Sequential interventional therapy for Budd-Chiari syndrome associated with fresh inferior vena cava thrombosis.
OBJECTIVE
Our study aimed to evaluate the safety and efficacy of sequential interventional therapy for Budd-Chiari syndrome (BCS) caused by obstruction of the inferior vena cava (IVC) with fresh thrombus in the IVC.


METHODS
Full medical records were obtained for 20 patients with BCS associated with fresh IVC thrombus who received sequential interventional therapy from 2014 to 2019 at our hospital. All patients underwent small-diameter percutaneous transluminal angioplasty (PTA) balloon catheter predilation combined with sequential catheter-directed thrombolysis and large-diameter PTA balloon dilation. Ultrasound examinations were performed at 1 week, 1 month, 3 months, and every 6 months thereafter. Therapeutic effects and perioperative and postoperative adverse effects were recorded to assess the safety of the treatment.


RESULTS
All 20 patients were treated with small PTA balloon catheters (diameter, 10-14 mm) to predilate the occlusive segment of the IVC. Urokinase 400,000 to 600,000 (465,000 ± 93,000) units was administered to patients through the catheter for 6 to 20 (9.7 ± 4.2) consecutive days postoperatively. Ultrasound re-examination showed that the IVC thrombus disappeared completely in 14 patients (70.0%), and a small amount of the old thrombus remained in 6 patients (30.0%). After thrombolysis, all 20 patients received PTA balloon dilation (diameter, 26-30 mm) in the stenosed IVC segment, and blood flow recovered subsequently. No pulmonary embolism or death occurred in the perioperative course. The perioperative survival rate was 100.0%.


CONCLUSIONS
Sequential interventional therapy for BCS associated with fresh IVC thrombus is safe and effective.
['Zeng|Yan-Wei|YW|', 'Liu|Chao|C|', 'Yin|Mei-Pan|MP|', 'Zhao|Yue|Y|', 'Wang|Zhi-Wei|ZW|', 'Zhou|Peng-Li|PL|', 'Ma|Yao-Zhen|YZ|', 'Li|Chun-Xia|CX|', 'Wu|Gang|G|']
D000328:Adult D000368:Aged D000800:Angioplasty, Balloon D006502:Budd-Chiari Syndrome D003131:Combined Modality Therapy D005260:Female D005343:Fibrinolytic Agents D006801:Humans D008297:Male D008875:Middle Aged D012189:Retrospective Studies D015912:Thrombolytic Therapy D013997:Time Factors D016896:Treatment Outcome D014568:Urokinase-Type Plasminogen Activator D014682:Vena Cava, Inferior D055815:Young Adult
Sequential interventional therapy Budd-Chiari syndrome Fresh thrombus Predilation Thrombolysis