Mukhiya Gauri, Jiao Dechao, Han Xinwei, Zhou Xueliang, Pokhrel Gaurab
Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
J Clin Imaging Sci. 2023 Jan 24;13:5. doi: 10.25259/JCIS_130_2022. eCollection 2023.
Budd-Chiari syndrome is a complex clinical disorder of hepatic venous outflow obstruction, originating from the accessory hepatic vein (HV), large HV, and suprahepatic inferior vena cava (IVC). This disorder includes both HV and IVC obstructions and hepatopathy. This study aimed to conduct a systematic review of the survival rate and clinical success of different types of endovascular treatments for Budd-Chiari syndrome (BCS). All participant studies were retrieved from four databases and selected according to the eligibility criteria for systematic review of patients with BCS. The survival rate, clinical success of endovascular treatments in BCS, and survival rates at 1 and 5 years of publication year were calculated accordingly. A total of 3398 patients underwent an endovascular operation; among them, 93.6% showed clinical improvement after initial endovascular treatment. The median clinical success rates for recanalization, transjugular intrahepatic portosystemic shunt (TIPS), and combined procedures were 51%, 17.50%, and 52.50%, respectively. The median survival rates at 1 and 5 years were 51% and 51% for recanalization, 17.50% and 16% for TIPS, and 52.50% and 49.50% for combined treatment, respectively. Based on the year of publication, the median survival rates at 1 and 5 years were 23.50% and 22.50% before 2000, 41% and 41% in 2000‒2005, 35% and 35% in 2006‒2010, 51% and 48.50% in 2010‒2015, and 56% and 55.50% after 2015, respectively. Our findings indicate that the median survival rate at 1 and 5 years of recanalization treatment is higher than that of TIPS treatment, and recanalization provides better clinical improvement. The publication year findings strongly suggest progressive improvements in interventional endovascular therapy for BCS. Thus, interventional therapy restoring the physiologic hepatic venous outflow of the liver can be considered as the treatment of choice for patients with BCS which is a physiological modification procedure.
布加综合征是一种肝静脉流出道梗阻的复杂临床病症，起源于副肝静脉、大肝静脉和肝上下腔静脉。这种病症包括肝静脉和下腔静脉梗阻以及肝病。本研究旨在对布加综合征（BCS）不同类型血管内治疗的生存率和临床成功率进行系统评价。所有参与研究均从四个数据库中检索，并根据布加综合征患者系统评价的纳入标准进行选择。相应地计算了布加综合征血管内治疗的生存率、临床成功率以及发表年份的1年和5年生存率。共有3398例患者接受了血管内手术；其中，93.6%的患者在初次血管内治疗后临床症状改善。再通、经颈静脉肝内门体分流术（TIPS）和联合手术的临床成功率中位数分别为51%、17.50%和52.50%。再通、TIPS和联合治疗的1年和5年生存率中位数分别为51%和51%、17.50%和16%、52.50%和49.50%。根据发表年份，2000年前1年和5年生存率中位数分别为23.50%和22.50%，2000 - 2005年为41%和41%，2006 - 2010年为35%和35%，2010 - 2015年为51%和48.50%，2015年后为56%和55.50%。我们的数据表明，再通治疗1年和5年的生存率中位数高于TIPS治疗，且再通能带来更好的临床改善。发表年份的研究结果强烈提示布加综合征血管内介入治疗有逐步改善。因此，恢复肝脏生理性肝静脉流出道的介入治疗可被视为布加综合征患者的首选治疗方法，这是一种生理性改良手术。
