Strategy and Long-term Outcomes of Endovascular Treatment for Budd–Chiari Syndrome Complicated by Inferior Vena Caval Thrombosis

Objectives The aim of this study was to evaluate the strategy and long-term outcomes of endovascular treatment of Budd–Chiari syndrome (BCS) complicated by inferior vena cava (IVC) thrombosis. Methods The treatment strategy and outcomes of BCS complicated by IVC thrombosis were retrospectively evaluated in a single-center study. The treatment was aimed at the IVC thrombus, not hepatic vein occlusion. All 133 patients with BCS complicated by IVC thrombosis from February 2003 to March 2013 underwent endovascular treatment. For the fresh thrombus group ( n = 75) recanalization was performed after transcatheter thrombolysis with urokinase. For the mixed thrombus group ( n = 19) a small balloon pre-dilation of the IVC was performed first, followed by transcatheter thrombolysis using urokinase and a large balloon dilation of the IVC. For the old thrombus group ( n = 39) a large balloon dilation or/and stent placement was performed directly. Pre- and post-treatment follow-ups were recorded. Results The endovascular treatment was successful in 131 out of 133 patients (98.5%). Thirty seven patients had synchronous hepatic vein occlusion. The incidence of serious complications was 4.5% (6/133). Symptomatic pulmonary embolism occurred in three cases, cerebral hemorrhage in two, and cardiac tamponade in one. The cumulative 1-, 5-, and 10-year primary patency rate was 96.3%, 84.0%, and 64.6%, respectively. The cumulative 1-, 5-, and 10-year secondary patency rate was 99.0%, 96.1% and 91.3%, respectively. Segmental occlusion of the IVC and duration of anticoagulant therapy less than 6 months were independent risk factors for reocclusion. Conclusions For patients with BCS complicated by IVC thrombosis, an individualized treatment strategy based on the property of the thrombus can result in excellent long-term patency.