A three-decade experience of radical open endvenectomy with pericardial patch graft for correction of Budd-Chiari syndrome

• Published in: Journal of vascular surgery Vol. 50; no. 3; pp. 590 - 593
• Main Authors: Inafuku, Hitoshi, MD, Morishima, Yuji, MD, Nagano, Takaaki, MD, Arakaki, Katsuya, MD, Yamashiro, Satoshi, MD, PhD, Kuniyoshi, Yukio, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.09.2009; Elsevier
• Subjects: Adult; Aged; Anticoagulants - therapeutic use; Biological and medical sciences; Budd-Chiari Syndrome - diagnostic imaging; Budd-Chiari Syndrome - mortality; Budd-Chiari Syndrome - surgery; Female; Hepatic Veins - diagnostic imaging; Hepatic Veins - surgery; Hospital Mortality; Humans; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Pericardium - transplantation; Phlebography; Reoperation; Retrospective Studies; Severity of Illness Index; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Time Factors; Tomography, X-Ray Computed; Transplantation, Autologous; Treatment Outcome; Vascular Patency; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality; Vena Cava, Inferior - diagnostic imaging; Vena Cava, Inferior - surgery; Young Adult; Vascular disease; Budd-Chiari syndrome; Portal circulation disease; Surgery; Digestive diseases; Cardiovascular disease; Patch; Venous disease; Pericardium
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2009.03.040

Background We previously reported the value of our operative procedure for Budd-Chiari syndrome (BCS) that comprised reconstruction of the occluded or severely stenosed inferior vena cava (IVC) using an autologous pericardium patch and reopening as many occluded hepatic veins as possible. Here, we present the long-term durability and efficacy of the autologous pericardium patch for reconstruction of the IVC in BCS. Methods We retrospectively analyzed a series of 53 consecutive patients (mean age, 48.4 ± 12.8 years; range, 24-76 years; 34 men) who underwent surgical treatment for BCS at our institution from 1979 to 2008. Patency of the IVC and hepatic veins was examined by venography at discharge. Patients attended an outpatient clinic every 1 or 2 months for follow-up. The reconstructed IVC was evaluated by enhanced computed tomography every 1 or 2 years. Results Two in-hospital (operative mortality, 3.7%) and 15 late deaths occurred. During a mean follow-up of 7.6 ± 6.5 years (range, 0.08-24.1 years), the reconstructed IVC became totally obstructed in three patients, of whom two underwent reoperation, and severely stenosed in two patients, who required percutaneous transvenous balloon venoplasty (PTV). The 5- and 10-year patency rates without reoperation or PTV for the reconstructed IVC were 90.5% and 84.3%, respectively. The cumulative 5- and 10-year survival rates were 89.8% and 70.7%, respectively. Conclusion The autologous pericardium patch is effective and durable for reconstructing a diseased IVC in BCS.