Accessory hepatic vein recanalization for treatment of Budd-Chiari syndrome due to long-segment obstruction of the hepatic vein: initial clinical experience

Fu, Yu Fei; Xu, Hao; Zhang, Ke; Zhang, Qing Qiao; Wei, Ning

doi:10.5152/dir.2014.14128

Cited by 17 publications

(29 citation statements)

References 14 publications

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“…They then used the accessory hepatic vein to reach occluded main hepatic veins through intrahepatic communicating branched veins and subsequently formed a loop to the IVC, allowing for successful recanalization in two separate cases of short segment hepatic vein occlusion. In addition to providing a route of access for recanalization of main hepatic veins, some larger accessory hepatic veins can be utilized/recanalized to independently provide adequate decompression in select cases of extensive occlusion of multiple hepatic veins (8). Although no complications were reported in these cases, we suspect caudate vein access risks venous avulsion and hemorrhage as well as damage to a critical route of hepatic venous drainage.…”

Section: Discussionmentioning

confidence: 99%

“…Percutaneous transhepatic access is more technically challenging and the possibility of potentially serious bleeding complications must be considered. One recent study of 93 patients with Budd-Chiari syndrome treated with transhepatic venous balloon angioplasty reported major complications in six patients (6.45%) (8). Transhepatic procedures of any kind are associated with elevated risks, particularly in patients with coagulopathy, liver dysfunction, and ascites.…”

Section: Discussionmentioning

confidence: 99%

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Single-access liver floss technique with antegrade hepatic vein access and recanalization in Budd-Chiari syndrome

Weaver

Dobrow

Hsu

et al. 2018

Diagn Interv Radiol

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B udd-Chiari syndrome encompasses a variety of conditions, all characterized by hepatic outflow obstruction but heterogeneous in etiology and morphology of venous occlusion as well as clinical manifestations of hepatic congestion. Prompt, appropriate treatment improves prognosis. A transjugular intrahepatic portosystemic shunt (TIPS) may be created to manage sequelae of portal hypertension and provide a bridge to transplant if significant hepatic injury has occurred. Liver transplant may be the sole treatment option if the disease is identified in late stages. When early in the disease process, however, parenchymal damage may be mitigated by reestablishing hepatic venous outflow which has classically been achieved by transjugular or percutaneous transhepatic access approaches when transjugular approaches prove infeasible. TECHNIQUEA 14-year-old male presented with a 6-month history of progressive exercise intolerance and abdominal distension. Evaluation at an outside hospital identified massive ascites and concluded with a provisional diagnosis of cirrhosis on the basis of ascites and the abnormal appearance of the liver on abdominal computed tomography (CT). The patient was subsequently transferred to our institution for further evaluation. On presentation, he was found to have a tense and distended abdomen without other signs of liver failure. Initial serologic workup including liver enzymes, ceruloplasmin, alpha-1 antitrypsin pi typing, autoimmune hepatitis serologies, and hepatitis B and C studies were negative, and he was referred to interventional radiology for paracentesis and transjugular liver biopsy.Right internal jugular vein access was obtained. Attempts to cannulate the hepatic veins were unsuccessful despite several catheter configurations. A single plane digital subtraction cavogram was acquired, notable for the absence of reflux into normal hepatic veins at the level of the venous confluence (Fig. 1a). Additional evaluation of the inferior vena cava (IVC) and tributaries was performed with axial intravascular ultrasound (Volcano Visions PV .035, Philips), demonstrating the absence of right (RHV), middle (MHV) and left hepatic veins (LHV) at the hepatic vein confluence. An engorged caudate vein was identified, connecting to the IVC via a small orifice. A 5 French (F) angled hydrophilic catheter (Glidecath, Terumo) and 0.035-inch hydrophilic guidewire (Glidewire, Terumo) were introduced and used to cannulate the identified orifice and were subsequently advanced into the right intrahepatic venous system. Planar digital subtraction venogram (Fig. 1b) I N T E R V E N T I O N A L R A D I O LO G Y T E C H N I C A L N OT EABSTRACT A 14-year-old boy presented with several months of increasing abdominal girth and fatigue. Imaging confirmed massive ascites and hepatic congestion secondary to central hepatic venous obstruction. Several large intrahepatic collateral veins were seen draining via caudate and emissary veins. After an unsuccessful attempt at retrograde recanalization utilizing intravascular ultr...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Single-access liver floss technique with antegrade hepatic vein access and recanalization in Budd-Chiari syndrome

Weaver

Dobrow

Hsu

et al. 2018

Diagn Interv Radiol

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“…The diameter of the target HV/AcHV should be at least 5 mm to enable significant drainage of the liver. Venoplasty of an AcHV is usually done with balloons 6-11 mm in diameter [1]. In the present patient, balloons of increasing size were inflated stepwise in the stenotic segment of the AcHV because a single large balloon would have been too invasive.…”

Section: Discussionmentioning

confidence: 99%

“…Budd-Chiari syndrome (BCS) is an uncommon condition caused by the blockade of hepatic venous outflow in the hepatic veins (HV) or inferior vena cava (IVC) [1]. The classical symptom triad seen in BCS includes abdominal pain, ascites, and hepatomegaly, but patients can present with other symptoms, such as liver dysfunction, jaundice, portal hypertensive gastroenteropathy, gastroesophageal varices, splenomegaly, thrombocytopenia, venous thrombosis, and leg edema/ulcers [2,3].…”

Section: Introductionmentioning

confidence: 99%

“…The shunts that can be created by interventionists include a transjugular intrahepatic portosystemic shunt (TIPS) and a direct intrahepatic portosystemic shunt (DIPS), with the latter being preferred when the three major HV are obstructed [4]. In addition, percutaneous transluminal venoplasty (PTV) can relieve hepatic congestion by resolving the blockage of hepatic venous outflow [1]. PTV, TIPS, and DIPS are all less invasive than surgery.…”

Section: Introductionmentioning

confidence: 99%

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Successful Angioplasty of a Hepatic Vena Caval Branch in a Patient with Budd-Chiari Syndrome Due to Occlusion of the Three Major Hepatic Veins

Yamashita

Hayashi

Takeuchi

et al. 2017

Interventional Radiology

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Comparison of 3.0T MRI with 3D LAVA sequence and digital subtraction angiography for the assessment of accessory hepatic veins in Budd-Chiari syndrome

Han

et al. 2016

J. Magn. Reson. Imaging

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Accessory hepatic vein recanalization for treatment of Budd-Chiari syndrome due to long-segment obstruction of the hepatic vein: initial clinical experience

Cited by 17 publications

References 14 publications

Single-access liver floss technique with antegrade hepatic vein access and recanalization in Budd-Chiari syndrome

Single-access liver floss technique with antegrade hepatic vein access and recanalization in Budd-Chiari syndrome

Successful Angioplasty of a Hepatic Vena Caval Branch in a Patient with Budd-Chiari Syndrome Due to Occlusion of the Three Major Hepatic Veins

Comparison of 3.0T MRI with 3D LAVA sequence and digital subtraction angiography for the assessment of accessory hepatic veins in Budd-Chiari syndrome

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