[Assessment of hemodynamics in patients with Budd-Chiari syndrome after interventional treatment].

OBJECTIVE: To study the changes in morphology of liver and spleen and hemodynamics of the patients with Budd-Chiari syndrome (BCS) after interventional treatment. METHODS: The dimensions of liver and spleen were detected by routine ultrasonography in 30 normal control subjects and 256 BCS patients before and after inventional therapy. Color duplex sonography was employed to measure the hemodynamic changes. RESULTS: Compared with the control group, BCS patients before interventional therapy showed obvious liver and spleen enlargements (P<0.005), specially the caudate lobe of the liver (P<0.001), which were significantly reduced 7 days after interventional treatment (P<0.005), but the spleen was still larger than that of the control group (P<0.005) even till 6 months after the therapy. Color Doppler flow imaging (CDFI) revealed local high-speed blood flow in patients with stenosis of the inferior vena cave (IVC), but color flow was not detected in patients with IVC obstruction, who had hepatic vein dilation (P<0.005) with slowed blood flow and collateral formation of in the liver, as well as decreased velocity of blood flow in the portal vein. After interventional treatment, the diameter of the involved IVC increased with blood flow restoration and the size and shape of the stent were detected clearly. The velocity of blood flow was increased in both the hepatic and portal veins (P<0.005). CONCLUSION: Interventional therapy can relieve obstruction of blood flow in the liver and improve the hemodynamics of patients with BCS.

Evolution of management for Budd-Chiari syndrome: a team's view from 2564 patients.

AIM: Exploring the development of therapy for a formerly rare and life-threatening disorder, Budd-Chiari syndrome (BCS). METHODS: From 1981 to 2003, 2677 patients with BCS were admitted including 2546 cases that underwent intervention. Therapeutic means included 170 membranotomies, 181 cavoatrial shunts, 312 mesoatrial shunts including mesocavoatrial shunt, 67 mesojugular shunts, 232 radical resections, 1289 PTA, and 295 miscellaneous procedures. RESULTS: Patients treated in the first decade had an effective rate of 77.7%, patency for various approaches was approximately 60-90% at 7 years. In our early experience, 55.7% patients underwent shunts, 26.1% had the transcardiac membranotomy and only 0.8% the interventional modality. Recently this has shifted to 16.2%, 5.2%, and 55.6%, respectively (P < 0.01). In the early phase, 11.6% of patients were classified as stage I (less clinical severity), and 28.6% patients in stage IV (most severe). In contrast, recent patients, they were 56.1% and 4.8% (P < 0.01). CONCLUSION: Chronologically, therapy has evolved from the relatively simple to the more complex (such as variety of shunts and radical correction) procedures, and finally, the interventional approaches as the main modality. However, for patients with type II (long segment occlusion in the inferior vena cava), major procedures maintain an essential role, especially the mesocavoatrial shunt. For those with type III (the HV lesions), shunts remain the procedures of choice. This increased use of the interventional methods is a reflection of greater clinical awareness and more frequent detection of much less severe cases. In stark contrast is declining numbers of advanced cases, signalling a landmark breakthrough in the management of BCS.