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

• Published in: Liver international 2017-01, Vol.37 (1), p.111-120
• Main Authors: Tripathi, Dhiraj, Sunderraj, Lawrence, Vemala, Vishwaraj, Mehrzad, Homoyon, Zia, Zergham, Mangat, Kamarjit, West, Richard, Chen, Frederick, Elias, Elwyn, Olliff, Simon P
• Format: Article
• Language: English
• Subjects: Adult; ascites; Budd-Chiari Syndrome - diagnostic imaging; Budd-Chiari Syndrome - surgery; Cardiovascular system; Complications; Data processing; Female; Follow-Up Studies; Hematology; Hepatic encephalopathy; Hepatic vein; Hepatic Veins - surgery; Humans; Implants; Intervention; Kaplan-Meier Estimate; liver; Male; Middle Aged; Multivariate analysis; Occlusion; Patients; Phlebography; portal hypertension; Portasystemic Shunt, Transjugular Intrahepatic; Postoperative Complications - epidemiology; radiology/imaging; Regression Analysis; Retrospective Studies; Risk factors; Stenosis; Stents; Surgery; Surgical implants; Survival; Survival Rate; Tomography, X-Ray Computed; Treatment Outcome; United Kingdom; Vena Cava, Inferior - surgery; Young Adult
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/liv.13180

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.