Interventional therapy of Budd-Chiari syndrome with hepatic vein obstruction

Objective To evaluate the effect of interventional therapy for Budd-Chiari syndrome with hepatic vein obstruction (HVBCS). Methods Eighty-three patients of HVBCS underwent inferior vena cava and hepatic venography. PTA, PTA and stenting, and transjugular intrahepatic portosystemic shunt (TIPS) were used for treatment in 71 patients. Results All patients were divided into two types, those with central obstruction of hepatic veins (COHV, n =65),and those with extensive obstruction of hepatic veins (EOHV, n =18). Hepatic vein PTA alone ( n =46) or PTA and stenting ( n =19) were successfully performed in all patients of COHV. The symptoms and signs disappeared or markedly alleviated in 64 of 65 (99.2%) patients. During a 12-118 month follow up (mean 67 months), recurrence occurred in a total of 9 patients. Seven patients treated with PTA alone were treated again by stent placement. In 2 patients treated initially with stent placement, one underwent further PTA through the stent and the other failed to treat. TIPS placement was successful in all 6 consenting patients with EOHV. Clinical symptoms and signs showed dramatic improvement in 4 of 6 patients. Restenosis of the shunt developed in 2 patients during follow up. No serious procedure-related complications occurred. Conclusion PTA or PTA and stenting are choices for treatment of the COHV with excellent results. TIPS placement can be offered as a modality for treatment of the EOHV, with common results.