Treatment and Follow-Up Results of Inferior Vena Cava Blocking Budd-Chiari Syndrome with Thrombosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LIUShi-rui ¹ ,  LIZhen ¹ , DINGPeng-xu ¹ , ZHANGWen-guang ¹ , HUAZhao-hui ¹ , WUZhi-hui ¹ , HUANGBi-run ¹ , XUPeng ¹ , LIHao ¹ , WANGZhi-wei ¹ , WANGZhong-gao ^1,2,3

1. Department of Endovascular Surgery, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, Henan Province, China;
2. Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;
3. Department of Vascular Surgery, The Second Artillery General Hospital of Chinese People's Liberation Army, Beijing 100088, China;

Corresponding?author：

LIZhen, Email: lizhen1029@hotmail.com

Keywords：

Budd-Chiari syndrome; Inferior vena cava; Thrombosis; Interventional therapy; Thrombolytic

DOI：

10.7507/1007-9424.20140355

Video：

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Objective To investigate therapeutic method, curative effect, and prognosis of inferior vena cava (IVC) blocking Budd-Chiari syndrome (BCS) with thrombosis. Methods Clinical data of 128 BCS patients with membranous or short-segment occlusion of IVC as well as IVC thrombosis, who accepted interventional treatment in The Affiliated Hospital of Zhengzhou University from Apr. 2004 to Jun. 2012, were retrospectively analyzed. Comparison of the difference on effect indicators between predilation group and stent filter group was performed. Results Thereinto, 9 patients with fresh IVC thrombosis were treated with agitation thrombolysis (agitation thrombolysis group), 56 patients were predilated by small balloon (predilation group), for the rest 63 patients, a stent filter was deployed (stent filter group). Besides 1 stent filter fractured during the first removal attempt and had to be extracted surgically in the stent filter group (patients suffered with sent migration), in addition, the surgeries of other patients were technically successful without procedure-related complication. effect indicators were satisfactory in all patients, and there were no statistical differences between predilation group and stent filter group in dosage of urokinase, urokinase thrombolysis time, hospital stay, and incidence of complication (P > 0.05), but the cost of predilation group was lower than that of stent filter group (P < 0.01). All of the 128 patients were followed-up postoperation, and the duration range from 18 to 66 months with an average of 44.2 months. During the follow-up period, reobstruction of the IVC was observed in 13 patients without thrombosis, of which 1 patient in agitation thrombolysis group, 6 patients in predilation group, and 6 patients in stent filter group. There was no significant difference in recurrence rate between predilation group and stent filter group (P > 0.05). Patients with recurrence got re-expansion treatment, and no stenosis or thrombogenesis recurred. Conclusions Agitation thrombolysis for fresh IVC trombosis in the patients with BCS is safe and effective. Predilation and stent filter techniques are all effective in the treatment of BCS with chronic IVC thrombosis, but the former technique seems to be more economic.

Citation： LIUShi-rui, LIZhen, DINGPeng-xu, ZHANGWen-guang, HUAZhao-hui, WUZhi-hui, HUANGBi-run, XUPeng, LIHao, WANGZhi-wei, WANGZhong-gao. Treatment and Follow-Up Results of Inferior Vena Cava Blocking Budd-Chiari Syndrome with Thrombosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(12): 1495-1499. doi: 10.7507/1007-9424.20140355 Copy

