What is the role of radiologic intervention in the treatment of Budd-Chiari syndrome?

Updated: Oct 10, 2018
  • Author: Praveen K Roy, MD, AGAF; Chief Editor: BS Anand, MD  more...
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Systemic thrombolysis can be a high-risk endeavor; local thrombolysis performed by an interventional radiologist is preferable.

Other available radiologic interventions include balloon angioplasty, as well as placement of a stent or a transjugular intrahepatic portacaval shunt (TIPS). [18, 32, 33]

In a single-center retrospective study (1996-2012), Tripathi et al reported good long-term outcomes in 67 patients with Budd-Chiari syndrome following successful transjugular intrahepatic portosystemic stent-shunt (TIPSS) using either polytertrafluoroethane (PTFE)-covered (n=40) or bare (n=27) stents. [34]  At a mean follow-up of 82 months, 15% of patients experienced post-TIPSS encephalopathy; 2 patients underwent transplantation, 2 patients developed hepatocellular cancer, and 6 patients had liver-related deaths. The PTFE-covered stents had significantly better primary patency (76%) and shunt reinterventions (22%) compared to the bare stents (27% and 100%, respectively). Survival at 6 and 12 months was at 92% or above; that at 24 and 60 months was 80% or above; and 120-month survival was 72%. The investigators indicated that in symptomatic patients in whom hepatic vein patency cannot be restored, TIPSS should be considered as the first-line therapy. [34]

In another single center retrospective study (2008-2014) of 190 patients with Budd-Chiari syndrome who underwent endovascular procedures (hepatic vein, collateral vein or IVC plasty with or without stenting, or TIPSS), venous recanalization and TIPPS were safe and effective: 153 patients (80.5%) experienced treatment response, with 19 patients (10.0%) requiring repeat interventions and 9 patients (4.7%) with complications. [35]  Of the 190 patients, 147 had hepatic vein obstruction, 40 had IVC obstruction, and 3 had both. Thirty-eight patients underwent hepatic vein/stenting; 3, collateral vein stenting; 40, IVC plasty/stenting; 3, hepatic vein and IVC stenting; and 106, TIPSS. [35]

Tripathi et al reported similar findings for venous recanalization and TIPPS in 122 patients. [36]

More recently, retrospective data (2011-2016) from another study with 68 patients revealed excellent efficacy and long-term outcomes of endovascular therapy (hepatic vein recanalization and accessory hepatic vein recanalization) for hepatic vein-type Budd-Chiari syndrome. [50] Investigators found a 100% technical success rate, with a 95.6% clinical success rate. The mean follow-up period was 39.4 ± 13.6 months. At 1 year, the primary and secondary patency rates were 80.0% and 93.8%; at 2 years, 72.8% and 90.3%; and at 5 years, 67.9% and 91.2%, respectively. Survival was 96.9% at 1 year, 93.4% at 2 years, and 91.2% at 5 years. [50]

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