The application of staged incremental balloon dilatation technique in the interventional treatment of Budd-Chiari syndrome with inferior vena cava thrombosis
Liu Ya, Gao Yong, Yu Chaowen, Chen Shiyuan, Nie Zhonglin, Lu Ran, Song Tao, Sun Yong, Guan Zeyu, Tang Wenbo,Wang Xiaogao, Xu Chao, Cai Yao
Department of Vascular Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
Abstract：Objective To investigate the effect and safety of staged incremental balloon dilatation in the interventional treatment of Budd-Chiari syndrome (BCS) with inferior vena cava thrombosis.Methods From January 2016 to December 2018, the clinical data of 34 BCS patients with inferior vena cava thrombosis (18 males and 16 females aged 32-53 years) admitted to vascular surgery of the First Affiliated Hospital of Bengbu Medical College were analyzed retrospectively. All patients were treated by staged incremental balloon dilatation, namely whether the thrombus was fresh or not, the small balloon (8 mm) was dilated for the first time and anticoagulant treatment was given after the guide wire was opened, the small balloon (12 mm) was dilated for the second time after one week, and the large balloon (18-25 mm) was dilated after one month. The success rate, perioperative complications, short-term patency rate and laboratory related indexes were observed.Results Thirty-three cases were successfully opened, the total success rate was 97.06% (33/34). The other patient was a long segment occlusion of the inferior vena cava. Repeated attempts at the first dilation failed to pass the occlusion segment, and the operation of the inferior vena cava-right atrial bypass was performed instead; among them, 14 cases (14/34) of fresh thrombus underwent transcatheter thrombolysis followed by removal of inferior vena cava thrombus, recovery of blood flow and opening of lesion segment. Thirty-three cases underwent 12 mm balloon dilatation after 1 week and 1 month, respectively, the large balloon dilatation was successfully performed, and the guide wire could pass through the lesion. The levels of alkaline phosphatase, bilirubin and platelet were (111.91±22.38) U/L, (20.76±1.82) U/L and (103.85±21.98)×109/L before the first dilation of the small balloon in 33 patients with successful dilation, and (78.88±10.04) U/L, (19.79±2.03) U/L and (137.27±17.68)×109/L before the first dilation of the large balloon, respectively. The differences were statistically significant (t=7.741, 2.039, 6.802, all P values＜0.05); but the changes of red blood cells, white blood cells, alanine aminotransferase and aspartate aminotransferase were not obvious. Six months after the operation, the symptoms of portal hypertension were significantly improved, such as the reduction of ascites, the reduction of liver and spleen, and the reduction of liver function score. No patient died during hospitalization and follow-up. There were no serious complications such as fatal pulmonary embolism, inferior vena cava rupture and pericardial tamponade in the perioperative period, and no symptomatic pulmonary embolism and fatal pulmonary embolism in the thrombolysis period. The results showed that the patency rates of inferior vena cava were 96.97%(32/33) and 90.91%(30/33), when 33 patients were rechecked by color ultrasound 6 months and 1 year after operation.Conclusions Staged incremental balloon dilatation is a safe and effective technique in the treatment of BCS with inferior vena cava thrombus.
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Liu Ya, Gao Yong, Yu Chaowen, Chen Shiyuan, Nie Zhonglin, Lu Ran, Song Tao, Sun Yong, Guan Zeyu, Tang Wenbo,Wang Xiaogao, Xu Chao, Cai Yao. The application of staged incremental balloon dilatation technique in the interventional treatment of Budd-Chiari syndrome with inferior vena cava thrombosis. Chinese Journal of Anatomy and Clinics, 2020, 25(1): 49-54.
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2020, Vol. 25 
