Feasibility and midterm outcomes of percutaneous transhepatic balloon angioplasty for symptomatic Budd-Chiari syndrome secondary to hepatic venous obstruction

Abstract

PTBA of the hepatic vein is a safe and effective treatment of BCS. It is currently the most physiologic procedure, and the risk of postoperative encephalopathy is minimized because portal flow is not diverted. Midterm outcomes are satisfactory. Further investigation of the long-term outcomes is needed.

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

“…Recanalization of the HV has been increasingly used in the treatment of BCS in recent years, with the purpose of relieving hepatic congestion and resolving the symptoms of BCS (1,2,8,9). A retrospective study of HV recanalization in 101 BCS patients demonstrated that clinical improvement was achieved in all patients (92/92) who successfully underwent the procedure (2).…”

“…However, the study also demonstrated that nine patients experienced technical failure due to long-segment obstruction or diffused stenosis of the HV (2). The difficulty and challenge of HV recanalization in patients with long-segment obstruction of the HV may be attributed to the following factors: first, it is extremely difficult to cut through the long-segment of obstruction (1,2). Second, long-segment obstruction of the HV occasionally results in narrowing of the HV stem, which will impede its drainage function (2).…”

“…udd-Chiari syndrome (BCS) is a rare disease characterized by hepatic venous outflow obstruction at the level of the hepatic vein (HV) or inferior vena cava (IVC) resulting in portal hypertension (1,2). Thrombus is the most frequent cause in Western countries, whereas membranous webs are more common in Asia (2).…”

“…Thrombus is the most frequent cause in Western countries, whereas membranous webs are more common in Asia (2). HV recanalization has been reported as a simple, effective, and safe method for patients with BCS due to hepatic venous obstruction (1, 2).…”

“…However, if the patients display long-segment obstruction of the HV, recanalization is always difficult with a high failure rate of 31%-100% (1, 2). Even when successfully managed, there is a risk of HV reobstruction after treatment (2).…”