title: Necessity and indications of invasive treatment for Budd-Chiari syndrome.
abstract: BACKGROUND
  The development of collaterals in Budd-Chiari syndrome has been described and these collaterals play an important role in the presentation of this disease. These collaterals are diagnostic and their use in management strategy has never been evaluated. This study aimed to investigate the indications, feasibility and necessity of invasive treatment for patients with Budd-Chiari syndrome and to determine whether such a strategy is necessary for optimal management.
  
  
  METHODS
  Twenty-nine patients who had been treated at our unit were enrolled in this study. Based on physical and biochemical examination, and hemodynamic compensation by collaterals, 18 patients underwent radiological intervention (group A), while the other 11 had no invasive treatment (group B). The related hemodynamic parameters were acquired when percutaneous angiography was performed.
  
  
  RESULTS
  In group A, all patients underwent successfully inferior vena cava (IVC) balloon angioplasty with or without stenting. Four patients also underwent hepatic vein angioplasty. In these patients, the mean IVC pressure before and after treatment was statistically different (29.3+/-9.2 vs 15.1+/-4.6 mmHg, P<0.01). The mean IVC pressure was much lower in group B than in group A (12.9+/-2.4 vs 29.3+/-9.2 mmHg, P<0.01), but there was no difference from that of the patients after radiological treatment (12.9+/-2.4 vs 15.1+/-4.6 mmHg, P>0.05). Median follow-up was 32.3 months (mean 21.3 months; range 3-61 months). In the course of follow-up, the patients in group A survived with good systemic status except for re-stenosis in one patient who underwent re-canalization of the IVC. In group B, 10 patients had good systemic status except one patient who had a meso-caval shunt because of deterioration.
  
  
  CONCLUSIONS
  The rationale of "early diagnosis and early treatment" is not suitable for all patients with Budd-Chiari syndrome. Satisfactory survival can be achieved in some patients without invasive treatment, who are completely compensated by rich collaterals. Nonetheless, a positive treatment procedure should be performed if the patient's situation worsens in the course of regular follow-up.
authors.affiliation: Department of General Surgery, First Affiliated Hospital, Zhengzhou University School of Medicine, Zhengzhou 450052, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Fu
authors.forename: Yu-Ling
authors.initials: YL
authors.lastname: Sun
authors.forename: Xiu-Xian
authors.initials: XX
authors.lastname: Ma
authors.forename: Pei-Qin
authors.initials: PQ
authors.lastname: Xu
authors.forename: Liu-Shun
authors.initials: LS
authors.lastname: Feng
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tang
authors.forename: Sheng
authors.initials: S
authors.lastname: Guan
authors.forename: Zhi-Wei
authors.initials: ZW
authors.lastname: Wang
authors.forename: Cheng-Han
authors.initials: CH
authors.lastname: Luo
mesh_terms: D000328:Adult; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D000925:Anticoagulants / Q000627:therapeutic use; D006502:Budd-Chiari Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002681:China; D003097:Collateral Circulation; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008102:Liver Circulation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014690:Venous Pressure; D055815:Young Adult
chemical_list: D000925:Anticoagulants