Restenosis after recanalization for Budd-Chiari syndrome: Management and long-term results of 60 patients

Wei Zhang; Yu-Long Tian; Qiao-Zheng Wang; Xiao-Wei Chen; Qi-Yang Li; Jin-Hang Han; Xu-Dong Chen; Ke Xu

doi:10.12998/wjcc.v8.i14.2930

Restenosis after recanalization for Budd-Chiari syndrome: Management and long-term results of 60 patients

World J Clin Cases. 2020 Jul 26;8(14):2930-2941. doi: 10.12998/wjcc.v8.i14.2930.

Authors

Wei Zhang¹, Yu-Long Tian², Qiao-Zheng Wang², Xiao-Wei Chen², Qi-Yang Li¹, Jin-Hang Han¹, Xu-Dong Chen¹, Ke Xu³

Affiliations

¹ Department of Interventional Radiology, Shenzhen People's Hospital, the Second Affiliated Hospital of Jinan University, Shenzhen 518020, Guangdong Province, China.
² Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China.
³ Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China. kexu@vip.sina.com.

Abstract

Background: Budd-Chiari syndrome is defined as hepatic venous outflow tract obstruction. For Asian Budd-Chiari syndrome patients, the major treatment modality is recanalization (percutaneous transluminal angioplasty with or without stent implantation). The cumulative 1-, 5-, and 10-year primary patency rates and survival rates are reported to be excellent or satisfactory, but the long-term outcome of patients with restenosis (the most common complication after recanalization) is unknown.

Aim: To explore the treatment strategy for restenosis in patients with Budd-Chiari syndrome after interventional therapy and to evaluate the long-term follow-up results.

Methods: The clinical data and follow-up results of 60 patients with restenosis after interventional therapy from November 1983 to December 2013 were retrospectively analyzed.

Results: Sixty patients with restenosis were retrospectively divided into a percutaneous transluminal angioplasty (PTA) group (40 patients) and a PTA + stent group (20 patients) according to the primary recanalization method. For the patients with restenosis in the PTA group, 13 refused treatment, and 27 received further treatment; among these patients, five had a second restenosis, two had a third restenosis, and one had a fourth restenosis. For the patients with restenosis in the PTA + stent group, nine refused treatment, ten received PTA alone, and the other received PTA + stent implantation. Among the patients who received further treatment, five had a second restenosis, three had a third restenosis, and one had a fourth restenosis. The 1-, 5-, 10-, 20-, and 25-year cumulative survival rates of the 38 patients who received further treatment after restenosis were 100%, 78.3%, 78.3%, 70.5%, and 70.5%, respectively; however, for the 22 patients who refused treatment, the survival rates were 72.7%, 45.9%, 30.6%, 10.2%, and unavailable, respectively (P < 0.001).

Conclusion: Long-term follow-up after interventional therapy is very important. Active treatment for patients with restenosis can improve prognosis, and minimally invasive treatment strategies for restenosis allows to obtain satisfactory results.

Keywords: Budd-Chiari syndrome; Long-term follow-up; Restenosis; Treatment strategy.