1.	魏寧, 祖茂衡, 徐浩, 等.下腔靜脈阻塞端形態和破膜方法選擇的臨床研究[J].介入放射學雜志, 2008, 17(4):247-250.
2.	Beckett D, Olliff S.Interventional radiology in the management of Budd Chiari syndrome[J].Cardiovasc Intervent Radiol, 2008, 31(5):839-847.
3.	李春民, 卞策, 汪忠鎬.布-加綜合征的個體化手術治療[J].中國普外基礎與臨床雜志, 2010, 17(12):1306-1307.
4.	劉軍, 靳祖濤, 王占民, 等.布加氏綜合征外科治療78例報告[J].中國普外基礎與臨床雜志, 2000, 7(3):164-166.
5.	Wang YL, Ding PX, Li YD, et al.Comparative study of predila-tion with stent filter for Budd-Chiari syndrome with old IVC thrombosis:a nonrandomized prospective trial[J].Eur J Radiol, 2012, 81(6):1158-1164.
6.	Ding PX, Han XW, Wu G, et al.Outcome of a retrieval stent filter and 30 mm balloon dilator for patients with Budd-Chiari syndrome and chronic inferior vena cava thrombosis:a prospective pilot study[J].Clin Radiol, 2010, 65(8):629-635.
7.	Ding PX, Li YD, Han XW, et al.Agitation thrombolysis for fresh iatrogenic IVC thrombosis in patients with Budd-Chiari syndrome[J].J Vasc Surg, 2010, 52(3):782-784.
8.	Ren JZ, Huang GH, Ding PX, et al.Outcomes of thrombolysis with and without predilation of the inferior vena cava (IVC) in patients with Budd-Chiari syndrome with old IVC thrombosis[J].Vasc Endovascular Surg, 2013, 47(3):232-238.
9.	李震, 丁鵬緒, 汪忠鎬.布加綜合征的規范化治療[J/CD].中國血管外科雜志:電子版, 2013, 5(3):27-29.
10.	Sharma S, Texeira A, Texeira P, et al.Pharmacological thrombolysis in Budd Chiari syndrome:a single centre experience and review of the literature[J].J Hepatol, 2004, 40(1):172-180.
11.	Clark PJ, Slaughter RE, Radford DJ.Systemic thrombolysis for acute, severe Budd-Chiari syndrome[J].J Thromb Thrombo-lysis, 2012, 34(3):410-415.
12.	Robert LV, Mark WM.Deep venous thrombosis:catheter-directed thrombolytic therapy//Yao James ST, William HP.Practical vasc-ular surgery[M].Britain:Taylor Pub, 1998:366-367.
13.	D'amico M, Sammarco P, Pasta L.Thrombophilic genetic factors PAI-1, MTHFRC677T, V leiden 506Q, and prothrombin 20210A in noncirrhotic portal vein thrombosis and Budd-Chiari syndrome in a caucasian population[J].Int J Vasc Med, 2013, 2013:717480.
14.	徐浩, 祖茂衡, 顧玉明, 等.Budd-Chiari綜合征合并血栓形成的介入治療[J].中華放射學雜志, 2001, 35(1):24-27.
15.	樊云清.布加綜合征合并下腔靜脈血栓形成的彩色多普勒超聲診斷[J/CD].中華臨床醫師雜志:電子版, 2013, 7(15):7246-7248.
16.	仇煥, 徐浩, 徐新建, 等.布加綜合征合并下腔靜脈血栓形成的彩色多普勒超聲診斷[J].當代醫學, 2013, 318(19):5-7.
17.	李曉強, 吳允明, 周為民, 等.布加綜合征繼發下腔靜脈血栓的診治[J].中華普通外科雜志, 2002, 17(1):28-29.
18.	陳光文, 陳壢桃, 宋彬, 等.64層螺旋CT對布-加綜合征的診斷價值[J].中國普外基礎與臨床雜志, 2009, 16(9):763-767.
19.	Wang RH, Meng QY, Qu LF, et al.Treatment of Budd-Chiari syndrome with inferior vena cava thrombosis[J].Exp Ther Med, 2013, 5(4):1254-1258.
20.	Zhang QQ, Xu H, Zu MH, et al.Strategy and long-term outco-mes of endovascular treatment for Budd-Chiari syndrome complicated by inferior vena caval thrombosis[J].Eur J Vasc Endovasc Surg, 2014, 47(5):550-557.
21.	韓新巍, 丁鵬緒, 吳剛.布加綜合征下腔靜脈阻塞直徑30 mm大球囊擴張的可行性研究[J].介入放射學雜志, 2008, 17(4):243-246.
22.	王仲樸, 王茂強, 李志強, 等.Budd-Chiari綜合征合并下腔靜脈巨大血栓的介入性治療[J].中國醫學影像學雜志, 2000, 8(2):139-140.
23.	Ishiguchi T, Fukatsu H, Itoh S, et al.Budd-Chiari syndrome with long segmental inferior vena cava obstruction:treatment with thrombolysis, angioplasty, and intravascular stents[J].J Vasc Interv Radiol, 1992, 3(2):421-425.
24.	祖茂衡, 張慶橋, 顧玉明, 等.血管內支架在布-加綜合征遠期療效再評價[J].當代醫學:中國介入放射學, 2008, 2(3):206-208.

