Treatment of Budd-Chiari syndrome with inferior vena cava thrombosis

Abstract

The aim of this study was to evaluate the initial results of 41 patients with Budd-Chiari syndrome (BCS) with inferior vena cava (IVC) thrombosis, with regard to the clinical safety and feasibility of the therapeutic approaches selected according to the classification of the condition. Forty-one patients with BCS and IVC thrombosis were admitted for retrospective analysis. All 41 patients were classified as having one of three types of BCS. Interventional therapy was used successfully in 28 patients (68.3%), 7 patients (17.1%) were given conservative treatment and 6 patients (14.6%) were treated with surgical shunts. The interventional approach was used in 29 patients in total and was successful in 28 patients (all those of types I and II, and 3 of the 4 patients of type III with acute thrombosis; 96.6%). None of these 28 patients had pulmonary embolism, pericardial tamponade or intra-abdominal bleeding. After 1–5 years, 4 patients (9.8%) had a second dilation of the IVC. In the 7 cases treated in a conservative manner, 2 cases succumbed to upper gastrointestinal bleeding and 1 case succumbed to liver and kidney failure. This study indicates that the classification of BCS patients with IVC thrombosis is helpful in selecting a therapeutic approach. Interventional therapy is the first therapeutic choice for BCS patients with IVC thrombosis of type I, type II or type III with acute thrombosis. For the patients of type III with an obsolete thrombus, surgical shunts or conservative treatment are the main therapeutic methods.

An Individualised Strategy and Long-Term Outcomes of Endovascular Treatment of Budd–Chiari Syndrome Complicated by Inferior Vena Cava Thrombosis

“…These thrombi are difficult to dissolve during thrombolysis but are usually tightly incorporated within the IVC wall and not easily dislodged. 5,8 Accordingly, it is critical to determine the type of the thrombus, and different methods are used to treat these different kinds of thrombi. For assessment of IVC thrombi, Doppler ultrasound, CTV, and/or magnetic resonance venography, and intra-operative vena cavogram were used.…”

“…The objectives of restoring adequate IVC flow and simultaneously preventing pulmonary embolism often seem conflicting, and there are no standards for the diameter of balloon catheters to be used for pre-dilation of the IVC. Wang et al 8 used balloons of 5e7 mm diameter, whereas Zhang et al 5 used balloons of 8 or 10 mm diameter. In a previous study, balloons of 12e16 mm diameter were used for pre-dilation of the IVC; 3e5 days after the pre-dilation therapy, the lumen had retracted by more than 50%, to 8 mm, confirmed by Doppler ultrasound 13,15 ; Zhang et al 5 from another centre reported a similar experience.…”

“…5 IVC thrombosis was once considered a contraindication to endovascular therapy because of the risk of potentially fatal pulmonary embolism from dislodgement of the thrombus after opening the blocked IVC. However, in recent years, many therapeutic approaches to treating BCS with IVC thrombosis have been advanced: anticoagulation therapy, 6,7 thrombolytic therapy, 8 large lumen catheter aspiration, 5,9 stent press thrombus, 10,11 agitation thrombolysis, 12 pre-dilation therapy, 13 retrieval stent filter placement, 14e16 and direct large balloon dilation. 11,17 However, optimal treatment methods for BCS with IVC thrombosis have not been defined, and the numbers of reported cases are insufficient to permit reliable assessment of long-term outcome.…”

Budd‐chiari syndrome causing acute liver failure: A multicenter case series

“…Budd‐Chiari syndrome (BCS) is a rare clinical condition resulting from obstruction of the hepatic venous outflow tract anywhere from the hepatic venules to the right atrium, including the small and large hepatic veins (HVs) and the inferior vena cava (IVC) . Most cases of BCS in the Western world result from venous thrombosis that leads to diffuse obliteration of the veins, whereas in Asia the most common cause is IVC and/or HV obstruction due to membranous webs . Clinically, most patients have evidence of portosystemic collaterals with an enlarged caudate lobe at presentation due to incomplete occlusion of the 3 main HVs.…”

“…(1) Most cases of BCS in the Western world result from venous thrombosis that leads to diffuse obliteration of the veins, whereas in Asia the most common cause is IVC and/or HV obstruction due to membranous webs. (2) Clinically, most patients have evidence of portosystemic collaterals with an enlarged caudate lobe at presentation due to incomplete occlusion of the 3 main HVs. Most Western BCS patients have evidence of 1 or more underlying hypercoagulable states, most commonly polycythemia vera (PCV).…”