Department of Intervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Liver Int. 2019 Aug;39(8):1577-1586. doi: 10.1111/liv.14114. Epub 2019 May 15.
To evaluate individualized treatment strategy (ITS) and long-term outcomes of endovascular treatment of Budd-Chiari syndrome (BCS) with obstructed inferior vena cava (IVC) based on different degrees of hepatic vein (HV) involvement.
From January 2006 to June 2017, 456 consecutive patients with BCS with obstructed IVC underwent endovascular treatment with ITS. All patients received IVC recanalization. Then, 426 patients with at least one patent HV received no additional treatment. Twenty-fivepatients with membranous or segmental occlusion of HVs underwent HV recanalization and for the remaining five patients with diffuse HVs occlusion, a transjugular intrahepatic portosystemic shunt (TIPS) was performed.
The endovascular treatment was technically successful in 455 of the 456 patients (99.8%). The complication rate was 5.0% (23/456), with major complications in 13 patients (2.8%) and minor complications in 10 patients (2.2%). Median follow-up time was 60.5 months (range, 4-120 months). The cumulative 1-, 2-, 5- and 10-year primary vessel patency rates were 93.6%, 89.9%, 80.5% and 74.3% respectively and the cumulative 1-, 2-, 5-, 10- year secondary patency rates were 99.8%, 99.8%, 98.2% and 97.2% respectively. The cumulative 1-, 2-, 5- and 10-year survival rates were 98.4%, 95.8%, 91.2% and 76.5% respectively. Illness duration and decreased serum albumin were independent predictors of survival.
The ITS for Asian BCS with obstructed IVC and varying degrees of HV involvement appears to be effective and with good long-term outcomes.
评估基于不同肝静脉（HV）受累程度的布加综合征（BCS）伴下腔静脉（IVC）阻塞的个体化治疗策略（ITS）和长期结果。
2006 年 1 月至 2017 年 6 月，456 例连续的 BCS 伴 IVC 阻塞患者接受了 ITS 的血管内治疗。所有患者均接受了 IVC 再通。然后，426 例至少有一条 HV 通畅的患者未接受额外治疗。25 例 HV 膜性或节段性闭塞患者行 HV 再通术，其余 5 例弥漫性 HV 闭塞患者行经颈静脉肝内门体分流术（TIPS）。
456 例患者中，455 例（99.8%）血管内治疗技术成功。并发症发生率为 5.0%（23/456），其中 13 例（2.8%）为主要并发症，10 例（2.2%）为小并发症。中位随访时间为 60.5 个月（范围 4-120 个月）。累积 1、2、5 和 10 年的主血管通畅率分别为 93.6%、89.9%、80.5%和 74.3%，累积 1、2、5、10 年的次通畅率分别为 99.8%、99.8%、98.2%和 97.2%。累积 1、2、5 和 10 年的生存率分别为 98.4%、95.8%、91.2%和 76.5%。疾病持续时间和血清白蛋白降低是生存的独立预测因素。
对于亚洲 BCS 伴 IVC 阻塞和不同程度 HV 受累的患者，ITS 似乎是有效且具有良好的长期结果。
