Interventional therapy for Budd-Chiari syndrome: Analysis of 138 cases

ABSTRACT

Objective To investigate the selection and effectiveness of interventional treatment for different types of Budd-Chiari syndrome (BCS). Methods A total of 138 cases of BCS were divided into 4 types (type Ⅰ, membranous stenosis and obstruction of the inferior vena cava; type Ⅱ, segmental stenosis of the inferior vena cava; type Ⅲ, segmental obstruction of the inferior vena cava; type Ⅳ, patent inferior vena cava) and 9 subtypes according to results of angiography of the hepatic vein or the inferior vena cava. Therapeutic methods included percutaneous transluminal angioplasty (PTA) of the inferior vena cava and stent placement by way of the femoral vein, right cervical vein or subclavian vein, and PTA of the hepatic vein by way of the transhepatic approach, right cervical vein or inferior vena cava. Results The success rate was 100% (83/83) in type Ⅰ patients, 75.0% (9/12) in type Ⅱ patients, 81.6% (31/38) in type Ⅲ patients, and 60% (3/5) in type Ⅳ patients. One patient died (0.7%, 1/138). Complications occurred in 4 patients (2.9%, 4/138), including 2 cases of pericardial injury, 1 case of stent detachment, and 1 case of hepatic hemorrhage. Follow-up observations in 126 successful cases for 3~96 months (mean, 26 months) showed 8 recurrent cases, 2 of which expired, and 2 fatal cases because of hepatocarcinoma. Conclusions Interventional therapy, as a simple, safe and effective minimally invasive method, is the first choice for the treatment of BCS.