Long-term outcomes following percutaneous hepatic vein recanalization for Budd-Chiari syndrome

Research output: Contribution to journalArticlepeer-review

Authors

  • Dhiraj Tripathi
  • Lawrence Sunderraj
  • Vishwaraj Vemala
  • Homoyon Mehrzad
  • Zergham Zia
  • Kamarjit Mangat
  • Richard West
  • Elwyn Elias
  • Simon P Olliff

External organisations

  • Liver Transplant and Hepatobiliary Pancreatic Unit, Queen Elizabeth Hospital Birmingham
  • Imaging and Interventional Radiology Dept, Queen Elizabeth Hospital, Birmingham, UK.

Abstract

BACKGROUND & AIMS: A proportion of patients with Budd-Chiari Syndrome (BCS) associated with stenosis or short occlusion of the hepatic vein (HV) or upper inferior vena cava (IVC) can be treated with recanalization by percutaneous venoplasty ± HV stent insertion. We studied the long-term outcomes of this approach.

METHODS: Single-centre retrospective analysis of patients referred for radiological assessment ± intervention over a 27-year period. Of 155 BCS patients, 63 patients who underwent venoplasty were studied and compared to a previously reported series treated by TIPSS (n = 59).

RESULTS: Patients treated with HV interventions (32 venoplasty alone, 31 endovascular stents): mean age, 34.9 ± 10.9; M:F ratio 27:36; median follow-up, 113.0 months; 62% of patients had ≥1 haematological risk factor. Technical success was 100%, with symptom resolution in 73%. Cumulative secondary patency at 1, 5, 10 years was 92%, 79%, 79% and 69%, 69%, 64% in the stenting and venoplasty groups respectively. Where long-term patency was not achieved, 10 patients required TIPSS, and 8 underwent surgery. Actuarial survival at 1, 5, 10 years was 97%, 89% and 85%. When compared to TIPSS, HV interventions resulted in similar patency and survival rates but significantly lower procedural complications (9.5% vs 27.1%) and hepatic encephalopathy (0% vs 18%). Patient age predicted survival following multivariate analysis.

CONCLUSIONS: Our data support the stepwise approach to management of BCS, with very good outcomes from venoplasty combined with stenting when required. TIPSS should only be offered where HV interventions are not feasible or unsuccessful.

Details

Original languageEnglish
Pages (from-to)111-120
Number of pages10
JournalLiver International
Volume37
Issue number1
Early online date5 Jul 2016
Publication statusPublished - Jan 2017