Safety and Efficacy of Steerable Sheath-Assisted AngioJet Thrombectomy for Budd-Chiari Syndrome Complicated by Inferior Vena Cava Thrombosis

Objective To evaluate the safety and efficacy of the steerable sheath combined with the AngioJet thrombectomy system in patients with Budd–Chiari syndrome (BCS) complicated by inferior vena cava thrombosis (IVCT). Methods We retrospectively reviewed 32 patients treated from January 2020 to August 2024. All patients presented with symptomatic BCS and IVC obstruction with concomitant thrombosis. Mechanical thrombectomy was performed using the AngioJet system delivered via a steerable sheath to maximize vessel wall apposition. This was followed by a standardized “staged balloon angioplasty” protocol. Patients were followed for 7–24 months. Results Technical success was 100%. Immediate IVC recanalization was obtained in 93.8% of patients, with Grade III thrombus clearance (> 90%) achieved in 90.6%. No pulmonary embolism or severe renal injury occurred. Perioperative survival was 100.0%. During a median follow-up of 22.0 months, the cumulative primary patency rate at 24 months was 80.1%. Five patients (15.6%) developed restenosis or occlusion during surveillance. All underwent re-intervention (balloon angioplasty, n = 3; stenting, n = 2). While one patient experienced recurrent occlusion, definitive patency was restored in the remaining four, resulting in a secondary patency rate of 95.8% at 24 months. Conclusion The use of a steerable sheath-assisted AngioJet thrombectomy is safe and effective for BCS with IVCT, yielding high thrombus clearance and satisfactory mid-term patency rates.