Objective To explore the feasibility of the Budd-Chiari syndrome model establishment in rat by using the inferior vena cava coarctation. Methods Fifty SD rats were randomly divided into experimental group and sham operation group， the laparotomy was performed after general anesthesia by intraperitoneal injection， and dissociated the inferior vena cava. In the experimental group， the vena cava was tightly ligated with silk thread according to partial portal vein coarctation， enclosing 23 G L-style blunt needle in the ligature to prevent complete obliteration. The diameter of the vena cava was set to about 80% of its normal size after removing the 23 G L-style blunt needle. The abdominal Doppler， liver function， blood routine examination， and liver biopsy were tested at different time （on week 1， 4， 8， and 12） after operation. Results The signs of inferior vena cava and primary hepatic venous obstruction， liver congestion and cirrhosis， ascites， hepatosplenomegaly， portal vein extension， and collateral patency occurred on week 4 in the experimental group. The levels of AST， ALT， AKP， TBIL， DBIL， and TBA in the experimental group were significantly higher than those in the sham operation group （P＜0.05）， and the WBC， PLT， RBC， HGB， and ALB in the experimental group was significantly lower than those in the sham operation group （P＜0.05）. Conclusion The inferior vena cava coarctation can be successfully used to establish a rat model of Budd-Chiari syndrome.
Hepatic sinusoidal obstruction syndrome (HSOS) can be easily missed or misdiagnosed as Budd-Chiari syndrome in clinical practice. The authors displayed the imaging pictures of one patient with HSOS and made a brief description of typical imaging features, underlying pathophysiological mechanisms, and differential diagnosis of HSOS, with the hope of improving the understanding of HSOS and reducing the rates of leak diagnosis or misdiagnosis.
Objective To investigate the imaging features of Budd-Chiari syndrome (BCS) on 64 slice spiral computed tomography (64SCT) and the diagnostic value of 64SCT for BCS. Methods Twenty-nine patients diagnosed as BCS by 64SCT were retrospectively included into this study and all the patients were researched by digital substraction angiography (DSA). Two abdominal radiologists analyzed the CT imaging features of BCS, paying attention to the vascular lesion, the morphology abnormality of the liver and the degree of portal hypertension, with review of DSA findings. Results ①The accuracy of 64SCT for BCS was 93.1% (27/29), and there were 2 false positive cases and no false negative case. The accuracy of 64SCT for those patients with thrombosis of inferior vena cava (IVC) and (or) hepatic vein (HV) was high as compared to those with stenosis of IVC and (or) HV. ②The morphology abnormality of the liver included hepatomegaly (24 cases), low attenuation (27 cases) and inhomogeneous pattern of parenchymal contrast enhancement (5 patients in arterial phase and 19 patients in portal vein phase). ③The images of all the patients showed the features of portal hypertension. Conclusion The accuracy of 64SCT for BCS is satisfactory and the false negative is seldom. The 64SCT could accurately display the morphology abnormality of the liver and the compensatory circulation in BCS patients. For those patients with stenosis of IVC and (or) HV, however, the diagnostic power of 64SCT is limited.
Objective To explore the treatment of a case of clonorchiasis with Budd-Chiari syndrome through multidisciplinary team (MDT) discussion. Methods A case of clonorchiasis with Budd-Chiari syndrome was treated in the Second Affiliated Hospital of Chongqing Medical University in August 2021. We summarized the discussion of MDT and the process of diagnosis and treatment. Results The patient was admitted because of “more than 8 years after partial hepatectomy and more than 1 year of abdominal distension”. Eight years before admission, the patient underwent right hepatic trisegmentectomy and left hepaticojejunostomy due to a huge space occupying right liver. Postoperative pathological examination revealed multifocal necrosis with granulomatous reaction, and parasitic infection was considered. One year before admission, the patient began to have ascites, and the medical treatment was ineffective. The CT examination of the upper abdomen after admission showed hepatic segmental stenosis of the inferior vena cava, unclear display of the hepatic veins and a large amount of ascites. After MDT discussion, this patient underwent direct intrahepatic portosystemic shunt (DIPS) and percutaneous transluminal angioplasty (PTA) , and the stent was unobstructed in the 9-month follow-up after discharge, and no recurrence of ascites was found. Conclusions DIPS combined with PTA can significantly improve the clinical symptoms of clonorchiasis with Budd-Chiari syndrome. Discussion through MDT mode can improve the effectiveness of treatment and obtain better prognosis.
