title: Outcome of the Z-expandable metallic stent for Budd-Chiari syndrome and segmental obstruction of the inferior vena cava.
abstract: OBJECTIVE
  Treatment of segmental obstruction of the inferior vena cava (SOIVC) with Z-expandable metallic stents (Z-EMS) is controversial and data on long-term follow-up are lacking. We aimed to evaluate the long-term outcomes of the use of a Z-EMS for Budd-Chiari syndrome (BCS) patients with SOIVC.
  
  
  METHODS
  Between August 2004 and December 2014, 37 consecutive BCS patients with SOIVC were referred for Z-EMS treatment and subsequently underwent follow-up in our department. Data were collected retrospectively and follow-up observations were made 1, 2, 2-5, and 5-10 years postoperatively.
  
  
  RESULTS
  Percutaneous transluminal balloon angioplasty and Z-EMS placement were technically successful in all patients. Major procedure-related complications occurred in four of 37 patients (10.81%). Follow-up for 61.89±41.45 months in 37 patients indicated portal hypertension in one patient 4 months after stent placement and symptoms were resolved by transjugular intrahepatic portosystemic stent shunting. Hepatocellular carcinoma was observed in four patients and five patients died during follow-up. Reocclusion of the inferior vena cava occurred in four patients (10.81%, 4/41) and all reocclusions were managed by percutaneous transluminal balloon angioplasty. Cumulative 1-, 2-, 2-5-, and 5-10-year primary patency rates were 94.60% (35/37), 93.33% (28/30), 88.89% (24/27), and 85.0% (17/20), respectively. Cumulative 1-, 2-, 2-5-, and 5-10-year secondary patency rates were 100% at all time-points.
  
  
  CONCLUSIONS
  These data suggest that Z-EMS implantation is an efficacious, safe, and curative approach for BCS with SOIVC because satisfactory long-term outcomes were achieved. Long-term follow-up is required to ascertain stent patency and hepatocellular carcinoma occurrence.
authors.affiliation: Departments of aVascular and Endovascular Surgery bLiver, Gall and Pancreatic Surgery cIntervention dRadiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Peng-Xu
authors.initials: PX
authors.lastname: Ding
authors.forename: Zhen
authors.initials: Z
authors.lastname: Li
authors.forename: Shui-Jun
authors.initials: SJ
authors.lastname: Zhang
authors.forename: Xin-Wei
authors.initials: XW
authors.lastname: Han
authors.forename: Yan
authors.initials: Y
authors.lastname: Wu
authors.forename: Zhong-Gao
authors.initials: ZG
authors.lastname: Wang
authors.forename: Ming-Ti
authors.initials: MT
authors.lastname: Fu
mesh_terms: D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D006502:Budd-Chiari Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006528:Carcinoma, Hepatocellular / Q000209:etiology; D002681:China; D000072226:Computed Tomography Angiography; D003251:Constriction, Pathologic; D018450:Disease Progression; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D011474:Prosthesis Design; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014654:Vascular Patency; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000503:physiopathology