Sequential interventional therapy of Budd-Chiari syndrome complicated with fresh inferior vena cava thrombi

Abstract

Objective: To observe the safety and efficacy of sequential interventional therapy for Budd-Chiari syndrome (BCS) complicated with fresh inferior vena cava thrombosis. Methods: Totally 27 patients with BCS complicated with fresh IVC thrombosis who received sequential interventional therapy. The specific method was to pre-dilate the IVC occlusion segment with a small balloon first, and then place thrombolytic catheter for local thrombolysis. After thrombolysis was complete or nearly complete, the stenosis segment was dilated with large balloon. Therapeutic effects and adverse effects were recorded. Results: All patients were treated with small balloon catheters (diameter 10-14 mm) to pre-dilate the occlusive segment of IVC, the IVC occlusion segment was partially restored after dilation. After operation, micropump was used to pump urokinase through an indwelling thrombolytic catheter for 40-60×104 U/d, the average was (44.10±8.40)×104 U/d, and catheterization for 4-15 (6.72±5.21)d. Ultrasound re-examination showed that IVC thrombosis disappeared completely in 20 patients, and a small amount of the old thrombus remained in 7 patients. After thrombolysis, all patients received large balloon dilation (diameter, 25-30 mm) in stenotic IVC segment, and the blood flow recovered subsequently, collateral vessels were significantly reduced or disappeared. No serious complication such as pulmonary embolism and massive hemorrhage occurred during the perioperative period. The mean postoperative follow-up was (20.22±18.43) months. All the 27 patients survived, and their clinical symptoms and signs were relieved or disappeared to varying degrees. Conclusion: Sequential interventional therapy for BCS complicated with fresh inferior vena cava thrombosis was safe and effective.