Outcomes of endovascular interventional therapy for primary Budd‑Chiari syndrome caused by hepatic venous obstruction

Cheng,De‑Lei; Zhu,Nan; Xu,Hao; Li,Cheng‑Li; Lv,Wei‑Fu; Fang,Wei‑Wei; Li,Chuan‑Ting

doi:10.3892/etm.2018.6708

Outcomes of endovascular interventional therapy for primary Budd‑Chiari syndrome caused by hepatic venous obstruction

Authors:
- De‑Lei Cheng
- Nan Zhu
- Hao Xu
- Cheng‑Li Li
- Wei‑Fu Lv
- Wei‑Wei Fang
- Chuan‑Ting Li
View Affiliations

Affiliations: Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong 250021, P.R. China, Department of Radiology, People's Hospital of Wuhe County, Bengbu, Anhui 233300, P.R. China, Department of Interventional Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221100, P.R. China, Department of Interventional Radiology, Anhui Provincial Hospital, Hefei, Anhui 230000, P.R. China
Published online on: September 7, 2018 https://doi.org/10.3892/etm.2018.6708
Pages: 4141-4149
Copyright: © Cheng et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

To date, interventional therapy for patients with Budd-Chiari syndrome (BCS) due to hepatic vein obstruction (HVO) has not been standardized in China. In Western countries, BCS primarily occurs due to thrombosis and the majority of patients receive thrombolysis. In China, BCS is mostly caused by the membranous occlusion of the HV or IVC. The present retrospective study evaluated the efficacy of recanalization techniques in patients with primary BCS due to HVO. The data of 69 patients with BCS due to HVO, who underwent endovascular therapy at 2 centers in China between December 2010 and December 2012, were analyzed. All of the patients underwent balloon angioplasty. In addition, 14, 6 and 5 patients received thrombolysis, endovascular stent and thrombolysis + endovascular stent, respectively. The overall technical success rate was 95.7% (66/69), and was comparable among the treatments. The HV pressure after the treatments was significantly lower compared with that prior to the procedures (23.3±6.9 vs. 46.5±8.6 cmH2O; P<0.001). The mean follow‑up duration was 75 months (range, 60‑84 months). During the 5‑year follow‑up, 10 patients (15.2%) had developed a recurrence of BCS‑associated symptoms, of which 7 were successfully treated. The cumulative survival rates at 12, 36 and 60 months after endovascular interventional therapy (balloon angioplasty or combined treatment) were 98.5, 98.5 and 93.9%, respectively. After treatment by endovascular therapy, the patients with BCS caused by HVO had high survival rates and low recurrence rates in the short‑ and mid‑term.

