Catheter-directed thrombolytic therapy combined with angioplasty for hepatic vein obstruction in Budd-Chiari syndrome complicated by thrombosis

Abstract

The aim of this study was to assess the efficacy and safety of catheter-directed thrombolysis combined with angioplasty in the treatment of hepatic vein obstruction in Budd-Chiari syndrome (BCS) complicated by thrombosis. In 14 cases of BCS, the patients with hepatic vein obstruction complicated by thrombosis who underwent catheter-directed urokinase thrombolysis, balloon dilatation and/or stent placement were followed up with an ultrasound examination of the liver. Among the 13 cases of successful treatment, one hepatic vein was recanalized in 12 patients (right hepatic vein, seven cases; left hepatic vein, three cases; middle hepatic vein, one case and accessory hepatic vein, one case) and two hepatic veins (right and left) were recanalized in one patient without serious complications, such as bleeding and pulmonary embolism. There was one patient in whom the treatment was unsuccessful. During an average follow-up period of 24.8±19.6 months, hepatic vein restenosis was observed in one patient in the sixth month after opperation; however, a successful result was obtained following a second balloon dilatation. The remaining 12 patients did not demonstrate any recurrence of restenosis or thrombosis. Catheter-directed thrombolysis combined with angioplasty was observed to be an effective and safe method for the treatment of hepatic vein obstruction in BCS complicated by thrombosis.

Thrombolysis based on magnetically-controlled surface-functionalized Fe3O4nanoparticle

“…An amount of 10.32 mg thrombus was found to be removed in 180 s. Compared to existing medical procedures for thrombolysis, the most common uses direct hemolytic agent infusion into the vein or artery. [11][12][13][14] The time of treatment can last for a few hours to days or even longer because the system relies on the agent being aided by the natural blood flow toward the occlusion. However, the presence of such occlusions can slow or even stop the blood circulation.…”

Outcomes of endovascular interventional therapy for primary Budd‑Chiari syndrome caused by hepatic venous obstruction

“…The transjugular approach has a high success rate, as the angle between the HV and the proximal IVC is usually relatively large, and the guide wire may easily access the HV via the jugular vein ( 4 , 17 , 21 ). If recanalization of the HV via the transjugular fails, the femoral vein may be used, but this is technically more difficult.…”

“…If all 3 major HVs are obstructed, it may be attempted to reopen the right HV first. If the diameter and drainage range of the HVs selected for recanalization are sufficiently large, reperfusion may be effective for relieving the portal hypertension ( 4 , 17 , 21 ). However, if the diameter of the HV is small, multiple HVs may be considered for recanalization during the same procedure ( 4 , 7 , 11 , 13 , 18 , 21 ).…”

“…Therefore, it is indicated that the transmembrane pressure difference is a reliable predictor of successful treatment, although specific indicators require to be verified ( 7 ). The choice of treatment depends on the location and extent of the obstruction, as well as the characteristics of the lesion ( 3 , 4 , 8 , 13 , 17 , 21 , 22 ). For thrombus-free obstruction, balloon angioplasty has been recommended, with the diameter of the selected balloon based on the diameter of the vessel being treated, typically 12–20 mm ( 23 ).…”

“…While endovascular interventional therapy for patients with BCS due to IVC obstruction has been standardized ( 15 , 16 ), it is still evolving for patients with BCS due to HVO. Western countries advocate the use of TIPS as a primary treatment for HVO in BCS ( 3 , 9 , 10 ), while Chinese physicians prefer recanalization ( 4 , 13 , 17 ). The present retrospective study assessed the efficacy of recanalization in 69 consecutive patients with BCS due to HVO.…”