1. 魏寧, 祖茂衡, 徐浩, 等.下腔靜脈阻塞端形態和破膜方法選擇的臨床研究[J].介入放射學雜志, 2008, 17(4):247-250.
2. Beckett D, Olliff S.Interventional radiology in the management of Budd Chiari syndrome[J].Cardiovasc Intervent Radiol, 2008, 31(5):839-847.
3. 李春民, 卞策, 汪忠鎬.布-加綜合征的個體化手術治療[J].中國普外基礎與臨床雜志, 2010, 17(12):1306-1307.
4. 劉軍, 靳祖濤, 王占民, 等.布加氏綜合征外科治療78例報告[J].中國普外基礎與臨床雜志, 2000, 7(3):164-166.
5. Wang YL, Ding PX, Li YD, et al.Comparative study of predila-tion with stent filter for Budd-Chiari syndrome with old IVC thrombosis:a nonrandomized prospective trial[J].Eur J Radiol, 2012, 81(6):1158-1164.
6. Ding PX, Han XW, Wu G, et al.Outcome of a retrieval stent filter and 30 mm balloon dilator for patients with Budd-Chiari syndrome and chronic inferior vena cava thrombosis:a prospective pilot study[J].Clin Radiol, 2010, 65(8):629-635.
7. Ding PX, Li YD, Han XW, et al.Agitation thrombolysis for fresh iatrogenic IVC thrombosis in patients with Budd-Chiari syndrome[J].J Vasc Surg, 2010, 52(3):782-784.
8. Ren JZ, Huang GH, Ding PX, et al.Outcomes of thrombolysis with and without predilation of the inferior vena cava (IVC) in patients with Budd-Chiari syndrome with old IVC thrombosis[J].Vasc Endovascular Surg, 2013, 47(3):232-238.
9. 李震, 丁鵬緒, 汪忠鎬.布加綜合征的規范化治療[J/CD].中國血管外科雜志:電子版, 2013, 5(3):27-29.
10. Sharma S, Texeira A, Texeira P, et al.Pharmacological thrombolysis in Budd Chiari syndrome:a single centre experience and review of the literature[J].J Hepatol, 2004, 40(1):172-180.
11. Clark PJ, Slaughter RE, Radford DJ.Systemic thrombolysis for acute, severe Budd-Chiari syndrome[J].J Thromb Thrombo-lysis, 2012, 34(3):410-415.
12. Robert LV, Mark WM.Deep venous thrombosis:catheter-directed thrombolytic therapy//Yao James ST, William HP.Practical vasc-ular surgery[M].Britain:Taylor Pub, 1998:366-367.
13. D'amico M, Sammarco P, Pasta L.Thrombophilic genetic factors PAI-1, MTHFRC677T, V leiden 506Q, and prothrombin 20210A in noncirrhotic portal vein thrombosis and Budd-Chiari syndrome in a caucasian population[J].Int J Vasc Med, 2013, 2013:717480.
14. 徐浩, 祖茂衡, 顧玉明, 等.Budd-Chiari綜合征合并血栓形成的介入治療[J].中華放射學雜志, 2001, 35(1):24-27.
15. 樊云清.布加綜合征合并下腔靜脈血栓形成的彩色多普勒超聲診斷[J/CD].中華臨床醫師雜志:電子版, 2013, 7(15):7246-7248.
16. 仇煥, 徐浩, 徐新建, 等.布加綜合征合并下腔靜脈血栓形成的彩色多普勒超聲診斷[J].當代醫學, 2013, 318(19):5-7.
17. 李曉強, 吳允明, 周為民, 等.布加綜合征繼發下腔靜脈血栓的診治[J].中華普通外科雜志, 2002, 17(1):28-29.
18. 陳光文, 陳壢桃, 宋彬, 等.64層螺旋CT對布-加綜合征的診斷價值[J].中國普外基礎與臨床雜志, 2009, 16(9):763-767.
19. Wang RH, Meng QY, Qu LF, et al.Treatment of Budd-Chiari syndrome with inferior vena cava thrombosis[J].Exp Ther Med, 2013, 5(4):1254-1258.
20. Zhang QQ, Xu H, Zu MH, et al.Strategy and long-term outco-mes of endovascular treatment for Budd-Chiari syndrome complicated by inferior vena caval thrombosis[J].Eur J Vasc Endovasc Surg, 2014, 47(5):550-557.
21. 韓新巍, 丁鵬緒, 吳剛.布加綜合征下腔靜脈阻塞直徑30 mm大球囊擴張的可行性研究[J].介入放射學雜志, 2008, 17(4):243-246.
22. 王仲樸, 王茂強, 李志強, 等.Budd-Chiari綜合征合并下腔靜脈巨大血栓的介入性治療[J].中國醫學影像學雜志, 2000, 8(2):139-140.
23. Ishiguchi T, Fukatsu H, Itoh S, et al.Budd-Chiari syndrome with long segmental inferior vena cava obstruction:treatment with thrombolysis, angioplasty, and intravascular stents[J].J Vasc Interv Radiol, 1992, 3(2):421-425.
24. 祖茂衡, 張慶橋, 顧玉明, 等.血管內支架在布-加綜合征遠期療效再評價[J].當代醫學:中國介入放射學, 2008, 2(3):206-208.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Treatment and Follow-Up Results of Inferior Vena Cava Blocking Budd-Chiari Syndrome with Thrombosis

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