Zhang Wei, Tian Yu-Long, Wang Qiao-Zheng, Chen Xiao-Wei, Li Qi-Yang, Han Jin-Hang, Chen Xu-Dong, Xu Ke
Department of Interventional Radiology, Shenzhen People's Hospital, the Second Affiliated Hospital of Jinan University, Shenzhen 518020, Guangdong Province, China.
Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China.
World J Clin Cases. 2020 Jul 26;8(14):2930-2941. doi: 10.12998/wjcc.v8.i14.2930.
Budd-Chiari syndrome is defined as hepatic venous outflow tract obstruction. For Asian Budd-Chiari syndrome patients, the major treatment modality is recanalization (percutaneous transluminal angioplasty with or without stent implantation). The cumulative 1-, 5-, and 10-year primary patency rates and survival rates are reported to be excellent or satisfactory, but the long-term outcome of patients with restenosis (the most common complication after recanalization) is unknown.
To explore the treatment strategy for restenosis in patients with Budd-Chiari syndrome after interventional therapy and to evaluate the long-term follow-up results.
The clinical data and follow-up results of 60 patients with restenosis after interventional therapy from November 1983 to December 2013 were retrospectively analyzed.
Sixty patients with restenosis were retrospectively divided into a percutaneous transluminal angioplasty (PTA) group (40 patients) and a PTA + stent group (20 patients) according to the primary recanalization method. For the patients with restenosis in the PTA group, 13 refused treatment, and 27 received further treatment; among these patients, five had a second restenosis, two had a third restenosis, and one had a fourth restenosis. For the patients with restenosis in the PTA + stent group, nine refused treatment, ten received PTA alone, and the other received PTA + stent implantation. Among the patients who received further treatment, five had a second restenosis, three had a third restenosis, and one had a fourth restenosis. The 1-, 5-, 10-, 20-, and 25-year cumulative survival rates of the 38 patients who received further treatment after restenosis were 100%, 78.3%, 78.3%, 70.5%, and 70.5%, respectively; however, for the 22 patients who refused treatment, the survival rates were 72.7%, 45.9%, 30.6%, 10.2%, and unavailable, respectively ( < 0.001).
Long-term follow-up after interventional therapy is very important. Active treatment for patients with restenosis can improve prognosis, and minimally invasive treatment strategies for restenosis allows to obtain satisfactory results.
布加综合征定义为肝静脉流出道梗阻。对于亚洲布加综合征患者，主要治疗方式是再通（经皮腔内血管成形术，可带或不带支架植入）。据报道，1年、5年和10年的累计原发性通畅率和生存率极佳或令人满意，但再狭窄患者（再通后最常见的并发症）的长期预后尚不清楚。
探讨布加综合征患者介入治疗后再狭窄的治疗策略，并评估长期随访结果。
回顾性分析1983年11月至2013年12月期间60例介入治疗后发生再狭窄患者的临床资料和随访结果。
60例再狭窄患者根据初次再通方法回顾性分为经皮腔内血管成形术（PTA）组（40例）和PTA+支架组（20例）。PTA组再狭窄患者中，13例拒绝治疗，27例接受进一步治疗；其中，5例发生第二次再狭窄，2例发生第三次再狭窄，1例发生第四次再狭窄。PTA+支架组再狭窄患者中，9例拒绝治疗，10例仅接受PTA，其余接受PTA+支架植入。在接受进一步治疗的患者中，5例发生第二次再狭窄，3例发生第三次再狭窄，1例发生第四次再狭窄。38例再狭窄后接受进一步治疗患者的1年、5年、10年、20年和25年累计生存率分别为100%、78.3%、78.3%、70.5%和70.5%；然而，22例拒绝治疗患者的生存率分别为72.7%、45.9%、30.6%、10.2%和不可用（<0.001）。
介入治疗后的长期随访非常重要。对再狭窄患者进行积极治疗可改善预后，而再狭窄的微创治疗策略可取得满意结果。