Computational fluid dynamics was used to investigate the effect of the pathogenesis of membranous obstruction of inferior vena cava of Budd-Chiari syndrome with various angles between right hepatic vein and inferior vena cava. Mimics software was used to reconstruct the models from magnetic resonance imaging (MRI) angiograms of inferior vena cava, right hepatic vein, middle hepatic vein and left hepatic vein, and 3DMAX was used to construct the models of 30°, 60°, 90° and 120° angles between right hepatic vein and inferior vena cava, which was based on the reconstructed models.The model was conducted with clinical parameters in terms of wall shear stress distribution, static pressure distribution and blood velocity. The results demonstrated that the differences between wall shear stress and static pressure had statistical significance with various angles between right hepatic vein and inferior vena cava by SPSS. The pathogenesis of membranous obstruction of inferior vena cava had a correlation with the angles between right hepatic vein and inferior vena cava.
ObjectiveThe purpose of this study is to apply the method of CO-word analysis to the evidence-based study of the diagnosis and treatment of Budd-Chiari syndrome (BCS), to understand the trend of BCS research in China and to explore the hot spots of BCS in recent years, and to provide new evidence-based data for the clinical practice and experimental research of BCS in China.MethodsIn the Wanfang database, CNKI, and VIP retrieval platform, " Budd-Chiari syndrome” was used as the key word or title. According to the publication time, it was divided into before 1998 (study group 1), 1999–2008 (study group 2), and 2009–2018 years (study group 3). The relationship matrix was established by using the Netdraw tool in Ucinet6.0, and the common words were plotted with the Netdraw tool. The word relation network was used to get the analysis chart of the relation of the word.ResultsThis study found that, Budd-Chiari syndrome, inferior vena cava, hepatic vein, inferior vena cava obstruction, and syndrome were the most frequently used keywords in the study group 1. Budd-Chiari syndrome, inferior vena cava, hepatic venous, interventional therapy, and patients were the most frequent keywords in the study group 2. In the study group 3, Budd-Chiari syndrome, interventional therapy, inferior vena cava, hepatic vein, and patient were the most frequent keywords.ConclusionsHepatic vein type and inferior vena cava type have became a research hotspot in recent years, and the thrombosis mechanism is one of the directions for domestic scholars to study the etiology of BCS. The diagnosis and classification of BCS depend on color doppler ultrasound technology. Many studies focus on the differential diagnosis of BCS and cirrhosis.
ObjectiveTo summarize the differences between Budd-Chiari syndrome (BCS) and hepatic veno-occlusive disease (HVOD). MethodsBased on the current reports about BCS and HVOD, combined with the authors' clinical experience, a review was performed for the 2 kinds of diseases. ResultsBCS and HVOD were both post-hepatic portal hypertension symptoms, and both would result in liver cirrhosis in the late phase. According to the different causes of 2 kinds of diseases clinically, and the corresponding clinical characteristics, most cases can be confirmed by the preliminary judgment. As for the cases without clear diagnosis, corresponding imaging examinations may be helpful, but the final diagnosis depended on the pathologic examination after liver biopsy. ConclusionThere are some differences on the cause, clinical characteristic, and characteristic of images between the BCS and HVOD, that all of them contribute to differential diagnosis.