View Figures

View References

1	Martens P and Nevens F: Budd-Chiari syndrome. United European Gastroenterol J. 3:489–500. 2015. View Article : Google Scholar : PubMed/NCBI
2	Shin N, Kim YH, Xu H, Shi HB, Zhang QQ, Pons Colon JP, Kim D, Xu Y, Wu FY, Han S, et al: Redefining Budd-Chiari syndrome: A systematic review. World J Hepatol. 8:691–702. 2016. View Article : Google Scholar : PubMed/NCBI
3	Goel RM, Johnston EL, Patel KV and Wong T: Budd-Chiari syndrome: Investigation, treatment and outcomes. Postgrad Med J. 91:692–697. 2015. View Article : Google Scholar : PubMed/NCBI
4	Cui YF, Fu YF, Li DC and Xu H: Percutaneous recanalization for HV-type Budd-Chiari syndrome: Long-term patency and survival. Hepatol Int. 10:363–369. 2016. View Article : Google Scholar : PubMed/NCBI
5	Akamatsu N, Sugawara Y and Kokudo N: Budd-Chiari syndrome and liver transplantation. Intractable Rare Dis Res. 4:24–32. 2015. View Article : Google Scholar : PubMed/NCBI
6	Murad Darwish S, Plessier A, Hernandez-Guerra M, Fabris F, Eapen CE, Bahr MJ, Trebicka J, Morard I, Lasser L, Heller J, et al: Etiology, management, and outcome of the Budd-Chiari syndrome. Ann Intern Med. 151:167–175. 2009. View Article : Google Scholar : PubMed/NCBI
7	Sang HF and Li XQ: Endovascular treatment of Budd-Chiari syndrome with HV obstruction in China. J Laparoendosc Adv Surg Tech A. 24:846–851. 2014. View Article : Google Scholar : PubMed/NCBI
8	Seijo S, Plessier A, Hoekstra J, Dell'era A, Mandair D, Rifai K, Trebicka J, Morard I, Lasser L, Abraldes JG, et al: Good long-term outcome of Budd-Chiari syndrome with a step-wise management. Hepatology. 57:1962–1968. 2013. View Article : Google Scholar : PubMed/NCBI
9	Fitsiori K, Tsitskari M, Kelekis A, Filippiadis D, Triantafyllou K and Brountzos E: Transjugular intrahepatic portosystemic shunt for the treatment of Budd-Chiari syndrome patients: Results from a single center. Cardiovasc Intervent Radiol. 37:691–697. 2014. View Article : Google Scholar : PubMed/NCBI
10	Tripathi D, Macnicholas R, Kothari C, Sunderraj L, Al-Hilou H, Rangarajan B, Chen F, Mangat K, Elias E and Olliff S: Good clinical outcomes following transjugular intrahepatic portosystemic stent-shunts in Budd-Chiari syndrome. Aliment Pharmacol Ther. 39:864–872. 2014. View Article : Google Scholar : PubMed/NCBI
11	Cheng D, Xu H, Lu ZJ, Hua R, Qiu H, Du H, Xu X and Zhang J: Clinical features and etiology of Budd-Chiari syndrome in Chinese patients: A single-center study. J Gastroenterol Hepatol. 28:1061–1067. 2013. View Article : Google Scholar : PubMed/NCBI
12	Qi XS, Ren WR, Fan DM and Han GH: Selection of treatment modalities for Budd-Chiari syndrome in China: A preliminary survey of published literature. World J Gastroenterol. 20:10628–10636. 2014. View Article : Google Scholar : PubMed/NCBI
13	Cui YF, Fu YF, Wei N, Zhu HC and Xu H: Retrograde puncture assisted HV recanalization in treating Budd-Chiari syndrome with segmental obstruction of hepatic venous. Radiol Med. 120:1184–1189. 2015. View Article : Google Scholar : PubMed/NCBI
14	Kumar Shalimar A, Kedia S, Sharma H, Gamanagatti SR, Gulati GS, Nayak B, Thakur B and Acharya SK: Hepatic venous outflow tract obstruction: Treatment outcomes and development of a new prognostic score. Aliment Pharmacol Ther. 43:1154–1167. 2016. View Article : Google Scholar : PubMed/NCBI
15	Meng X, Lv Y, Zhang B, He C, Guo W, Luo B, Yin Z, Fan D and Han G: Endovascular management of Budd-Chiari syndrome with IVC thrombosis: A 14-year single-center retrospective report of 55 patients. J Vasc Interv Radiol. 27:1592–1603. 2016. View Article : Google Scholar : PubMed/NCBI
16	Huang Q, Shen B, Zhang Q, Xu H, Zu M, Gu Y, Wei N, Cui Y and Huang R: Comparison of long-term outcomes of endovascular management for membranous and segmental IVC obstruction in patients with primary Budd-Chiari syndrome. Circ Cardiovasc Interv. 9:e0031042016. View Article : Google Scholar : PubMed/NCBI
17	Zhang Q, Xu H, Zu M, Gu Y, Wei N, Wang W, Gao Z and Shen B: Catheter-directed thrombolytic therapy combined with angioplasty for hepatic venous obstruction in Budd-Chiari syndrome complicated by thrombosis. Exp Ther Med. 6:1015–1021. 2013. View Article : Google Scholar : PubMed/NCBI
18	Siriwardana RC, Niriella MA, Dassanayake AS, Liyanage C, Gunathilaka B, Jayathunge S and de Silva HJ: Clinical characteristics and outcome of hepatocellular carcinoma in alcohol related and cryptogenic cirrhosis: A prospective study. Hepatobiliary Pancreat Dis Int. 14:401–405. 2015. View Article : Google Scholar : PubMed/NCBI
19	Tang W, Zhang XM, Yang L, Mitchell DG, Zeng NL and Zhai ZH: Hepatic caudate vein in Budd-Chiari syndrome: Depiction byusing magnetic resonance imaging. Eur J Radiol. 77:143–148. 2011. View Article : Google Scholar : PubMed/NCBI
20	Mukund A and Gamanagatti S: Imaging and interventions in Budd-Chiari syndrome. World J Radiol. 3:169–177. 2011. View Article : Google Scholar : PubMed/NCBI
21	Gao Y, Chen S and Yu C: Applicability of different endovascular methods for treatment of refractory Budd-Chiari syndrome. Cell Biochem Biophys. 61:453–460. 2011. View Article : Google Scholar : PubMed/NCBI
22	Fan X, Liu K, Che Y, Wang S, Wu X, Cao J and Li J: Good clinical outcomes in Budd-Chiari syndrome with hepatic venous occlusion. Dig Dis Sci. 61:3054–3060. 2016. View Article : Google Scholar : PubMed/NCBI
23	Hanaoka J, Shimada M, Uchiyama H, Ikegami T, Imura S, Morine Y and Kanemura H: A simple formula to calculate the liver drainage volume of the accessory right HV using its diameter alone. Surgery. 146:264–268. 2009. View Article : Google Scholar : PubMed/NCBI
24	Miraglia R, Maruzzelli L and Luca A: Recanalization of occlusive transjugular intrahepatic portosystemic shunts inaccessible to the standard transvenous approach. Diagn Interv Radiol. 19:61–65. 2013.PubMed/NCBI
25	Gupta AC, Wang W, Shah C, Sands MJ, Bullen J, Remer EM, Bayona PM, Carey W and Kapoor B: Added value of covered stents in transjugular intrahepatic portosystemic shunt: A large single-center experience. Cardiovasc Intervent Radiol. 40:1723–1731. 2017. View Article : Google Scholar : PubMed/NCBI
26	Eapen CE, Velissaris D, Heydtmann M, Gunson B, Olliff S and Elias E: Favourable medium term outcome following hepatic vein recanalisation and/or transjugular intrahepatic portosystemic shunt for Budd Chiari syndrome. Gut. 55:878–884. 2006. View Article : Google Scholar : PubMed/NCBI
27	Valla D, Hadengue A, el Younsi M, Azar N, Zeitoun G, Boudet MJ, Molas G, Belghiti J, Erlinger S, Hay JM and Benhamou JP: Hepatic venous outflow block caused by short-length hepatic vein stenoses. Hepatology. 25:814–819. 1997. View Article : Google Scholar : PubMed/NCBI