenosis [8][9][10][11][12][13]. However, tracheal stents placement may bring a series of complications, and stent removal sometimes is necessary [23].…”

Section: Discussionmentioning

confidence: 99%

“…Besides, some patients may not be willing to undergo open surgery considering that they are too weak or sick under this circumstance [2]. Since first adoption of self-expanding metal stents to treat bronchial obstruction in 1989 [3], the efficacy and safety of tracheal stent has been proven for the treatment of tracheal fistula [4][5][6][7] or tracheal stenosis [8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of tracheal stents removal under fluoroscopy guidance: comparison of tracheal fistulas with tracheal stenosis

Bai

et al. 2020

Preprint

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Background: No study compared the techniques and complications of stent removal under fluoroscopy guidance for tracheal fistula and tracheal stenosis.Methods: We conducted a retrospective analysis of 152 patients who underwent fluoroscopy-guided stent removal from January 2011 to June 2017. Eighty-five patients underwent stent removal for tracheal fistula (TF group), and 67 patients for tracheal stenosis (TS group). All patients underwent tracheal CT scans before stent removal and during follow up. The technical success rate, complications, survival rate were compared between the two groups.Results: The technical success rate of stent removal was 98.9% and 97.4% for tracheal fistula and tracheal stenosis, respectively. Except for the routine removal for half of patients, excessive granulation tissue was the common indications for stent removal, which was found 142.1±25.9 days later for tracheal fistula, and 89.9±15.0 day for tracheal stenosis. The total incidence of complications was 21.1% and 22.4% for tracheal fistula and tracheal stenosis, respectively. One perioperative death of asphyxia was found in TF group, and 2 deaths in TS group. Recurrence of fistula or stenosis requiring stenting was the most comment complication in both groups. The 0.5-, 3-, 6-year survival rates were 90.3%, 59.6%, and 36.1% for TF group, and 80.4%, 75.7%, 75.7% for TS group.Conclusions: Fluoroscopic removal of tracheal stent is safe and effective for both tracheal fistula and tracheal stenosis, with no significant difference. Recurrence of fistula or stenosis requiring stenting was the most comment complication.

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Percutaneous recanalization for hepatic vein-type Budd-Chiari syndrome: long-term patency and survival

Abstract: Percutaneous recanalization can provide good long-term patency and survival in HV-type BCS patients.

Cited by 40 publications

References 20 publications

Budd-Chiari syndrome managed with percutaneous recanalization: Long-term outcome and comparison with medical therapy

Budd-Chiari syndrome managed with percutaneous recanalization: Long-term outcome and comparison with medical therapy

Review article: a multidisciplinary approach to the diagnosis and management of Budd‐Chiari syndrome

Long-term outcomes of tracheal stents removal under fluoroscopy guidance: comparison of tracheal fistulas with tracheal stenosis

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