One-stage interventional treatment of Budd-Chiari syndrome with upper gastrointestinal hemorrhage

Objective To evaluate the feasibility and clinical outcomes of interventional treatment of Budd-Chiari syndrome (BCS) associated with simultaneous upper gastrointestinal hemorrhage. Methods The clinical data of 32 patients of BCS with upper gastrointestinal hemorrhage from October 2015 to April 2008 in First Affiliated Hospital of Zhengzhou University were analyzed retrospectively. Variceal embolization and inferior vena cave (IVC) and/or hepatic veins (HV) angioplasty were performed simultaneously. Perioperative complications were observed. Portal vein pressures were measured through catheterization pre- and post-operation. Restenosis of IVC and HV, upper gastrointestinal hemorrhage were observed on follow-up. Results Percutaneous transluminal balloon angioplasty were successfully carried out in all patients: 16 patients with IVC and 17 patients with HV stenosis underwent angioplasty without stent placement. Portography indicated one esophageal and gastric varices in 17 patients and two in 15 patients. All the varices were embolized successfully. The portal vein pressure reduced from (35.7±2.9) cmH2O to (31.2±2.5) cmH2O (P<0.05, 1 cmH2O=0.098 kPa). Portal vein pressure reduced from (35.8±3.0) cmH2O to (30.7±2.3) cmH2O in HV type BCS post-operation, and reduce from (35.6±3.0) cmH2O to (31.8±2.6) cmH2O in HV and IVC involved type, which indicated that portal vein pressure decreased more obviously after HV recanalization. On follow-up for 3 to 32 months (mean 11.7 ±7.8 months), 7 patients with IVC and 5 patients with HV stenosis developed restenosis. Transluminal balloon angioplasty was performed. No upper gastrointestinal hemorrhage occurred during the follow-up period. Conclusion One-stage interventional treatment of BCS with upper gastrointestinal hemorrhage was safe and effective, and had satisfactory medium-long term outcomes. Key words: Hypertension, portal vein; Varices; Budd-Chiari syndrome; Upper gastrointestinal hemorrhage; Transluminal balloon angioplasty; Embolization