To evaluate clinical efficacy of interventional therapy for patients with different types of hepatic vein-type Budd-Chiari syndrome (BCS).

Clinical data of 189 patients with hepatic vein-type BCS admitted to the Affiliated Hospital of Xuzhou Medical University from January 2014 to December 2024 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 89 patients were male and 100 female, aged from 20 to 79 years, with a median age of 46 years. According to different types of hepatic venous lesions, all patients were divided into the membranous obstruction group (n=65), segmental obstruction group (n=53), extensive obstruction group (n=39) and thrombus group (n=32). In the membranous and segmental obstruction groups, balloon dilatation and/or stent implantation were performed. In the extensive obstruction group, transjugular intrahepatic portosystemic shunt (TIPS) was adopted. In the thrombus group, thrombi were removed, followed by angioplasty or TIPS. Postoperative color Doppler ultrasound, magnetic resonance venography (MRV) or CT venography were used to monitor the patency of blood vessels. The changes of venous pressure before and after treatment were compared by paired t-test. Child-Pugh scores of liver function were compared by Chi-square test. The first cumulative patency rate was calculated by Kaplan-Meier method and compared with Log-rank test.

All patients were successfully treated by interventional therapy without severe complications. Before and after interventional therapy, the pressure difference between hepatic vein and inferior vena cava was decreased from (13.6±3.7) mmHg (1 mmHg=0.133 kPa) to (4.1±1.6) mmHg in the membranous obstruction group, from (11.7±2.3) mmHg to (4.7±2.4) mmHg in the segmental obstruction group , and from (14.2±3.1) mmHg to (4.9±2.7) mmHg in the thrombus group (t=15.649, 16.537, 17.341; all P<0.05). Portal pressure gradient (PPG) was decreased from (24.7±3.5) mmHg to (9.8±2.8) mmHg in the extensive obstruction group (t=18.036, P<0.05). The follow-up time was 3.0-134.0 months. The median follow-up time was 65.3 months. 8 cases were lost to follow-up. Among 62 patients in the membranous obstruction group, 51 cases achieved the patency of hepatic veins and 11 cases developed restenosis. The restenosis rate of patients undergoing stent implantation was significantly higher than that of those receiving balloon dilatation (χ²=9.605, P=0.002). Among 51 cases in the segmental obstruction group, 34 patients achieved the patency of hepatic veins and 17 cases had restenosis. The restenosis rate of patients with stent implantation was significantly higher than that of those receiving balloon dilatation (χ²=6.951, P=0.008). In the extensive obstruction group (n=37), 21 cases had vessel patency after TIPS and 16 cases had in-stent restenosis. 3 patients were diagnosed with hepatic encephalopathy after operation. 2 patients died of liver failure at postoperative 17 and 68 months,respectively. In the thrombus group, 12 of 26 patients undergoing angioplasty experienced hepatic venous restenosis, 1 of 5 cases receiving TIPS had in-stent restenosis, and 1 case died at postoperative 105 month, which was unrelated to BCS. According to preoperative Child-Pugh classification of liver function, 58, 76 and 47 patients were classified as Child-Pugh A, Child-Pugh B and Child-Pugh C, and 98, 68 and 15 cases of Child-Pugh A, Child-Pugh B and Child-Pugh C at postoperative 3 months, respectively. The liver function was significantly improved (χ²=27.217, P<0.001). The first cumulative patency rates at postoperative 1, 3, 5 and 10 years were 92.2%, 83.5%, 75.4% and 61.8% in the membranous obstruction group, 90.8%, 81.1%, 63.3% and 51.4% in the segmental obstruction group, 91.6%, 81.6%, 72.7% and 52.2% in the extensive occlusion group, and 84.7%, 78.9%, 67.3% and 55.1% in the thrombus group, respectively. No significant difference was observed in the first cumulative patency rate among four groups (χ²=1.094, P=0.778).

According to different types of hepatic vein-type BCS, corresponding interventional therapies can achieve favorable middle-and long-term efficacy. In the membranous obstruction group, balloon dilatation alone is recommended. Segmental obstruction is mainly treated by balloon dilatation, and stent implantation can be used as a remedial treatment. TIPS is recommended for extensive obstruction. For thrombosis patients, thrombi should be removed first, followed by angioplasty or TIPS according to individual conditions.