Treatment of Budd-Chiari syndrome by metallic stent as a bridge to liver transplantation

Abstract

A 49-year-old male with Budd-Chiari syndrome complicated by liver cirrhosis and intractable ascites is reported. The left hepatic vein was stenosed by a short subocclusive ostial web; the right and medial hepatic veins were thrombosed. A spontaneous intrahepatic portosystemic shunt had developed between the left portal and left hepatic veins. After ineffective balloon angioplasty, the left hepatic venous outflow was restored by placement of a 10-mm-diameter Wallstent across the web via a femoral approach. The hepatic venous pressure dropped from 29 to 12 mmHg. Rapid clinical improvement followed. The patient underwent liver transplantation 3 months later in stable condition.

Incidence and clinical significance of spontaneous intrahepatic portosystemic venous shunts detected by sonography in adults without potential cause

“…They usually are used to confirm the diagnosis when sonography leads to the suspicion of PSVS. 3,5,[11][12][13]15,16 Arterial portography, percutaneous transhepatic portography, and retrograde venography are the most sensitive modalities used in the detection of small shunts. However, these examinations are invasive and expensive and should be reserved for treatment planning in symptomatic patients.…”

“…Its origin can be either congenital [1][2][3][4][5][6][7][8][9][10][11][12] or acquired by liver injury or portal hypertension. 3,13,14 This disorder may also occur in patients with Budd-Chiari syndrome 15 or focal nodular hyperplasia. 16 The incidence and clinical significance of spontaneous intrahepatic PSVS in adults without potential cause has not been well clarified.…”

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

“…In only 1 of these patients, however, was BCS related to a documented prothrombotic disorder [3]. To our knowledge, 9 cases of so-managed hepatic vein stenosis have been reported with a mean follow-up of 19 months (range 3-29 months) [12,18,24,25,26,27]. Angioplasty has also been attempted in patients with short-length hepatic vein stenosis [4] or with stenosis of major collaterals to obstructed hepatic veins.…”

Percutaneous hepatic vein reconstruction for Budd-Chiari syndrome.

“…Because of the high restenosis rate after balloon angioplasty, further dilate tion of the hepatic veins and NC was neces sary at a mean time of 2-4 months [2]. The use of vascular stents improved the patency rate, with veins remaining patent at 3â€"12 months'follow-up [2,3].…”