Sun Jingmin, Zhang Qingqiao, Xu Hao, Huang Qianxin, Shen Bin, Zu Maoheng, Gu Yuming
Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China.
Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China.
Ann Vasc Surg. 2014 Nov;28(8):1862-8. doi: 10.1016/j.avsg.2014.07.002. Epub 2014 Jul 9.
To evaluate the safety and clinical efficacy of warfarin anticoagulation after balloon dilation alone for the treatment of Budd-Chiari syndrome (BCS) complicated by old inferior vena cava (IVC) thrombosis.
From January 2008 to November 2013, 19 BCS patients complicated with old IVC thrombosis were treated with balloon dilation followed by oral administration of anticoagulant warfarin. Follow-up was performed at 1 week, then 1, 2, 3, 6, and 12 months after balloon dilation, and then annually thereafter. IVC patency and morphologic changes of the old thrombus were examined by ultrasound, and clinical symptoms and signs were determined by clinical examinations during follow-up.
Successful IVC balloon dilation was achieved in the 19 patients (100%). Inferior vena cavography demonstrated the patency of IVC lumen, and the size of the old thrombus was not altered. The mean pressure gradient between IVC and the right atrium was reduced from 27.5 ± 3.0 cm H2O (range, 22-35) before treatment to 5.4 ± 1.3 cm H2O (range: 2-7) after treatment (t = 41.6, P < 0.05; 1 cm H2O = 0.098 kPa). Patients were followed up as outpatients for an average of 15.9 ± 14.4 months (range, 3-66). Anticoagulation with warfarin was well tolerated in all patients after balloon dilation alone. Of the 19 patients, complete resolution of the old thrombus was achieved in 12 patients and partial resolution was achieved in 7 patients. Color Doppler ultrasound showed that 17 patients had IVC lumen patency, and 2 patients had IVC reocclusion. None of the patients had recurrence of thrombosis, symptomatic pulmonary embolism, and bleeding complications throughout the follow-up period.
Our results indicate that warfarin anticoagulation after balloon dilation alone is a safe and effective therapy for BCS patients with old IVC thrombosis.
评估单纯球囊扩张术后华法林抗凝治疗布加综合征（BCS）合并陈旧性下腔静脉（IVC）血栓形成的安全性及临床疗效。
2008年1月至2013年11月，19例BCS合并陈旧性IVC血栓形成患者接受球囊扩张术，随后口服抗凝剂华法林。术后1周进行随访，之后在球囊扩张术后1、2、3、6和12个月进行随访，此后每年随访一次。通过超声检查IVC通畅情况及陈旧血栓的形态学变化，随访期间通过临床检查确定临床症状和体征。
19例患者（100%）成功完成IVC球囊扩张。下腔静脉造影显示IVC管腔通畅，陈旧血栓大小未改变。IVC与右心房之间的平均压力梯度从治疗前的27.5±3.0 cm H2O（范围22 - 35）降至治疗后的5.4±1.3 cm H2O（范围2 - 7）（t = 41.6，P < 0.05；1 cm H2O = 0.098 kPa）。患者平均门诊随访15.9±14.4个月（范围3 - 66个月）。单纯球囊扩张术后所有患者对华法林抗凝耐受性良好。19例患者中，12例陈旧血栓完全溶解，7例部分溶解。彩色多普勒超声显示17例患者IVC管腔通畅，2例患者IVC再闭塞。随访期间所有患者均未出现血栓复发、有症状的肺栓塞及出血并发症。
我们的结果表明，单纯球囊扩张术后华法林抗凝治疗BCS合并陈旧性IVC血栓形成患者是一种安全有效的治疗方法。
