Applicability of different endovascular methods for treatment of refractory Budd-Chiari syndrome.

The study's objective was to evaluate the applicability of different endovascular methods for treatment of refractory type of Budd-Chiari syndrome (BCS) under specific scenarios frequently encountered in patients. The treatment methods were evaluated in 197 patients with the following four types of refractory BCS: lesions of the inferior vena cava (IVC) including a special shape diaphragm (e.g., a knife- or a vertically shaped diaphragm, etc.), occlusion of the long segment of IVC, IVC obstruction combined with thrombosis, and occlusion of the hepatic vein. The choice of endovascular treatment depended on the degree of difficulty to puncture the membrane after spatial orientation. There was a need to adjust the curvature of the device to fit the natural angle of IVC. When IVC lesions were combined with thrombosis, the treatment was adjusted depending on the freshness of the thrombus. Different routes were used to rupture the membrane and expand the lesion. The majority of patients recovered without complications. The few complications observed were the following: 1 case of death due to a postoperative stress ulcer, 1 case of a successfully treated pericardial tamponade, 1 case of stent migration, and 3 cases of failure to stent and re-occlusion that occurred in the follow-up period. To conclude, BCS is preferably treated via endovascular intervention; however, the particular choice depends on individual circumstances.