Interventional Treatment of Budd-Chiari Syndrome

Area of Science:

• Interventional Cardiology
• Hepatology
• Vascular Surgery

Background:

• Budd-Chiari syndrome (BCS) management primarily relies on medical treatment, which has limited efficacy.
• Many BCS patients necessitate interventional procedures due to disease progression or complications.
• Hepatic vein or inferior vena cava stenosis/occlusion is prevalent, particularly in Asian populations.

Purpose of the Study:

• To review the efficacy and outcomes of interventional treatments for Budd-Chiari syndrome.
• To compare angioplasty, stenting, and transjugular intrahepatic portosystemic shunt (TIPS) procedures for BCS.
• To discuss the evolving treatment algorithms for BCS, including early intervention.

Main Methods:

• Review of angioplasty with or without stent implantation for short-segment stenosis/occlusion.
• Evaluation of portocaval shunting for long-segment thrombotic occlusion.
• Analysis of transjugular intrahepatic portosystemic shunt (TIPS) efficacy and long-term patency, especially with PTFE-covered stents.

Main Results:

• Interventional treatments achieve high success rates (approx. 95%) even in complete hepatic vein obliteration.
• PTFE-covered stents have improved TIPS long-term patency.
• Interventions demonstrate low complication rates and excellent survival (5-year: 90%, 10-year: 80%).

Conclusions:

• Angioplasty and TIPS are highly effective interventions for Budd-Chiari syndrome.
• Current guidelines suggest a step-up approach, but early interventional treatment is increasingly proposed.
• Interventional therapies offer superior outcomes compared to medical management alone for many BCS patients.