个体化介入治疗原发性布加综合征合并下腔静脉血栓形成的长期疗效。
Long-term outcomes of individualized interventional treatment for primary Budd-Chiari syndrome complicated by inferior vena cava thrombosis.
机构信息
School of Medicine, Nankai University, Tianjin.
Department of Interventional Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, P.R. China.
出版信息
Eur J Gastroenterol Hepatol. 2021 Dec 1;33(1S Suppl 1):e642-e649. doi: 10.1097/MEG.0000000000002191.
BACKGROUND
Various endovascular treatments were used for Budd-Chiari syndrome (BCS) patients complicated by inferior vena cava (IVC) thrombosis. The best treatment for this disease remains unknown. To evaluate safety and efficacy of individualized interventional treatment for primary BCS with IVC thrombosis.
METHODS
Forty-seven consecutive patients with IVC involvement BCS complicated by IVC thrombosis between June 2002 and August 2020 were analyzed retrospectively. They were treated with individualized interventional treatment based on thrombus type and size. Agitation thrombolysis, transcatheter thrombus aspiration, and catheter-directed thrombolysis were initially used for fresh and mixed thrombus (n = 20), then stent implantation for compressing thrombus and IVC recanalization were performed according to the size of the residual thrombus. Direct balloon angioplasty was used for old thrombus (n = 27).
RESULTS
Median follow-up duration was 109 (5-223) months (average 114 ± 60 months). IVC recanalization were attempted in forty patients and failed in one. The technical successful rate of IVC recanalization was 97.5%. Thrombus was completely lysed in eight patients with fresh thrombus (40%, 8/20), partially lysed in 11 patients with mixed thrombus (55%, 11/20), and no response in one patient with mixed thrombus (5%, 1/20). Thrombolytic-related complications occurred in one patient (5%, 1/20). No symptomatic pulmonary embolism occurred. Among the 11 patients with thrombus partially lysed, five patients underwent stent implantation for compressing thrombus, six patients received conservative treatment. Old thrombus was completely lysed in 15 patients (55.6%, 15/27) during follow-up. Restenosis occurred in six patients (15.4%, 6/39). Primary patency rates at 1, 5, 10 and 15 years were 92, 92, 86 and 80%, respectively. Hepatocellular carcinoma (HCC) occurred in four patients (8.5%, 4/47). One patient died of HCC. The survival rate was 97.9%.
CONCLUSIONS
The individualized interventional treatment based on thrombus type and size for primary BCS complicated by IVC thrombosis patients is safe and effective with long-term patency and survival.
背景
各种血管内治疗方法已用于伴下腔静脉（IVC）血栓形成的布加氏综合征（BCS）患者。该疾病的最佳治疗方法仍不清楚。本研究旨在评估基于血栓类型和大小的个体化介入治疗原发性布加氏综合征合并 IVC 血栓形成的安全性和疗效。
方法
回顾性分析 2002 年 6 月至 2020 年 8 月期间连续 47 例 IVC 受累 BCS 合并 IVC 血栓形成患者。根据血栓类型和大小，采用个体化介入治疗。新鲜和混合血栓（n=20）采用机械性溶栓、经导管血栓抽吸和导管定向溶栓治疗，根据残留血栓大小行支架植入以压迫血栓并开通 IVC。陈旧性血栓（n=27）采用直接球囊血管成形术。
结果
中位随访时间为 109（5-223）个月（平均 114±60 个月）。40 例患者尝试开通 IVC，1 例失败。IVC 再通技术成功率为 97.5%。20 例新鲜血栓中，8 例（40%，8/20）血栓完全溶解，11 例（55%，11/20）混合血栓部分溶解，1 例混合血栓无反应（5%，1/20）。溶栓相关并发症 1 例（5%，1/20）。无症状性肺栓塞发生。11 例部分溶解的血栓中，5 例行支架植入压迫血栓，6 例保守治疗。15 例陈旧性血栓（55.6%，15/27）在随访期间完全溶解。6 例（15.4%，6/39）发生再狭窄。1、5、10、15 年的原发性通畅率分别为 92%、92%、86%和 80%。47 例患者中 4 例（8.5%，4/47）发生肝细胞癌（HCC）。1 例 HCC 死亡。生存率为 97.9%。
结论
根据血栓类型和大小对原发性布加氏综合征合并 IVC 血栓形成患者进行个体化介入治疗是安全有效的，具有长期通畅率和生存率。
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