Accuracy of computed tomographic angiography in the diagnosis of patients with inferior vena cava partial obstruction in Budd-Chiari syndrome.

The diagnosis of the partially obstructed inferior vena cava (IVC) in Budd-Chiari syndrome (BCS) patients has received little attention. We aimed to evaluate the diagnostic accuracy of computed tomographic angiography (CTA) for patients with BCS and a partially obstructed IVC. A total of 329 patients with BCS and an obstructed IVC were endovascularly treated with balloon dilation and/or stent placement. All patients underwent a CTA examination prior to endovascular treatment, and the data were retrospectively reviewed. The presence of a round, oval, irregular shape or jet sign low-density area without enhancement within the enhanced proximal IVC was considered a sign of a partially obstructed IVC. Digital subtraction angiography was used as the gold standard. The results from the digital subtraction angiography revealed a partially obstructed IVC in 108 BCS patients and a complete obstruction in 221 patients. The CTA discovered a partially obstructed IVC in 99 patients and a completely obstructed IVC in 230 patients. From the CTA results, 15 were false negatives, and six were false positives. The patient-based evaluation yielded an accuracy of 93.6%, a sensitivity of 86.1%, specificity of 97.3%, positive predictive value of 93.9%, and negative predictive value of 93.5% for the detection of BCS patients with a partial IVC obstruction. Computed tomographic angiography offered a high diagnostic accuracy and sensitivity in BCS patients with a partially obstructed IVC. The low-density area within the enhanced proximal IVC above the membrane in artery phase can be considered a reliable indicator of a stenotic IVC in BCS patients.

Liu SY ，Xiao P ，Cao HC ，Jiang HS ，Li TX ... -  《-》

Comparison of Long-Term Outcomes of Endovascular Management for Membranous and Segmental Inferior Vena Cava Obstruction in Patients With Primary Budd-Chiari Syndrome.

Endovascular management is important for the treatment of primary Budd-Chiari syndrome, which is caused by inferior vena cava (IVC) obstruction. The aims of this study were to compare long-term outcomes of endovascular management for primary Budd-Chiari syndrome patients with membranous obstruction of IVC (MOVC) and segmental obstruction of IVC (SOVC) and explore the optimal endovascular strategy for these conditions. Clinical data of 265 patients with Budd-Chiari syndrome who received endovascular management (MOVC group, n=136; SOVC group, n = 129) were retrospectively reviewed. Cumulative IVC patency rates were generated by the Kaplan-Meier method and compared by log-rank test. In total, 245 patients were followed up from 3 to 72 months after treatment. The difference of long-term outcomes of balloon dilation alone versus stent placement was not significant in each group. The overall cumulative 1-, 3-, and 5-year primary IVC patency rates were 98.3%, 90.7%, and 83.8% in the MOVC group and 88.3%, 79.1%, and 67.9% in the SOVC group (P=0.007), respectively. The long-term IVC patency rates were lower in the SOVC group than in the MOVC group for patients who underwent balloon dilation alone (P=0.001) and did not significantly differ for patients who underwent stent placement between both the groups (P=0.687). The long-term treatment outcome of endovascular management was better for primary Budd-Chiari syndrome patients with MOVC than for those with SOVC. Balloon dilation alone could be the optimal treatment for patients with MOVC. However, stent placement should be more strongly recommended for patients with SOVC.

Huang Q ，Shen B ，Zhang Q ，Xu H ，Zu M ，Gu Y ，Wei N ，Cui Y ，Huang R ... -  《-》

Outcome of the Z-expandable metallic stent for Budd-Chiari syndrome and segmental obstruction of the inferior vena cava.

Ding PX ，Li Z ，Zhang SJ ，Han XW ，Wu Y ，Wang ZG ，Fu MT ... -  《-》

Comparison of retrievable stents and permanent stents for Budd-Chiari syndrome due to obstructive inferior vena cava.

The aim of this study is to compare long-term outcomes of retrievable stents (RSs) and permanent stents (PSs) for Budd-Chiari syndrome (BCS) due to long-segment obstructive inferior vena cava (IVC). Between July 2000 and August 2016, 42 patients with BCS due to long-segment obstructive IVC were treated with RSs, and 41 patients were treated with PSs. The RSs were removed eventually after thrombus disappeared. Patients were subsequently followed up by color Doppler sonography or computed tomography scanning. All RS placements were successful, and 37 RSs were retrieved 8 to 29 days later. Forty-two stents were implanted in PS group. One failure retrieval of RSs occurred, and two failures of cannulations were found in PS group. Two deaths may be procedure related and died from acute pulmonary thromboembolism perioperatively. One patient developed acute cerebral infarction and recovered after treatment. In PS group, minor complications were found in three patients. The length of IVC lesion segment and length and thickness of IVC thrombus decreased significantly, and diameter of retrocaval IVC and diaphragm IVC increased significantly in both groups. During follow-up, three patients died from liver failure in RS group, and two patients died in PS group. RS group showed a significantly higher primary patency rate than PS group. Cumulative 1-, 3-, and 5-year secondary patency rates were 95.2%, 89.6%, and 89.6% in RS group and 100%, 96.6%, and 96.6% in PS group (P = 0.7109). Retrievable stents are effective for BCS because of long-segment obstructive IVC, with a higher primary patency rate.

Bi Y ，Chen H ，Ding P ，Ren J ，Han X ... -  《-》

Value of blood flow velocity on color Doppler ultrasonography for optimization of delay in scanning time on computed tomography venography in patients with Budd-Chiari syndrome and inferior vena cava obstruction.

Zhou PL ，Yan L ，Wu G ，Han XW ，Zhang WG ... -  《-》