【Abstract】ObjectiveTo report the author’s experience with the first case of an adult-to-adult living donor liver transplantation (LDLT) for Budd-Chiari syndrome (BCS) using cryopreserved vena cava graft in postheptic vena cava reconstruction. MethodsA 35-year-old male patient with a diagnosis of BCS complicated with inferior vena cava (IVC) obstruction received medical treatment and radiologic intervention for nine months, no relief of the symptoms could be achieved. Finally, the patient underwent LDLT, which required posthepatic vena cava reconstructed using cryopreserved vena cava graft. ResultsThe patient has had an uneventful course since the LDLT. ConclusionWe believe that LDLT combined with posthepatic IVC reconstruction using cryopreserved vena cava graft is considered to be a sound modality for IVC obstructed BCS.
Objective To explore the effect of endovascular treatment guided by ultrasonography combined with portosystemic shunts on the patients with Budd-Chiari Syndrome （BCS）.Methods The clinical data of 136 patients with BCS treated by balloon angioplasty and stent implantation guided by Doppler ultrasonography in our hospital from January 1995 to January 2011 were retrospectively analyzed.After balloon angioplasty,53 patients were treated by inferior vena cava （IVC） stent implantation and 31 patients with hepatic venous occlusion underwent portosystemic shunts （PSSs） at one week after endovascular treatment.The long-and short-term effects after treatment were studied.Results After endovascular procedures,the IVC pressure of patients significantly decreased （P＜0.01）,while IVC diameter, flow velocity in the lesion,and right atrial pressure of patients showed significant increase（P＜0.01）.Slight heart dysfunction appeared in 13 cases of patients.After shunting,acute pancreatitis occurred in 3 cases, and 1 patient died of upper gastrointestinal hemorrhage on the 10 d after PSSs.Doppler ultrasonography for IVC and shunt vessels showed：the swollen liver and spleen lessened on 3d after endovascular procedures.The swollen liver lessened 2-7cm （mean 5.5cm）,swollen spleen lessened 3-8cm （mean 5.8cm）, and the time of ascites disappearance was 3-60d （mean 14d）.All the patients were followed up for 1 month to 15 years with an average of 3 years.Restenosis of the distal part of stent was found in 1 patient in 2 years after operation, hepatic vein occlusion occurred in 1 case in 1 year after treatment,hepatocellular carcinoma occurred in 1 patient in 3 years after stent implantation,and 1 patient died of C type hepatitis after 1 year,and 5 out of 6 cases of patients with infertility had babies after 1 year.All patients had no stent migration or occlusion of shunts and the symptoms of portal hypertension were obviously relieved.Conclusions Endovascular treatment guided by Doppler ultrasonography is a convenient,safe,and effective method for BCS.Portosystemic shunts are commended to patients with hepatic venous occlusions.The above mentioned methods provide a feasible and effective means for IVC stenosis and short segment occlusion with hepatic vein occlusion of BCS.
Objective To analyze the prognosis and indications of transjugular intrahepatic portosystemic shunt (TIPS) in patients with Budd-Chiari syndrome (BCS). MethodsPatients with primary BCS who received TIPS in the Department of Gastroenterology, West China Hospital of Sichuan University between February 2009 and February 2020 were retrospectively reviewed. The medical history, preoperative imaging, surgical records, and postoperative outpatient follow-up medical records were recorded. The laboratory indexes before and after operation were compared, and the cumulative free from hepatic encephalopathy rate, stent patency rate, and cumulative survive rate were calculated. Cox proportional hazards model was used to analyze the independent risk factors of hepatic encephalopathy, shunt dysfunction and death. Results A total of 48 patients were included. The main indications for TIPS included variceal bleeding (16 cases), refractory ascites (24 cases), and diffuse obstruction of hepatic vein with acute liver function impairment (8 cases). The cumulative 1 year, 2 years and 3 years of free from hepatic encephalopathy rates were 92.3%, 89.2% and 85.3%, respectively. The stent patency rates were 89.7%, 72.2% and 54.8% at postoperative 1 year, 3 years and 5 years, respectively. The cumulative survival rates were 86.0%, 79.5% and 71.4% at postoperative 1 year, 3 years and 5 years, respectively. Conclusion TIPS can achieve good efficacy in patients with BCS, and most patients receive TIPS for portal hypertension complications rather than acute liver function impairment.