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Management of the Budd-Chiari syndrome by balloon cavoplasty
1Department of Medicine, Institute of Postgraduate Medical Education and Research, Kolkata. binaykde@apexmail.com
Insights
Balloon cavoplasty effectively manages Budd-Chiari syndrome caused by inferior vena cava (IVC) obstruction. This procedure offers encouraging long-term outcomes for patients with membranous or stricture-related IVC blockages.
Area of Science:
- Vascular Surgery
- Hepatology
- Interventional Radiology
Background:
- Budd-Chiari syndrome (BCS) is frequently caused by suprahepatic inferior vena cava (IVC) obstruction in the Eastern Hemisphere.
- Membranous or stricture-related obstructions of the IVC are the most common etiologies.
- This study evaluates the efficacy of balloon cavoplasty in managing these specific IVC obstructions.
Purpose of the Study:
- To assess the outcomes of balloon cavoplasty in patients with Budd-Chiari syndrome.
- To evaluate the long-term success rates and complications associated with the procedure.
- To analyze the hemodynamic changes post-cavoplasty.
Main Methods:
- A prospective follow-up of 40 consecutive Budd-Chiari syndrome patients over seven years.
- Diagnostic tools included Doppler studies, liver biopsy, necropsy, and inferior vena cavography.
- Balloon cavoplasty was performed in selected cases with IVC obstruction.
Main Results:
- Inferior vena cavography revealed membranous obstruction (12 cases) or segmental occlusion (11 cases) of the IVC.
- Successful balloon cavoplasty was achieved in 18 patients with IVC obstruction (membrane or stricture).
- Fifteen patients remained well at a mean follow-up of 56 months; three experienced restenosis, with two successfully re-treated.
Conclusions:
- Balloon cavoplasty demonstrates encouraging results for Budd-Chiari syndrome management.
- The procedure is effective in cases of membranous obstruction or stricture of the IVC.
- Significant reduction in IVC-to-right atrium pressure gradient confirms procedural success.
Background:
Obstruction of the suprahepatic inferior vena cava (IVC) by a membrane or stricture is the commonest cause of Budd-Chiari syndrome in the eastern hemisphere. We present our experience with the outcome of balloon cavoplasty in such cases.
Methods:
We followed up 40 consecutive cases of Budd-Chiari syndrome over seven years. Doppler study of hepatic venous outflow tract (in all cases), liver biopsy (30 cases) and necropsy (two cases) were performed. Balloon cavoplasty was done in selected cases.
Results:
Of 40 patients with BCS (mean age 35.2 [SD 8.7] years; 26 men) 5, 5 and 30 had fulminant, acute and chronic presentation, respectively. Inferior vena cavography was performed in 32 cases, and showed membranous obstruction of the IVC in 12, segmental occlusion of the IVC in 11 cases, and block in both the IVC and the main hepatic veins in the rest. Successful balloon cavoplasty was done in 18 cases with obstruction of the IVC (membrane or stricture); 15 of them are well over a mean follow up of 56 (14.6) months. Three patients developed restenosis; two of them, treated with redilatation, are doing well, and one died of septicemia and hepatic failure following a surgical bypass. Pressure gradient between the IVC and right atrium decreased significantly after cavoplasty (15.4 [2.8] vs 6.6 [2.0] mmHg; p< 0.001).
Conclusion:
Balloon cavoplasty gave encouraging results in the management of Budd-Chiari syndrome due to membranous obstruction or stricture of the IVC.
