INTERVENTIONAL OR SEMI―INTERVENTIONAL TREATMENT FOR BUDD―CHIARI SYNDROME

摘要

Objective. Report the results of interventional or semi―interventional techniques for 173 patients with Budd―Chiari syndrome. Method. This group included 120 males and 53 females. The pathologic lesions composed of localized complete occlusion of inferior vena cava (IVC) (78), IVC stenosis (49), IVC membrane with a hole (37), membrane of hepatic vein (HV) (3), IVC thrombosis (4), IVC membrane with thrombosis (2) and IVC lesion with occlusion of HV (32). Treatment methods included that Ⅰ: Percutaneous transinferior vena cava angioplasty (PTA) (76); Ⅱ: IVC PTA with stent (59); Ⅲ: Percutaneous transhepatie vein recanalization (3); Ⅳ: IVC thrombolysis through a catheter (4); Ⅴ: Combined transcardiac and trans-femoral venous membranotomy and balloon dilation (22); Ⅵ: V and stent (17); Ⅶ: Stenting during radical surgery (3); Ⅷ: Additional operation after intervention (23). Results. The immediate technique success rate for intervention was 90.1%, for the semi ―intervention was 100%. The IVC pressure was reduced from 3 to 29 cmH2O. Complications occurred in 8 cases. The death rate was 2.9%. A follow―up study showed the recurrence rates were 14.5% in IVC PTA group, 1.7% in IVC PTA with stent, 18.2% in combined technique without stent and no recurrence was found in other groups. Conclusion. The PTA is the first choice for localized lesions. When elastic recoil occurs, immediate stenting is suggested. The semi―interventional approach is advised for PTA failure and more complicated cases. For those with both IVC lesion and occlusion of HV, the additional operation is needed after IVC intervention.