Therapeutic hepatic vein angioplasty for Budd-Chiari syndrome

Ida, Masahiro; Arai, Kunizo; Yoshikawa, Jun; Takayama, Shigeru; Miyamori, Hirotoshi; Toya, Taishu; Yanagi, Sekiya; Miura, Shoji; Fujisawa, Masakiyo; Matsui, Osamu

doi:10.1007/bf02577938

Cited by 12 publications

(8 citation statements)

References 11 publications

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“…Based on PTA experience in the treatment of vascular stenosis, this approach is considered the first therapeutic option. Many authors have already related their favorable experience in hepatic vein and IVC percutaneous angioplasty (4,(13)(14)(15)(16)(17)(18). More than 150 liver transplantations in children have been carried out in a period of 11 yr in our service.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of stenosis between hepatic vein and inferior vena cava following liver transplantation in a child: A case report

Carnevale

Borges

Pinto

et al. 2004

Pediatric Transplantation

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The liver transplantation technique advances have allowed the endovascular treatment of stenosis between hepatic vein and inferior vena cava, and this has become an established and widely acceptable method for the treatment of patients with end-stage liver disease. However, in spite of the advances in the surgical technique of liver transplantation there is relatively still a high incidence of postoperative complications, especially those related to vascular complications. One technical variant of orthotopic liver transplantation is the piggyback technique with conservation of the recipient vena cava, which is anastomosed to the graft hepatic veins. As a consequence of the increased number of liver transplants in children, there is a higher demand for endovascular treatment of vascular stenosis, such as those at the level of the hepatic veins. This leads to more consistent experience of endovascular treatment of the surgical vascular complications following liver transplantation. This article describes the case of a child submitted to liver transplantation with reduced graft (left lateral segment) who presented stenosis of the anastomosis between the hepatic vein and IVC 6 months later which was successfully treated by PTA.

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Section: Discussionmentioning

confidence: 99%

Endovascular treatment of stenosis between hepatic vein and inferior vena cava following liver transplantation in a child: A case report

Carnevale

Borges

Pinto

et al. 2004

Pediatric Transplantation

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“…Recently, various percutaneous procedures, including transjugular intrahepatic portosystemic shunt [17], balloon angioplasty [2,3,4,5], or endovascular stent placement [3,6,7,8,9,10,11,12,13,18], has been reported in patients with BCS. We have applied stent placement in hepatic veins, inferior vena cava, or stenosed mesenterico-caval shunts for therapy of BCS in patients with proven prothrombotic disorders.…”

Section: Discussionmentioning

confidence: 99%

“…With regard to the inferior vena cava, balloon angioplasty has been applied in Asian patients with membranous obstruction of the hepatic [2,3,4,5]. Overall, short-term results have been good with primary patency rates at 1 year as high as 80% [2,3,4,5].…”

Section: Discussionmentioning

confidence: 99%

“…Endovascular stents have been used in BCS caused by inferior vena cava obstruction with low rate of restenosis [3,6,7,8,9,10,11,12,13,18]. Angioplasty has also been attempted in patients with short-length hepatic vein stenosis [4] or with stenosis of major collaterals to obstructed hepatic veins. Recent data suggest that inferior vena cava obstruction in Asia may well be caused by conditions similar to those causing hepatic vein stenosis in Western countries [23].…”

Section: Discussionmentioning

confidence: 99%

“…Thrombosis followed by diffuse fibrous obliteration or short-length stenosis is the main mechanism leading to hepatic venous or inferior vena cava obstruction [1]. Large series of angioplasty [2,3,4,5] and stent placement have been reported in patients with BCS caused by caval obstruction [3,6,7,8,9,10,11,12,13]. Large series of angioplasty [2,3,4,5] and stent placement have been reported in patients with BCS caused by caval obstruction [3,6,7,8,9,10,11,12,13].…”

Section: Introductionmentioning

confidence: 99%

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Budd-Chiari syndrome due to prothrombotic disorder: mid-term patency and efficacy of endovascular stents

et al. 2003

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Our objective was to evaluate efficacy and patency of metallic stent placement for symptomatic Budd-Chiari syndrome (BCS) due to prothrombotic disorders. Eleven patients with proved BCS due to prothrombotic disorders were referred for endovascular treatment because of refractory ascites (n=9), abdominal pain (n=8), jaundice (n=6), and/or gastrointestinal bleeding (n=4). Stents were inserted for stenosed hepatic vein (n=7), inferior vena cava (n=2), or mesenterico-caval shunt (n=2). Clinical efficacy and stent patency was evaluated by clinical and Doppler follow-up. After a mean follow-up of 21 months, 6 patients had fully patent stents without reintervention (primary stent patency: 55%). Two patients with hepatic vein stenosis had stent thrombosis and died 4 months after procedure. Restenosis occurred in 3 cases (2 hepatic vein and 1 mesenterico-caval shunt stenosis) and were successful-ly treated by balloon angioplasty (n=2) and addition of new stents (n=1) leading to a 82% secondary stent patency. Of 9 patients with patent stent, 7 were asymptomatic (77%) at the end of the study. Stent placement is a safe and effective procedure to control of symptomatic BCS. Prothrombotic disorder does not seem to jeopardize patency in anticoagulated patients.

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Which is the best surgery for budd-chiari syndrome: Venous decompression or liver transplantation? a single-center experience with 50 patients

et al. 1995

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The optimal treatment of Budd-Chiari syndrome (BCS) remains an open question. It is still a matter of controversial discussion whether venous decompression or liver transplantation is superior. To elucidate the role and prognosis of both surgical options in our own experience, a consecutive series of 50 patients treated between 1981 and 1993 was retrospectively analyzed. Twelve patients had different types of portosystemic shunts or local decompressive procedures, and transplantation was performed in 43 cases, including five with previous conventional surgery. The overall mortality of 18 of 50 was conventional surgery. The overall mortality of 18 of 50 was concentrated within the early postoperative period, with no patient lost after 1 year. In the venous decompression group, the success rate was only 29%, and treatment failure was closely related to the finding of cirrhosis or technical problems like vascular thrombosis. After transplantation, early complications were rejection, primary nonfunction, or graft necrosis, and contributed significantly to the risk of sepsis. Thirty of 43 liver recipients are currently alive, including four rescued after failed decompressive surgery, with 1- and 10-year survival of 69%, and excellent recurrence-free rehabilitation. These results clearly indicate that patient selection plays a dominant prognostic role in the treatment of BCS. Venous decompression and liver transplantation should both be integrated in a common therapeutic concept, and the individual decision for the preferred approach must be based on the leading clinical symptom: portal hypertension or liver failure, together with the assessment of reversibility of hepatic damage, and the potential of cure of the underlying disease.

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Therapeutic hepatic vein angioplasty for Budd-Chiari syndrome

Cited by 12 publications

References 11 publications

Endovascular treatment of stenosis between hepatic vein and inferior vena cava following liver transplantation in a child: A case report

Endovascular treatment of stenosis between hepatic vein and inferior vena cava following liver transplantation in a child: A case report

Budd-Chiari syndrome due to prothrombotic disorder: mid-term patency and efficacy of endovascular stents

Which is the best surgery for budd-chiari syndrome: Venous decompression or liver transplantation? a single-center experience with 50 patients

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