What is the role of angioplasty 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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Answer

The European Association for the Study of the Liver (EASL) indicates angioplasty/stenting should be considered the first-line decompressive procedure in patients with short hepatic vein or inferior vena cava stenosis. [48]  For those in whom initial therapy or angioplasty/stenting is ineffective, treat with portal derivative techniques, of which transjugular intrahepatic portosystemic shunt (TIPS) using polytertrafluoroethane (PTFE)-covered stents is deemed the derivative therapy of choice by the EASL. Consider surgical shunting in the setting of TIPS unfeasibility or failure. [48]

Angioplasty procedure can help relieve obstruction caused by membranous webs. In a study of 101 patients with Budd-Chiari syndrome, Li et al concluded that the condition can be safely and effectively treated with percutaneous transhepatic balloon angioplasty (PTBA). [46]  The authors reported successful PTBA (performed after hepatovenography, with or without stenting) in 92 of the study’s patients, with all of the successful procedures resulting in significant symptom improvement.

Complications included acute hepatic vein thrombosis, occurring during or after the operation (n=3); sustained intraperitoneal bleeding from the transhepatic puncture track (n=2); pulmonary embolism, which occurred during the procedure (n=1); and intrahepatic hematoma (n=1). [46]  All were managed nonsurgically. Primary patency rates at 6-, 12-, and 24-month follow-up were 84%, 78%, and 76%, respectively (with several patients lost to follow-up); secondary patency rates were 95%, 92%, and 84%, respectively. Despite these satisfactory midterm patient outcomes, the authors cautioned that long-term outcomes in patients treated with PTBA for Budd-Chiari syndrome require investigation. [46]


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