Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2020; 8(14): 2930-2941
Published online Jul 26, 2020. doi: 10.12998/wjcc.v8.i14.2930
Restenosis after recanalization for Budd-Chiari syndrome: Management and long-term results of 60 patients
Wei Zhang, Yu-Long Tian, Qiao-Zheng Wang, Xiao-Wei Chen, Qi-Yang Li, Jin-Hang Han, Xu-Dong Chen, Ke Xu
Wei Zhang, Qi-Yang Li, Jin-Hang Han, Xu-Dong Chen, Department of Interventional Radiology, Shenzhen People’s Hospital, the Second Affiliated Hospital of Jinan University, Shenzhen 518020, Guangdong Province, China
Yu-Long Tian, Qiao-Zheng Wang, Xiao-Wei Chen, Ke Xu, Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
Author contributions: Zhang W, Xu K, and Chen XD designed the research; Tian YL, Wang QZ, and Chen XW performed the research; Zhang W, Li QY, and Han JH analyzed the data; Zhang W wrote the paper; Tian YL, Wang QZ, Chen XW, Li QY, Han JH, Chen XD, and Xu K critically revised the manuscript for important intellectual content.
Institutional review board statement: This study was reviewed and approved by Research Ethics Committee of Faculty of Medcine, The First Affiliated Hospital of China Medical University Institutional Review Board.
Informed consent statement: All study participants provided informed written consent for personal and medical data collection prior to study enrollment and each patient agreed to management via written consent.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at kexu@vip.sina.com. The participants gave informed consent for the data sharing.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ke Xu, MD, PhD, Professor, Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, No 155, Nanjing Bei Street, Shenyang 110001, Liaoning Province, China. kexu@vip.sina.com
Received: March 6, 2020
Peer-review started: March 6, 2020
First decision: April 12, 2020
Revised: June 3, 2020
Accepted: July 4, 2020
Article in press: July 4, 2020
Published online: July 26, 2020
Processing time: 139 Days and 23.5 Hours
Abstract
BACKGROUND

Budd-Chiari syndrome is defined as hepatic venous outflow tract obstruction. For Asian Budd-Chiari syndrome patients, the major treatment modality is recanalization (percutaneous transluminal angioplasty with or without stent implantation). The cumulative 1-, 5-, and 10-year primary patency rates and survival rates are reported to be excellent or satisfactory, but the long-term outcome of patients with restenosis (the most common complication after recanalization) is unknown.

AIM

To explore the treatment strategy for restenosis in patients with Budd-Chiari syndrome after interventional therapy and to evaluate the long-term follow-up results.

METHODS

The clinical data and follow-up results of 60 patients with restenosis after interventional therapy from November 1983 to December 2013 were retrospectively analyzed.

RESULTS

Sixty patients with restenosis were retrospectively divided into a percutaneous transluminal angioplasty (PTA) group (40 patients) and a PTA + stent group (20 patients) according to the primary recanalization method. For the patients with restenosis in the PTA group, 13 refused treatment, and 27 received further treatment; among these patients, five had a second restenosis, two had a third restenosis, and one had a fourth restenosis. For the patients with restenosis in the PTA + stent group, nine refused treatment, ten received PTA alone, and the other received PTA + stent implantation. Among the patients who received further treatment, five had a second restenosis, three had a third restenosis, and one had a fourth restenosis. The 1-, 5-, 10-, 20-, and 25-year cumulative survival rates of the 38 patients who received further treatment after restenosis were 100%, 78.3%, 78.3%, 70.5%, and 70.5%, respectively; however, for the 22 patients who refused treatment, the survival rates were 72.7%, 45.9%, 30.6%, 10.2%, and unavailable, respectively (P < 0.001).

CONCLUSION

Long-term follow-up after interventional therapy is very important. Active treatment for patients with restenosis can improve prognosis, and minimally invasive treatment strategies for restenosis allows to obtain satisfactory results.

Keywords: Budd-Chiari syndrome; Restenosis; Long-term follow-up; Treatment strategy

Core tip: This is the first study to explore the treatment strategy for restenosis in Chinese patients with Budd-Chiari syndrome after interventional therapy and evaluate the outcomes with more than 20-year follow-up. The 1-, 5-, 10-, 20-, and 25-year cumulative survival rates of the 38 patients who received further treatment after restenosis were 100%, 78.3%, 78.3%, 70.5%, and 70.5%, respectively; however, for the 22 patients who refused treatment, the survival rates were 72.7%, 45.9%, 30.6%, 10.2%, and unavailable, respectively (P < 0.001). Regular follow-up and active treatment can result in satisfactory prognosis in Budd-Chiari syndrome patients with restenosis.