Excellent long-term outcomes of endovascular treatment in budd-chiari syndrome with hepatic veins involvement: A STROBE-compliant article

Abstract

This study aimed to evaluate the long-term efficacy and safety of percutaneous transhepatic balloon angioplasty (PTBA) and transjugular intrahepatic portosystemic stent-shunt (TIPSS) in the treatment of Budd-Chiari syndrome (BCS) with hepatic veins involvement. Between June 2008 and August 2016, a total of 60 BCS patients with hepatic vein involvement in our department were enrolled in this study. Thirty-three cases underwent hepatic vein balloon angioplasty in PTBA Group and 27 cases underwent TIPSS. Data were retrospectively collected, and follow-up observations were performed. TIPSS Group showed significantly higher thrombotic/segmental obstruction and peripheral stenosis/obstruction compared with PTBA Group. The success rates were 93.9% and 100.0% in PTBA Group and TIPSS Group, respectively. The mean portal vein pressure decreased significantly after stenting. Except for 1 patient died from repeated hemorrhage, other sever complications had not been observed in both group. Twenty-six patients and 21 patients were clinically cured in PTBA Group and TIPSS Group, respectively. The primary patency rates were 89.7%, 79.3%, and 79.3% for short-term, mid-term and longterm in PTBA Group, which were significantly higher than TIPSS Group for long-term follow up. The second patency rates were 100.0%, 96.6% and 96.6% for short-term, mid-term and long-term in PTBA Group, which were similar to TIPSS Group (P = 1.0000). In conclusion, PTBA and TIPSS are safe and effective in the treatment of BCS with hepatic veins involvement, with an excellent long-term patency rate of hepatic vein and TIPSS shunt. TIPSS can be used to treat patients with all 3 hepatic veins lesion and failure PTBA.

Figure 1

Balloon angioplasty was performed for hepatic vein and IVC. (a) The segmental obstruction in hepatic vein was shown via angiography. (b) PTBA performed by using a balloon of 14 mm in diameter. (c) Patency of hepatic vein was confirmed by second angiography. (d) Proximal segment occlusion of IVC was shown via angiography. (e) A balloon of 26 mm in diameter was used for dilation. (f) Second angiography showed the patency of IVC. IVC = inferior vena cava, PTBA = percutaneous transhepatic balloon angioplasty.

Figure 2

TIPSS procedure. (a) Hepatic vein was catheterized. (b) The main portal vein was punctured by the Rupss-100 puncture device. (c) The esophageal and gastric varices should be embolized. (d) A balloon catheter of 6 mm diameter and 40 mm length was used to dilate the shunt. (e) A covered metal stents of 8 mm diameter and 60 mm length were implanted, and second angiography performed to show the patency of shunt. (f) Post-dilation performed with a balloon catheter of 10 mm diameter.

Figure 3

CTA and color Doppler ultrasonograpy test after procedure. The stent shunt and stent in IVC were shown by CTA in coronal (a) and sagittal position (b). The color Doppler ultrasonograpy was used to exam the patency of IVC (c) and stent shunt (d) during follow up. CTA = computerized tomography angiography, IVC = inferior vena cava.

Figure 4

Patency rate of hepatic vein and shunt. PTBA Group showed a higher primary patency rate of hepatic vein than that of shunt in TIPSS Group. There was no significant difference of second patency between 2 groups. PTBA = percutaneous transhepatic balloon angioplasty, TIPSS = transjugular intrahepatic portosystemic stent-shunt.