Accessory hepatic vein recanalization for Budd-Chiari syndrome: a systematic review and meta-analysis

Background Budd-Chiari syndrome (BCS) results when the outflow of the hepatic vein (HV) is obstructed. BCS patients exhibiting an accessory HV (AHV) that is dilated but obstructed can achieve significant alleviation of liver congestion after undergoing AHV recanalization. This meta-analysis was deve...

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Bibliographic Details
Published in:BMC gastroenterology 2023-10, Vol.23 (1), p.1-340, Article 340
Main Authors: Lv, Lu-Lu, Xu, Han-Bo, Li, Sheng-Li, Xu, Peng
Format: Article
Language:English
Subjects:
Accessory hepatic vein
Analysis
Anticoagulants
Bias
Budd-Chiari syndrome
Care and treatment
Endovascular stents
Football (College)
Gastroenterology
Health aspects
Hepatic vein
Hepatic vein thrombosis
Liver
Medical examination
Medical research
Medicine, Experimental
Meta-analysis
Prognosis
Recanalization
Stenosis
Success
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Summary:Background Budd-Chiari syndrome (BCS) results when the outflow of the hepatic vein (HV) is obstructed. BCS patients exhibiting an accessory HV (AHV) that is dilated but obstructed can achieve significant alleviation of liver congestion after undergoing AHV recanalization. This meta-analysis was developed to explore the clinical efficacy of AHV recanalization in patients with BCS. Materials and methods PubMed, Embase, and Wanfang databases were searched for relevant studies published as of November 2022, and RevMan 5.3 and Stata 12.0 were used for pooled endpoint analyses. Results Twelve total studies were identified for analysis. Pooled primary clinical success, re-stenosis, 1- and 5-year primary patency, 1- and 5-year secondary patency, 1-year overall survival (OS), and 5-year OS rates of patients in these studies following AHV recanalization were 96%, 17%, 91%, 75%, 98%, 91%, 97%, and 96%, respectively. Patients also exhibited a significant reduction in AHV pressure after recanalization relative to preoperative levels (P < 0.00001). Endpoints exhibiting significant heterogeneity among these studies included, AHV pressure (I.sup.2 = 95%), 1-year primary patency (I.sup.2 = 51.2%), and 5-year primary patency (I.sup.2 = 62.4%). Relative to HV recanalization, AHV recanalization was related to a lower rate of re-stenosis (P = 0.002) and longer primary patency (P < 0.00001), but was not associated with any improvements in clinical success (P = 0.88) or OS (P = 0.29) relative to HV recanalization. Conclusions The present meta-analysis highlights AHV recanalization as an effective means of achieving positive long-term outcomes in patients affected by BCS, potentially achieving better long-term results than those associated with HV recanalization. Keywords: Budd-Chiari syndrome, Accessory hepatic vein, Recanalization, Meta-analysis
ISSN:1471-230X
1471-230X
DOI:10.1186/s12876-023-02969-z