ObjectiveTo evaluate the applicability and the long-term outcomes of percutaneous transluminal balloon angioplasty (PTBA) in the management of Budd-Chiari syndrome (BCS) secondary to hepatic venous obstruction. MethodsClinical data of 94 patients with BCS secondary to hepatic venous obstruction who underwent PTBA of the hepatic vein from Jan. 2005 to Dec. 2013 in The First Affiliated Hospital of Zhengzhou University were analyzed retrospectively. ResultsPTBA were technically successful in 93 of the 94 patients (98.94%). Ninety-one of the 93 patients (97.85%) were treated with PTBA alone and 2 patients (2.15%) were treated with PTBA and stent. One patient with primary hepatocellular carcinoma (HCC) underwent resection of liver cancer after interventional therapy. Hepatic venous pressure value of 93 patients was significantly decreased after balloon interventional procedures. Symptoms were significantly improved in the 93 patients who had successful PTBA. Procedure-related complications occurred in 6 of the 93 patients (6.38%), and 1 patient (1.06%) died in 2 months after operation because of intra-abdominal bleeding. Two patients lost during follow-up with a follow-up loss rate of 2.15% (2/93), and the 91 patients were followed-up for 1-96 months [(49.72±28.60) months]. HCC occurred in 3 patients during follow-up period. Restenosis of targeted hepatic vein developed in 8 patients (11 times), and the overall recurrence rate was 11.83% (11/93). One patient of them underwent surgical operation, the remaining 7 patients underwent PTBA successfully. The 1-, 2-, 3-, and 5-year primary patency rates were 97.47% (77/79), 94.20% (65/69), 91.67% (55/60), and 91.67% (33/36), respectively. The 1-, 2-, 3-, and 5-year secondary patency rates were 98.73% (78/79), 98.55% (68/69), 98.33% (59/60), and 97.22% (35/36), respectively. ConclusionsPTBA is a safe and effective treatment for BCS with the hepatic vein obstruction and had good mild-term outcomes. The liver function of the patients improved after treatment, with few patients died from HCC caused by hepatic cirrhosis, so we must pay attention on it, as well as the targeted hepatic vein.
Objective To investigate the feasibility and efficacy of transcatheter directed thrombolysis （TDT） approach in treatment for deep venous thrombosis （DVT） of lower limbs and as compared with trans-dorsal pedis vein thrombolysis （TPVT） approach. Methods The clinical data of 437 patients with acute DVT （184 males and 253 females） at the age of （43±12） years （range 19-76 years） from July 2008 to January 2012 in the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively. Patients in the group TDT received TDT were 293 cases， 32 inferior vena cava filters were implanted. Patients in the group TPVT received TPVT were 65 cases， 4 inferior vena cava filters were implanted. Results The resolution time of thrombus in the group TDT was shorter than that in the group TPVT （6 d versus 9 d， P＜0.05）. The circumference difference of leg or upper leg before and after treatment in the TDT group was significantly greater than that in the TPVT group （P＜0.05）. The rate of venous patency was （65.2±15.4）% and preservation rate of valvular function was （78.2±12.6）% in the group TDT， and which was （63.8±16.3）% and （91.1±10.7）% in the group TPVT， respectively. The differences of venous patency rate was not statistically significant（P＞0.05） between two groups， but the prevervation rate of valvular function was significant difference （P＜0.05） .Hematomas in 3 cases and gross hematuria in 4 cases were observed， and displacement of inferior vena cava filter occurred in 1 patient in the group TDT. The gums bleed or gross hematuria in 5 cases were observed in the group TPVT. Conclusions Both TDT and TPVT can effectively relieve symptoms. TDT can shorten the course of disease， but itincreases functional damage of the deep vein valvular.
ObjectiveTo investigate therapeutic method, curative effect, and prognosis of inferior vena cava (IVC) blocking Budd-Chiari syndrome (BCS) with thrombosis. MethodsClinical 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. ResultsThereinto, 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. ConclusionsAgitation 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.