Interventional Therapy Of Complex Budd-Chiari Syndrome

Objective To explore the imaging diagnosis and the best therapy for the treatment of complex Budd-Chiari Syndrome (BCS). Methods The imaging diagnosis and interventional therapy result of 80 cases with complex Budd-Chiari syndrome was analyzed retrospectively. Preoperatively use Ultrasound and angiography to detect the modality of main and accessory hepatic vein (HV). Acquire the hemodynamics change of inferior vena cava (IVC) and HV. Find the outlet, diameter, thrombsis, compensatory circulation with systemic circulation of IVC and HV. Identify the 3-D modality between HV and IVC. CT and MRI be used to supplementary imaging diagnosis. According the imaging results to categorize. 80 cases complex Budd-Chiari syndrome were divided into 5 types:①TypeⅠ21 cases (26.3%);②TypeⅡ2 cases (2.5%);③TypeⅢ30 cases (37.5%);④TypeⅣ7 cases (8.8%) ;⑤TypeⅤ20 cases (25.0%). Therapeutic methods included that: percutaneous transinferior vena cava membranotomy and occlusion dilatation (PTA); endovascular stent (ES); percutaneous transhepatic vein recanalization; IVC thrombolysis through a catheter and transjugular intrahepatic portasystemic stent shunt (TIPSS). Deploy the routine anti-infection and anticoagulation methods postoperatively. Follow-up and survey the complications and clinical symptoms and signs to evaluate therapeutic effect. Results Technical success was achieved in 79 cases (98.8%), except 1 case small amounts hemorrhage in abdominal cavity, without serious complications. The compensatory circulation was divided ino 3 types and 8 subtypes. The pressure gradient in IVC dropped from 31.2±10.1 cmH2O to 5.8±3.4cmH2O(p<0.05)and in HV from 39.0±14.2 cmH2O to 6.8±1.3 cmH2O(p<0.05). Then the right atrium pressure advanced from 3.0±0.9 cmH2O to 12.2±2.9 cmH2O(p<0.05). The clinical symptoms of occlusion were disappeared within 3 to 7 days. Follow-up 3months to 7 years, 5 cases were palindromia (6.3%) and secondly interventional therapy succeeded. Conclusion Synthesize imaging results of Ultrasound,CT,MRI and angiography to categorize and identify the complex pathological modality change of BCS is essential. The first-choice diagnosis method and Gold standard of BCS were Ultrasound and angiography respectively. Interventional therapy of BCS should completely dilate the occlusion of IVC and HV. Advocate to selectively deploy appropriate kinds of interventional therapeutic techniques.