Z-expandable metallic stent implantation for the treatment of segmental inferior vena cava type Budd-Chiari syndrome: mid-to-long-term follow-up results

Objective: To discuss the application of percutaneous Z-expandable metallic stent (Z-EMS) implantation in treating segmental inferior vena cava type Budd-Chiari syndrome (BCS) and to analyze its mid-to-long-term results. Methods: The clinical data of 41 consecutive BCS patients with segmental obstruction of inferior vena cava (SOIVC), who were admitted to authors' hospital to receive percutaneous Z-EMS implantation during the period from August 2004 to December 2014, were retrospectively analyzed. The cumulative follow-up data of one, 2, 2-5 and 5-10 years were collected. Results: Both percutaneous transluminal balloon angioplasty (PTBA) and Z-EMSimplantation were successful accomplished in all 41 patients. After the treatment, the symptoms of inferior vena cava (IVC) hypertension were obviously improved; significant response was achieved in 35 patients (85.4%) and curative effect in 6 patients (14.6%), the total effect rate being 100%. Stent migration occurred in 4 patients (9.8%). All patients were followed up for 1-125 months, with a mean of (64.12 ± 41.48) months. One patient developed IVC hypertension at 4 months after treatment, which was relieved after receiving transjugular intrahepatic portosystemic stent shunting; 4 patients developed hepatocellular carcinoma (HCC) and 5 patients died. Re-obstruction of the stent was seen in 4 patients and the stent returned to patent after receiving PTBA. The cumulative primary patency rates of IVC at one, 2, 2-5 and 5-10 years were 95.1% (39/41), 94.1% (32/34), 90.3% (28/31) and 83.3% (20/24) respectively, while the secondary patency rates of IVC at one, 2, 2-5 and 5-10 years were 100% (41/41), 100% (34/34), 100% (31/31) and 100% (24/24) respectively. Conclusion: For the treatment of segmental inferior vena cava type Budd-Chiari syndrome, Z-EMS implantation is safe and effective, its re-occlusion rate is lower and its mid-to-long-term result is satisfactory. Follow-up observation should be focused on the stent patency and the occurrence of HCC. (authors)