An update on the diagnosis and management of Budd–Chiari syndrome

MacNicholas, Ross; Olliff, Simon; Elias, Elwyn; Tripathi, Dhiraj

doi:10.1586/egh.12.56

Cited by 37 publications

(45 citation statements)

References 78 publications

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“…From the viewpoint of patient costs, balloon dilation alone minimizes the operative cost and procedure complexity, making it a more appropriate first-choice endovascular treatment for patients with MOVC. Moreover, the complications of long-term indwelling stents, such as stent fracture, migration to the heart, and occlusion of the ostium of the hepatic or accessory hepatic veins, 26,27 serve as a reminder that caution should be used when choosing and placing stents in BCS patients with MOVC.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Long-Term Outcomes of Endovascular Management for Membranous and Segmental Inferior Vena Cava Obstruction in Patients With Primary Budd–Chiari Syndrome

Huang

Shen

Zhang

et al. 2016

Circ: Cardiovascular Interventions

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Budd-Chiari syndrome (BCS) is a vascular disorder characterized by obstruction of hepatic venous outflow from the hepatic venules to the entrance of the inferior vena cava (IVC) into the right atrium.1,2 In contrast to Western countries, IVC obstruction is a common cause of BCS in China. This disorder is classified into membranous obstruction of IVC (MOVC; obstructed segment of IVC is ≤1.0 cm) and segmental obstruction of IVC (SOVC; obstructed segment of IVC is >1.0 cm). [3][4][5][6] Treatments for this disorder include medical management, surgical operation, and endovascular intervention. Medical management alone has a limited ability to arrest progression of the disease, as reported in a study of 237 patients, where 72% failed to show a significant survival benefit.7 Surgery has been associated with high mortality rates (≤50%) and complicated by dysfunction rates as high as 32%. 8,9 Endovascular intervention has proven more effective than medical management and is associated with lower rates of mortality than open surgical procedures. [10][11][12] It has become the primary treatment of choice for BCS management in China because of its minimal invasiveness and good efficacy.Although several studies reported the safety and efficacy of endovascular intervention for the management of primary BCS caused by IVC obstruction, [13][14][15][16] few studies compared long-term outcomes of endovascular management between MOVC and SOVC patients. Moreover, there are still controversies about the optimal endovascular strategy for these conditions according to previous reports. 5,[13][14][15][16] Two previous studies showed that balloon dilation alone was sufficient in most BCS patients with MOVC and SOVC, and <3% had recurrence in 3 to 8 years of follow-up.5,13 However, otherBackground-Endovascular management is important for the treatment of primary Budd-Chiari syndrome, which is caused by inferior vena cava (IVC) obstruction. The aims of this study were to compare long-term outcomes of endovascular management for primary Budd-Chiari syndrome patients with membranous obstruction of IVC (MOVC) and segmental obstruction of IVC (SOVC) and explore the optimal endovascular strategy for these conditions. Methods and Results-Clinical data of 265 patients with Budd-Chiari syndrome who received endovascular management (MOVC group, n=136; SOVC group, n = 129) were retrospectively reviewed. Cumulative IVC patency rates were generated by the Kaplan-Meier method and compared by log-rank test. In total, 245 patients were followed up from 3 to 72 months after treatment. The difference of long-term outcomes of balloon dilation alone versus stent placement was not significant in each group. The overall cumulative 1-, 3-, and 5-year primary IVC patency rates were 98.3%, 90.7%, and 83.8% in the MOVC group and 88.3%, 79.1%, and 67.9% in the SOVC group (P=0.007), respectively. The long-term IVC patency rates were lower in the SOVC group than in the MOVC group for patients who underwent balloon dilation alone (P=0.001) and did not significantly d...

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Section: Discussionmentioning

confidence: 99%

Comparison of Long-Term Outcomes of Endovascular Management for Membranous and Segmental Inferior Vena Cava Obstruction in Patients With Primary Budd–Chiari Syndrome

Huang

Shen

Zhang

et al. 2016

Circ: Cardiovascular Interventions

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“…3,[5][6][7] Idiopathic forms, combined membranous occlusion of the inferior vena cava and the hepatic veins, and higher incidence of hepatocellular carcinoma are typical features of most Chinese BCS patients. [5][6][7][8] In addition, selection of treatment modalities for BCS patients is different between China and Western countries.…”

Section: -7mentioning

confidence: 99%

“…[5][6][7][8] In addition, selection of treatment modalities for BCS patients is different between China and Western countries. 3,9,10 Chinese patients with BCS are usually treated using percutaneous transluminal angioplasty and have a similar good clinical outcome to Western patients, who often are treated with transjugular intrahepatic portosystemic shunt plus long-term anticoagulants. 9,10 As an update, there have been around 3000 articles on BCS in China, but the real prevalence might be higher than estimated due to increased awareness and improved diagnostic methods in China.…”

Section: -7mentioning

confidence: 99%

“…2 In a recent meta-analysis of observational studies, the presence and severity of NAFLD at baseline were associated with an increased incidence and stage of CKD, independently of traditional risk factors. 3 CKD might be a mediator or a marker of an increased CVD risk in NAFLD. Thus, we explored the impact of the two polymorphisms in PNPLA3 and TM6SF2 genes, both modulating liver disease severity and CVD risk in NAFLD, on renal function in a cohort of 202 nonobese nondiabetic subjects (61 with biopsyproven noncirrhotic NAFLD; Table 1).…”

Section: Jian-gaomentioning

confidence: 99%

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Autosis occurs in the liver of patients with severe anorexia nervosa

et al. 2015

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“…Budd-Chiari syndrome (BCS) is caused by hepatic venous obstruction and/or inferior vena cava obstructive lesions above the junction, and belongs to a type of posthepatic portal hypertension characterized by portal hypertension and/or inferior vena cava hypertension (MacNicholas et al, 2012). In China, BCS is the most common type of membranous obstruction of the inferior vena cava (MOVC) whose development is characterized by septum formation above the junction of the inferior vena cava and hepatic veins with vascular endothelial tissues on both the upper and lower surfaces of the septum.…”

Section: Introductionmentioning

confidence: 99%