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Expandable venous stents for treatment of the Budd-Chiari syndrome
R R Lopez1, K G Benner, L Hall
1Department of Surgery, Oregon Health Sciences University and Surgical Service, Veterans Affairs Medical Center, Portland.
Insights
Budd-Chiari syndrome treatment can be improved with metallic stents. This case study shows successful resolution of severe symptoms and restored hepatic function after stent placement in the inferior vena cava and hepatic veins.
Area of Science:
- Interventional Radiology
- Hepatology
- Vascular Surgery
Background:
- Budd-Chiari syndrome (BCS) is a rare condition characterized by obstruction of hepatic venous outflow.
- Treatment goals include relieving portal hypertension, inferior vena cava (IVC) syndrome, and preserving liver function.
- Traditional treatments have limitations, necessitating innovative approaches.
Observation:
- A 26-year-old male presented with severe ascites and lower extremity edema, indicative of BCS.
- Imaging revealed a suprahepatic caval web, intrahepatic IVC stenosis, and hepatic vein occlusion.
- Despite symptoms, the patient had relatively preserved hepatic function.
Findings:
- A minimally invasive endovascular approach was employed, involving balloon angioplasty and stent placement.
- Expandable metallic stents were successfully deployed in the intrahepatic IVC and the left hepatic vein.
- Complete elimination of pressure gradients across the obstructed venous segments was achieved post-procedure.
Implications:
- This endovascular technique offers a safe, effective, and potentially long-lasting treatment for selected BCS patients.
- Successful stent deployment led to complete resolution of ascites, edema, and normalization of liver function.
- The patient returned to work, demonstrating significant clinical improvement and quality of life restoration.
Abstract:
The goals of treatment of the Budd-Chiari syndrome are relief of portal hypertension, relief of inferior vena cava syndrome, if present, and preservation of hepatic function. This study presents a patient with clinical resolution of the Budd-Chiari syndrome after placement of expandable metallic stents in the inferior vena cava and hepatic veins. A 26-year-old man with severe ascites and lower extremity edema but with relatively preserved hepatic function had a small gradient across a suprahepatic caval web, large gradients across an intrahepatic caval stenosis and the left hepatic vein, and an occluded right hepatic vein. Under angiographic control, web and caval stenosis were balloon-dilated, and modified Gianturco expandable metallic stents were placed in the intrahepatic vena cava. The left hepatic vein was dilated twice and a stent was placed. All gradients were completely eliminated. There were no complications and after 1 year, the stents have fully expanded without migration, edema and ascites have resolved, hepatic function has normalized, and the patient has returned to work. This new technique provides a simple, safe, effective, relatively inexpensive, and potentially long-lasting treatment for selected patients with the Budd-Chiari syndrome.
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