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Vol. 44. Issue 6.
Pages 405-417 (June - July 2021)
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Vol. 44. Issue 6.
Pages 405-417 (June - July 2021)
Original article
DOI: 10.1016/j.gastre.2020.06.030
The outcomes of interventional treatment for Budd-Chiari Syndrome complicated by inferior vena cava thrombosis: Systematic review and meta-analysis
Resultados del tratamiento intervencionista del síndrome de Budd-Chiari agravado por trombosis de la vena cava inferior: Una revisión y un metaanálisis sistemáticos
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Xuedong Suna, Tingting Qinb, Jinlong Zhangc, Maoqiang Wanga,c,
Corresponding author
wangmq@vip.sina.com

Corresponding author.
a School of Medicine, Nankai University, No.94 Weijin Road, Nankai District, Tianjin, PR, China
b Department of Clinical Laboratory, Liaocheng People's Hospital, No.67 Dongchang Road, Dongchangfu District, Liaocheng, PR, China
c Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fu-xing Rd, Beijing 100853, PR, China
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Table 1. Baseline characteristics of included studies of interventional treatment with BCS complicated by IVCT.
Table 2. Clinical data of the included studies.
Table 3. Comparison of clinical manifestations pre- and post-treatment of the included studies.
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Abstract
Purpose

The aim of this study was to perform a systematic review and meta-analysis to assess the safety and efficacy of interventional treatment for Budd-Chiari syndrome (BCS) complicated by Inferior Vena Cava thrombosis (IVCT) patients.

Methods

We evaluated the published studies on interventional treatment for BCS complicated by IVCT. Meta-analysis was used to calculate the combined effect size and their 95% confidence intervals (CI) based on random effect. The publication bias was assessed by Begg's test.

Results

Sixteen studies on interventional treatment for BCS complicated by IVCT patient were selected for meta-analysis, a total of 767 BCS complicated by IVCT patients were included. The combined effect size (95% CI) were 99% (98–100%) for the total successful rate of IVC recanalization, 15% (11–21%) for the rate of IVC restenosis after initial operation, 92.0% (86–97%) for the rate of clinical improvement, 76% (68–84%) for the rate of thrombus clearance and 0.00% (0–1%) for the incidence of pulmonary embolism (PE). Through subgroup meta-analysis about the rate of thrombus clearance, we got the pooled results (95% CI) of individualized treatment strategy (ITS) group and non-individualized treatment strategy (non-ITS) group, were 81% (71–92%) and 73% (63–83%), respectively.

Conclusions

The interventional treatment for BCS complicated by IVCT patients is safe and effective with low incidence of PE, high thrombus clearance rate, high technically successful rate, good patency, and high clinical improvement rate. Moreover, subgroup analysis indicated that management based on the type and extent of the thrombus is proposed.

Keywords:
Interventional treatment
Budd-Chiari syndrome
Inferior vena cava thrombosis
Meta-analysis
Abbreviations:
CI
BCS
IVC
IVCT
PE
HV
ITS
non-ITS
PTBA
TIPS
Resumen
Objetivo

El objetivo de este estudio fue realizar una revisión y un metaanálisis sistemáticos para evaluar la seguridad y la eficacia del tratamiento intervencionista en los pacientes con el síndrome de Budd-Chiari (SBC), agravado por trombosis de la vena cava inferior (TVCI).

Métodos

Evaluamos los estudios publicados sobre el tratamiento intervencionista del SBC agravado por TVCI. Se utilizó el metaanálisis para calcular el tamaño del efecto combinado y los intervalos de confianza (IC) del 95%, basados en el efecto aleatorio. El sesgo de publicación se evaluó con la prueba de Begg.

Resultados

Para el metaanálisis se seleccionaron 16 estudios sobre el tratamiento intervencionista de pacientes con SBC agravado por TVCI; se incluyó un total de 767 pacientes con SBC agravado por TVCI. El tamaño del efecto combinado (IC del 95%) fue del 99% (98-100%) para la tasa de éxito global de la recanalización de la vena cava inferior (VCI), un 15% (11-21%) para la tasa de reestenosis de la VCI después de la operación inicial, un 92% (86-97%) para la tasa de mejora clínica, un 76% (68-84%) para la tasa de eliminación de trombos y un 0% (0-1%) para la incidencia de embolia pulmonar. En el metaanálisis de subgrupos de la tasa de eliminación de trombos, los resultados combinados (IC del 95%) para el grupo de estrategia de tratamiento individualizado y el grupo de estrategia de tratamiento no individualizado fueron del 81% (71-92%) y del 73% (63-83%), respectivamente.

Conclusiones

El tratamiento intervencionista de pacientes con SBC agravado por TVCI es seguro y eficaz, con una baja incidencia de embolia pulmonar, una alta tasa de eliminación de trombos, una alta tasa de éxito técnico, una buena permeabilidad y una tasa elevada de mejora clínica. Además, el análisis de subgrupos reveló que el mejor enfoque es el tratamiento basado en el tipo y la extensión del trombo.

Palabras clave:
Tratamiento intervencionista
Síndrome de Budd-Chiari
Trombosis de la vena cava inferior
Metaanálisis

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