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Percutaneous hepatic vein recanalization in pediatric Budd-Chiari syndrome - 10 years' experience from a tertiary
Usha Mandikal Kodandarama Sastry1, Madhu Swandenahalli Doddaiah2, Priyadarshini Arunakumar1
1Department of Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.
Insights
Catheter interventions can restore blood flow in pediatric Budd-Chiari syndrome (BCS). Stenting offers better outcomes than balloon angioplasty, but lifelong surveillance is crucial due to high mortality in BCS patients.
Area of Science:
- Interventional Radiology
- Pediatric Hepatology
- Vascular Medicine
Background:
- Budd-Chiari syndrome (BCS) is a rare liver disease caused by hepatic venous outflow obstruction.
- It often presents with severe symptoms and has a poor prognosis without intervention.
- Catheter-based interventions are a key treatment modality for BCS.
Purpose of the Study:
- To analyze the clinical characteristics and outcomes of interventional treatments for pediatric BCS.
- To compare the effectiveness of balloon angioplasty versus stenting in BCS.
- To evaluate the role of transhepatic (TH) access in BCS interventions.
Main Methods:
- Retrospective single-center study of pediatric BCS patients over 10 years.
- Analysis of clinical, laboratory, imaging, and interventional data.
- Use of balloon angioplasty and/or stenting, with TH access in recent cases.
Main Results:
- 27 pediatric BCS patients were included; 93% had acute or subacute BCS.
- Intervention success rate was 82%; stenting showed better immediate outcomes (91% vs. 64%).
- At 60-month follow-up, 64% of stented patients were alive with patent veins, versus 25% of balloon angioplasty patients.
Conclusions:
- Catheter interventions are effective in restoring blood flow in pediatric BCS.
- Stenting provides superior medium-term outcomes compared to balloon angioplasty.
- Transhepatic access improves success rates for hepatic vein cannulation; lifelong surveillance is essential due to high mortality.
Background:
Budd - Chiari syndrome (BCS) due to hepatic venous outflow obstruction is a rare cause of liver disease with dismal outcome, often amenable to catheter intervention.
Materials And Methods:
This retrospective single-center study analyzed the clinical profile and medium-term outcome of interventional treatment with balloon angioplasty ± stenting in all pediatric BCS over a 10-year period. Clinical, laboratory, imaging, and interventional data were retrieved. Transhepatic (TH) access was utilized in the recent 3 years.
Results:
We included a total of 27 patients. Acute and subacute BCS comprised 93% of subjects. Ascites was the most common symptom. COVID-19 infection and Takayasu arteritis were two novel etiologies in our study. There was isolated hepatic vein (HV) narrowing in 11 (41%), isolated inferior vena cava obstruction in 4, and combined occlusion in 12 (44%). Intervention was successful in 22 (82%) patients. Stenting was required in 14 (64%) patients and the rest underwent balloon angioplasty. The immediate outcome was better with stenting than balloon (91% vs. 64%). Transhepatic access in 6 patients allowed HV cannulation in all and achieved patency in five patients. Two patients from the balloon group (25%) and 9 from the stent group (64%) are alive with patent veins at a median follow-up of 60 months, indicating a high attrition rate.
Conclusion:
Catheter interventions restored physiological blood flow in pediatric BCS. TH route improved cannulation of occluded HV compared to other accesses. Immediate and medium-term outcomes were better after stenting with lower rates of reinterventions than balloon angioplasty. Life-long surveillance is required as mortality is high on follow-up.
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