Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2025
Interventional Radiological Management for Budd-Chiari Syndrome: A 10-Year Retrospective, Multicenter Survey on 997 Patients in China.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Xia Dongdong, Luo Bohan, Zhang Chunqing, Zhang Kewei, Wang Qiuhe, Li Mingxing, Fan Qingyong, Fan Jiahao, Li Kai, Bai Wei, Guo Wengang, Wang Guangchuan, Xiu Aiyuan, Wang Qiaozheng, Lv Yong, Li Menghao, Wang Zhengyu, Yuan Jie, Li Bing, Dong Zenghui, Zhang Na, Shang Yiwei, Dai Wei, Wang Yalan, Tang Hong, Yin Zhanxin, Zhao Yan, Xia Jielai, Fan Daiming, Xu Ke, Wu Kaichun, Han Guohong
Аннотация
BACKGROUND & AIMS: Large-scale cohort studies on interventional radiological treatments for Budd-Chiari syndrome (BCS), including percutaneous angioplasty (PTA) with or without routine stenting and transjugular intrahepatic portosystemic shunt (TIPS), are lacking. We aimed to evaluate the long-term outcomes of these treatments in Chinese BCS patients.
METHODS: Consecutive patients diagnosed with BCS in 6 Chinese tertiary centers were retrospectively screened for eligibility between January 2010 and May 2019. The roles of the treatment modalities, as well as their associated clinical outcomes, were assessed.
RESULTS: Overall, 997 patients were enrolled, with obstruction types classified as inferior vena cava (15.7%), hepatic vein (16.2%), and combined (68.1%). The majority (93.5%) presented with moderate-to-severe symptoms, with 60.7% (n = 607) showing a disease course exceeding 6 months. All patients received anticoagulation, among them, 117 (11.7%) patients underwent medical therapy alone, including 65 asymptomatic or mildly symptomatic patients, and 52 with failed, unfeasible, or declined recanalization; 834 (83.7%) patients successfully recanalized through PTA alone (n = 566) or PTA with routine stenting (n = 268); 90 (9.0%) patients received TIPS placement (comprising 46 initial and 44 converted procedures); and no patients underwent liver transplantation. With a median follow-up of 57.3 months, 103 (10.5%) deaths occurred, primarily from liver failure. The 5-year rates for overall, TIPS-free, stenting-TIPS-free, and intervention-free survival were 90.2% (95% confidence interval [CI]: 88.2%-92.3%), 83.0% (95% CI: 80.5%-85.6%), 59.3% (95% CI: 56.2%-62.6%), and 10.6% (95% CI: 8.8%-12.7%), respectively (P < .001), with consistent outcomes across BCS subtypes.
CONCLUSIONS: With predominantly inferior vena cava obstruction presented and recanalization used, interventional radiological treatment could achieve a good long-term outcome in Chinese patients with BCS.
METHODS: Consecutive patients diagnosed with BCS in 6 Chinese tertiary centers were retrospectively screened for eligibility between January 2010 and May 2019. The roles of the treatment modalities, as well as their associated clinical outcomes, were assessed.
RESULTS: Overall, 997 patients were enrolled, with obstruction types classified as inferior vena cava (15.7%), hepatic vein (16.2%), and combined (68.1%). The majority (93.5%) presented with moderate-to-severe symptoms, with 60.7% (n = 607) showing a disease course exceeding 6 months. All patients received anticoagulation, among them, 117 (11.7%) patients underwent medical therapy alone, including 65 asymptomatic or mildly symptomatic patients, and 52 with failed, unfeasible, or declined recanalization; 834 (83.7%) patients successfully recanalized through PTA alone (n = 566) or PTA with routine stenting (n = 268); 90 (9.0%) patients received TIPS placement (comprising 46 initial and 44 converted procedures); and no patients underwent liver transplantation. With a median follow-up of 57.3 months, 103 (10.5%) deaths occurred, primarily from liver failure. The 5-year rates for overall, TIPS-free, stenting-TIPS-free, and intervention-free survival were 90.2% (95% confidence interval [CI]: 88.2%-92.3%), 83.0% (95% CI: 80.5%-85.6%), 59.3% (95% CI: 56.2%-62.6%), and 10.6% (95% CI: 8.8%-12.7%), respectively (P < .001), with consistent outcomes across BCS subtypes.
CONCLUSIONS: With predominantly inferior vena cava obstruction presented and recanalization used, interventional radiological treatment could achieve a good long-term outcome in Chinese patients with BCS.