title: Staged management of Budd-Chiari syndrome caused by co-obstruction of the inferior vena cava and main hepatic veins.
abstract: BACKGROUND
  Collateralized intra- and extra-hepatic routes in patients with Budd-Chiari syndrome (BCS) were important. This study aimed to investigate the feasibility and clinical outcomes of the staged management of BCS based on the degree of compensation provided by intra- or extra-hepatic collateral circulations.
  
  
  METHODS
  A total of 103 adult patients with BCS caused by co-obstruction of the inferior vena cava (IVC) and main hepatic veins (MHVs) between March 2001 and October 2009 were enrolled in this study. Based on the pathological classification and degree of hemodynamic compensation by collateral circulations, treatment priority for IVC hypertension was determined in the first-stage treatment. Patients were deemed eligible for second-stage treatment when the first-stage treatment failed to relieve.
  
  
  RESULTS
  Imaging results revealed that most patients had collateral circulations to different extents. Based on the degree of compensation provided by these collateral circulations, 74 patients underwent single-stage treatment for IVC hypertension, i.e., radiologic intervention (RI) for 61 patients and surgical procedures (SPs) for 13. One patient was treated for portal hypertension. Twenty-nine patients underwent second-stage treatment (25 underwent RI and SP, and 4 only SP). The general morbidity and mortality after all procedures were 8.3% and 1.5%, respectively. After a median follow-up of 35 months, 4 patients underwent second-stage treatment and 7 underwent recanalization of the IVC/MHVs. Two patients died of hepatocellular carcinoma and 1 died of graft obstruction.
  
  
  CONCLUSIONS
  Staged management produces excellent outcomes for patients with BCS caused by co-obstruction of the IVC and MHVs.
authors.affiliation: Institute of Hepatobiliary and Pancreatic Diseases, Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhengzhou University, School of Medicine, Zhengzhou 450052, China. ylsun@zzu.edu.cn
authors.forename: Yu-Ling
authors.initials: YL
authors.lastname: Sun
authors.forename: Yang
authors.initials: Y
authors.lastname: Fu
authors.forename: Lin
authors.initials: L
authors.lastname: Zhou
authors.forename: Xiu-Xian
authors.initials: XX
authors.lastname: Ma
authors.forename: Zhi-Wei
authors.initials: ZW
authors.lastname: Wang
authors.forename: Yan
authors.initials: Y
authors.lastname: Wu
mesh_terms: D000328:Adult; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006502:Budd-Chiari Syndrome / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D003097:Collateral Circulation; D005240:Feasibility Studies; D005260:Female; D006503:Hepatic Veins / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D008102:Liver Circulation; D008297:Male; D008875:Middle Aged; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D014682:Vena Cava, Inferior / Q000503:physiopathology / Q000601:surgery*; D014690:Venous Pressure; D055815:Young Adult