Endovascular Management Of Budd-Chiari Syndrome With Inferior Vena Cava Thrombosis: A 14-year Single Center Retrospective Report Of 55 Patients.

Purpose: To evaluate the safety and efficacy of balloon dilation and stent placement combined with thrombus aspiration and thrombolysis to treat patients with Budd-Chiari Syndrome(BCS) with inferior vena cava(IVC) thrombosis.Materials and Methods: Charts from 55 consecutive primary BCS patients with IVC thrombosis treated between April 2000 and August 2014 were retrospectively analyzed. Transcatheter aspiration and percutaneous recanalization were attempted in all patients, and stents were placed if recanalization was successful. Catheter-directed thrombolysis using urokinase was performed when significant clot burden was present after recanalization.Results: Technically successful IVC recanalization was achieved in 53 of 55 patients(96.4%). The technical failures in two patients were due to a long segment of IVC obstruction and a widely fibrotic IVC, respectively. Forty-seven of 53 patients(88.7%) had a stent placed. Thrombus was successfully aspirated in 23 patients, and thrombolytic treatment was administered to 13 patients. Median follow-up was 58 months(range, 8-180 months). No symptomatic pulmonary embolism occurred. Eight patients experienced re-occlusion, and 6 of these patients(75%) underwent repeat recanalization by balloon dilation with or without stents. Cumulative 1-, 5-, and 10-year primary patency rates were 94%, 89%, and 66%, respectively. Alanine transaminase(ALT) and alkaline phosphatase(ALP) levelsbefore endovascular treatment were independent risk factors for reocclusion. Cumulative 1-, 5-, and 10-year survival rates were 90%, 86%, and 86%, respectively. Child-Pugh score and reocclusion were independent predictors of survival.Conclusion: Percutaneous vena caval balloon dilation and stent placement with thrombus aspiration and thrombolytic therapy is safe and effective for treatment of BCS patients with IVC thrombosis.