Evaluation of outcome from endovascular therapy for Budd-Chiari syndrome: a systematic review and meta-analysis

Abstract

This study was performed to evaluate the outcome of endovascular intervention therapy for Budd-Chiari syndrome (BCS) and compare recanalization, transjugular intrahepatic portosystemic shunt (TIPS)/direct intrahepatic portosystemic shunt (DIPS), and combined procedure treatment. For the meta-analysis, 71 studies were identified by searching four databases. The individual studies' samples were used to calculate a confidence interval (CI 95%), and data were pooled using a fixed-effect model and random effect model. The pooled measure and an equal-weighted average rate were calculated in all participant studies. Heterogeneity between the studies was assessed with I², and T² tests, and publication bias was estimated using Egger's regression test. A total of 4,407 BCS patients had undergone an endovascular intervention procedure. The pooled results were 98.9% (95% CI 97.8‒98.9%) for a technical success operation, and 96.9% (95% CI 94.9‒98.9%) for a clinical success operation. The re-intervention rate after the initial intervention procedure was 18.9% (95% CI 14.7‒22.9%), and the survival rates at 1 and 5 years after the initial intervention procedure were 98.9% (95% CI 96.8‒98.9%) and 94.9% (95% CI 92.9‒96.9%), respectively. Patients receiving recanalization treatment (98%) had a better prognosis than those with a combined procedure (95.6%) and TIPS/DIPS treatment (94.5%). The systematic review and meta-analysis further solidify the role of endovascular intervention treatment in BCS as safe and effective. It maintains high technical and clinical success and long-term survival rates. The recanalization treatment had a better prognosis and outcome than the combined procedures and TIPS/DIPS treatment.

Figure 1

PRISMA flowchart of studies selection.

Figure 2

The Forest plot of technically success rate of intervention procedures in BCS patients, horizontal lines indicate 95% confidence intervals, square size indicates study specific statistical weight, and diamond indicates the overall treatment effect with 95% confidence intervals.

Figure 3

The Forest plot of clinically success rate after intervention treatment in BCS patients, horizontal lines indicate 95% confidence intervals, square size indicates study specific statistical weigh, and diamond indicates the overall treatment effect with 95% confidence intervals.

Figure 4

The Forest plot of the re-intervention rate after initial intervention procedures in BCS patients, horizontal lines indicate 95% confidence intervals, square size indicates study specific statistical weigh, and diamond indicates the overall treatment effect with 95% confidence intervals.

Figure 5

The Forest plot of the survival rate at 1 year after initial intervention procedures in BCS patients, horizontal lines indicate 95% confidence intervals, square size indicates study specific statistical weigh, and diamond indicates the overall treatment effect with 95% confidence intervals.

Figure 6

The Forest plot of the survival rate at 5 years after initial intervention procedures in BCS patients, horizontal lines indicate 95% confidence intervals, square size indicates study specific statistical weigh, and diamond indicates the overall treatment effect with 95% confidence intervals.